1 00:00:10,280 --> 00:00:13,280 Everyone, welcome to The Doctors of Running Podcasts, where we, a 2 00:00:13,280 --> 00:00:15,720 group of Doctors of Physical therapy, talk about the art and 3 00:00:15,720 --> 00:00:18,320 the science of the things that we're putting on her feet today. 4 00:00:18,320 --> 00:00:21,840 I am incredibly honored to have Doctor Rich really on the 5 00:00:21,840 --> 00:00:23,730 podcast. Who is it? 6 00:00:23,730 --> 00:00:27,410 Has an incredible resume and CV that I'm going to try to keep as 7 00:00:27,410 --> 00:00:28,970 short as possible. But somebody that I've certainly 8 00:00:28,970 --> 00:00:31,370 looked up to in the research world and it's done quite a bit, 9 00:00:31,370 --> 00:00:35,010 not only on runners but on bone stress injuries has I got to 10 00:00:35,010 --> 00:00:37,530 give you credit? Because the Patella femoral 11 00:00:37,530 --> 00:00:39,850 clinical practice guidelines are something that I hold dear and 12 00:00:39,850 --> 00:00:41,730 dear to my heart that my students at West Coast will 13 00:00:41,730 --> 00:00:43,330 know. I go over extensively in our 14 00:00:43,650 --> 00:00:45,850 their ex course. But thank you for all that. 15 00:00:46,010 --> 00:00:48,010 He's an associate professor at the University of Montana, 16 00:00:48,010 --> 00:00:49,810 Missoula in the Department of Physical Therapy. 17 00:00:50,050 --> 00:00:53,470 He has a Bachelor in Sports Science from Ohio University, a 18 00:00:53,470 --> 00:00:56,670 Masters in Physical Therapy from Ohio University as well, and 19 00:00:56,670 --> 00:00:59,590 then his did his PhD on Patel for Moral Pain Syndrome with 20 00:00:59,590 --> 00:01:02,190 Irene Davis at University of Delaware. 21 00:01:02,830 --> 00:01:06,550 He's again studied on a variety of topics, particularly in the 22 00:01:06,550 --> 00:01:09,750 but also on wearables. Done very cool stuff with the 23 00:01:09,750 --> 00:01:13,990 military masters runners. Today what we're going to try to 24 00:01:13,990 --> 00:01:17,790 do is dive into some stuff on ultra marathoners and bone 25 00:01:17,790 --> 00:01:19,470 stress injuries. It's not to kind of give this 26 00:01:19,470 --> 00:01:20,990 away. He's got some research coming up 27 00:01:21,300 --> 00:01:23,860 trying to see what's happening to these athletes, especially 28 00:01:23,860 --> 00:01:25,660 among the elite. And we'll try to take some of 29 00:01:25,660 --> 00:01:27,980 those lessons, see if we can distill them down to the rest of 30 00:01:27,980 --> 00:01:31,100 us and go, what can we learn, not just about what's happening 31 00:01:31,100 --> 00:01:33,100 to our bodies during this event, but what do we need to think 32 00:01:33,100 --> 00:01:35,420 about long term? Because most of us want to keep 33 00:01:35,420 --> 00:01:37,620 doing this. So what do we need to start 34 00:01:37,620 --> 00:01:39,980 thinking about? So, Rich, really appreciate you 35 00:01:39,980 --> 00:01:41,780 coming on the podcast. Did I get everything? 36 00:01:41,940 --> 00:01:42,620 Oh, yeah. Thanks. 37 00:01:42,620 --> 00:01:44,700 That's perfect. Yeah, they very, yes. 38 00:01:44,700 --> 00:01:47,580 It's thanks for the very nice introduction. 39 00:01:48,400 --> 00:01:49,680 Very nice to be here. I'm excited to be here. 40 00:01:49,680 --> 00:01:51,960 So thanks. Yeah, we appreciate having you 41 00:01:51,960 --> 00:01:54,000 on. So I have to say I'm 42 00:01:54,000 --> 00:01:56,360 particularly interested in this area because my wife, I have to 43 00:01:56,520 --> 00:01:58,920 give her a shout out. She, as of this is 7 weeks 44 00:01:58,920 --> 00:02:02,680 postpartum and is now back to running 3 miles a day, which I 45 00:02:02,680 --> 00:02:06,120 don't know is totally advised. But she's a professional runner 46 00:02:06,120 --> 00:02:08,320 and she kind of does what she wants, which is when you said 47 00:02:08,320 --> 00:02:10,720 elite runners can be a little bit of their own population. 48 00:02:10,720 --> 00:02:12,520 This is where that's definitely true. 49 00:02:12,520 --> 00:02:14,400 But again, you mentioned this earlier. 50 00:02:14,400 --> 00:02:17,240 There's very little research in this area. 51 00:02:17,240 --> 00:02:20,520 Like I probably spent in the last hour viewing a bunch of 52 00:02:20,520 --> 00:02:22,560 stuff I had previously, and I think I've gone through most of 53 00:02:22,600 --> 00:02:24,960 everything, which blows my mind that more people wouldn't have 54 00:02:24,960 --> 00:02:27,200 studied this. Is there any particular reason 55 00:02:27,200 --> 00:02:29,280 you think people haven't looked into this as much? 56 00:02:29,640 --> 00:02:32,840 Yeah, it's a good question. Yeah, so you're right. 57 00:02:32,840 --> 00:02:34,840 It hasn't really been studied a whole lot. 58 00:02:35,760 --> 00:02:39,680 Ultra running is really big in Europe, you know, particularly 59 00:02:39,680 --> 00:02:41,360 like around Chaminy and and so forth. 60 00:02:41,360 --> 00:02:42,840 So there's a. There are a lot of. 61 00:02:44,180 --> 00:02:47,020 Like performance type research that's being done there, like 62 00:02:47,020 --> 00:02:50,820 looking at the Physiology of ultra running and that work is 63 00:02:50,900 --> 00:02:54,260 great and that's typically how it goes is you know and that's 64 00:02:54,260 --> 00:02:58,060 how it was with running. Like I think this is the 100 65 00:02:58,060 --> 00:03:01,380 year anniversary of the VO2 Max test this year, which is kind of 66 00:03:01,380 --> 00:03:03,980 cool and people didn't really start looking at running 67 00:03:03,980 --> 00:03:05,740 injuries until sometime after that. 68 00:03:05,740 --> 00:03:07,900 And so I think that what you're seeing now is you're starting to 69 00:03:07,900 --> 00:03:11,440 see this kind of. Kind of trailing part looking 70 00:03:11,440 --> 00:03:14,480 at, OK, well what about the injuries that ultra runners get 71 00:03:14,960 --> 00:03:18,040 And you know, I think that there, there have been some 72 00:03:18,040 --> 00:03:19,280 studies that have looked at that. 73 00:03:20,000 --> 00:03:22,480 And I, you know, I think that it's important probably to do an 74 00:03:22,480 --> 00:03:25,960 update on that because I think who is competing in ultras has 75 00:03:25,960 --> 00:03:29,160 changed quite a bit in the last 20 to 30 years. 76 00:03:29,160 --> 00:03:33,560 So when you think about like 20 years ago, a lot of ultra 77 00:03:33,560 --> 00:03:37,240 marathoners were maybe they came to ultra running from other 78 00:03:37,240 --> 00:03:40,270 sports. And so they came to it late in 79 00:03:40,270 --> 00:03:42,550 late in life, I think a lot of ultra runners tended to be 80 00:03:42,550 --> 00:03:46,390 masters runners and says we know masters runners tend to get 81 00:03:46,390 --> 00:03:49,110 different types of injuries than younger runners anyway, they 82 00:03:49,110 --> 00:03:50,710 tend to get more soft tissue injuries. 83 00:03:51,190 --> 00:03:53,230 But now what we're starting to see is particularly in elite 84 00:03:53,230 --> 00:03:57,350 runners, we're starting to see a lot of runners that are post 85 00:03:57,350 --> 00:04:00,270 collegiate. So they ran somewhere and from a 86 00:04:00,270 --> 00:04:02,550 collegiate level, you know, perhaps Division One? 87 00:04:03,450 --> 00:04:06,250 They've transitioned over to ultra running and so now we've 88 00:04:06,250 --> 00:04:10,170 got a new breed of ultra runner who is running very fast, who 89 00:04:10,170 --> 00:04:14,490 has has the this really excellent track background, but 90 00:04:14,490 --> 00:04:16,410 they're running, they're running very, very quickly and both 91 00:04:16,410 --> 00:04:19,730 their training runs but also and they're in these races, they 92 00:04:19,730 --> 00:04:22,690 also have the injury history that collegiate runners have as 93 00:04:22,690 --> 00:04:24,890 well. We know that that's the number 94 00:04:24,890 --> 00:04:27,610 one risk factor if you're going to get an injury in the future 95 00:04:27,610 --> 00:04:29,170 is if you've had that injury in the past. 96 00:04:29,210 --> 00:04:31,770 So, so they're they're bringing that to the sport. 97 00:04:32,620 --> 00:04:33,900 And they're running much faster too. 98 00:04:33,900 --> 00:04:37,980 So we see that, for instance, Western states in the last 20 99 00:04:37,980 --> 00:04:40,300 years, the finishing time has come down two hours. 100 00:04:40,340 --> 00:04:45,540 So we know that when you run faster, bone is more susceptible 101 00:04:45,540 --> 00:04:48,300 to very fast running. And so I think that's a big 102 00:04:48,300 --> 00:04:50,500 reason why we're starting to see more and more bone stress 103 00:04:50,500 --> 00:04:52,820 injuries in the Elite ultramarathoner. 104 00:04:53,140 --> 00:04:54,660 And that's especially challenging because there's 105 00:04:54,660 --> 00:04:57,970 interesting research. Obviously this group is very 106 00:04:57,970 --> 00:04:59,770 dedicated and you've got to do a lot of miles. 107 00:04:59,770 --> 00:05:02,930 There's some very interesting qualitative studies that have 108 00:05:02,930 --> 00:05:05,530 asked, like, hey, if you knew that ultra running was bad for 109 00:05:05,530 --> 00:05:08,570 you, would you stop? I think like 78% said absolutely 110 00:05:08,570 --> 00:05:09,890 not. I would keep doing this. 111 00:05:09,890 --> 00:05:11,570 And it's not say, it's not saying it's bad. 112 00:05:11,570 --> 00:05:14,010 It says people are going to keep doing this and they're going to 113 00:05:14,010 --> 00:05:17,730 keep doing it in large numbers. We are in do. 114 00:05:17,730 --> 00:05:20,090 What's the term we're looking for in high volume? 115 00:05:20,090 --> 00:05:21,730 A lot of people are going to keep doing it and they're going 116 00:05:21,730 --> 00:05:24,010 to keep, continue doing it almost no matter what. 117 00:05:24,010 --> 00:05:26,740 So the question is how do we keep people healthy, which is 118 00:05:26,740 --> 00:05:28,300 our subjective question of the day. 119 00:05:28,300 --> 00:05:30,660 So wherever you're listening to this, let us know, do you 120 00:05:30,660 --> 00:05:34,180 participate in ultra marathons? And if you do, what do you do 121 00:05:34,180 --> 00:05:36,100 personally? What extra things you do to keep 122 00:05:36,100 --> 00:05:38,660 yourself healthy? And I feel like from a lot of 123 00:05:38,660 --> 00:05:41,340 the patients that I've treated, the answer is nothing but run, 124 00:05:41,660 --> 00:05:43,100 which has been the most common thing. 125 00:05:43,100 --> 00:05:45,180 Not that I'm judging because I know a lot of people, we talk 126 00:05:45,180 --> 00:05:47,620 about this all the time. Some of the things you might 127 00:05:47,620 --> 00:05:49,420 want to consider doing, especially when it comes to 128 00:05:49,420 --> 00:05:51,960 strength training, when it comes to other things, but what I'm 129 00:05:51,960 --> 00:05:54,640 especially hoping to get out of this conversation is being able 130 00:05:54,640 --> 00:05:58,120 to help both clinicians and runners from this conversation 131 00:05:58,120 --> 00:06:00,800 understand the why do we talk about that, especially in ultra 132 00:06:00,800 --> 00:06:02,760 marathoning? Because I think some of the 133 00:06:02,760 --> 00:06:05,200 stereotypes, correct me if I'm wrong, if I'm going the wrong 134 00:06:05,200 --> 00:06:08,160 way is that, you know, ultramart, you run all the time, 135 00:06:08,160 --> 00:06:11,000 so your bone density must be absolutely solid, right? 136 00:06:11,240 --> 00:06:14,680 It you, you know art you there's going to be completely different 137 00:06:14,680 --> 00:06:17,680 injuries from say if you're a road runner which might be true, 138 00:06:17,680 --> 00:06:19,240 might not as you kind of mention. 139 00:06:19,620 --> 00:06:22,140 And then also you can eat whatever you want. 140 00:06:22,140 --> 00:06:23,220 Health is different than you are. 141 00:06:23,220 --> 00:06:26,460 The ultimate in health, and I think that's my big question 142 00:06:26,540 --> 00:06:30,020 starting out, is what does health even mean in ultra 143 00:06:30,020 --> 00:06:33,300 marathoning to you when you talk about when we we just get into 144 00:06:33,300 --> 00:06:36,540 this topic? Yeah, I mean I think, you know, 145 00:06:36,540 --> 00:06:39,460 I think that's a great question. I think you know what draws 146 00:06:39,460 --> 00:06:42,180 people to ultra running, I think is is probably, you know, a good 147 00:06:42,180 --> 00:06:46,140 place to start and I think. You know, a lot of people maybe 148 00:06:46,140 --> 00:06:48,700 came from a road running background and they kind of 149 00:06:48,700 --> 00:06:51,060 gravitated towards trail running because perhaps they were burned 150 00:06:51,060 --> 00:06:54,820 out on training for marathons or half marathons and they've 151 00:06:54,820 --> 00:06:58,260 really have come to the kind of unstructured nature of ultra 152 00:06:58,260 --> 00:07:00,180 marathons. You know, there's no necessarily 153 00:07:00,180 --> 00:07:01,660 standard distance. I think, you know, a lot of 154 00:07:01,660 --> 00:07:06,180 times we hear about 100 KS or 100 miles, but I think too like 155 00:07:06,380 --> 00:07:09,380 that that unstructured environment, while it can be 156 00:07:09,380 --> 00:07:10,940 like what's a little bit of learning. 157 00:07:11,300 --> 00:07:13,260 It can also be part of the problem too. 158 00:07:13,260 --> 00:07:15,020 Like you know. So if you you contrast this with 159 00:07:15,020 --> 00:07:17,380 basketball for instance you know a basketball game is going to be 160 00:07:17,380 --> 00:07:22,380 a set length of time. Ultra marathoning can be you 161 00:07:22,380 --> 00:07:24,580 know you can you can train as much as you want. 162 00:07:24,620 --> 00:07:26,460 You know for as large as you're not getting injured. 163 00:07:27,180 --> 00:07:30,820 And when you when you think about there's you can look up 164 00:07:30,820 --> 00:07:33,220 online you can find like a online training plan for a 165 00:07:33,220 --> 00:07:36,940 marathon or for 5K and they they they tend to be pretty tame. 166 00:07:37,390 --> 00:07:41,070 But for ultra marathons you you just can't find that And so a 167 00:07:41,070 --> 00:07:44,550 lot of ultra marathon training tends to be you know let's go 168 00:07:44,550 --> 00:07:47,350 spend a lot of time in the hills on the weekends particularly 169 00:07:47,350 --> 00:07:49,870 perhaps doing back-to-back days that are that are pretty big. 170 00:07:50,990 --> 00:07:55,590 And and I think that the kind of that best practices on on how to 171 00:07:55,590 --> 00:07:58,510 structure your week and how to structure your season and season 172 00:07:58,510 --> 00:08:01,430 after season when so you're coming to your your best 173 00:08:01,430 --> 00:08:03,070 performance and your best overall health. 174 00:08:03,470 --> 00:08:05,430 And I don't, I don't think that that work has been done and I 175 00:08:05,430 --> 00:08:07,720 think that. Part of that too is just that, 176 00:08:07,720 --> 00:08:11,640 you know, the just the nature of ultra runners tends to, I don't 177 00:08:11,640 --> 00:08:13,400 know, maybe avoid that kind of structure. 178 00:08:13,400 --> 00:08:16,840 And so I think that there's a lot of benefits to that. 179 00:08:16,840 --> 00:08:19,120 But I think that there are some things for ultra runners to keep 180 00:08:19,120 --> 00:08:21,720 in mind as well when they're when they're training like that, 181 00:08:21,720 --> 00:08:24,120 so that they can maintain their overall musculoskeletal health 182 00:08:24,120 --> 00:08:25,920 along the way. So it sounds like there's some 183 00:08:25,920 --> 00:08:27,360 risks. Again, health kind of gets 184 00:08:27,360 --> 00:08:28,400 through. You're like, hey, I can, you 185 00:08:28,400 --> 00:08:31,160 know, the classic things I've heard is I can just go run how 186 00:08:31,160 --> 00:08:33,520 much ever I want to work, don't worry about it. 187 00:08:33,520 --> 00:08:37,030 I could eat whatever I want. I could just, you know, classic 188 00:08:37,030 --> 00:08:38,630 Weekend warrior. Again, a lot of these 189 00:08:38,630 --> 00:08:41,270 individuals frequently are masters runners. 190 00:08:41,270 --> 00:08:43,830 They've kind of been through their career or we're now seeing 191 00:08:43,830 --> 00:08:46,310 this new group that's much younger that can focus on this 192 00:08:46,310 --> 00:08:49,790 all the time. The challenges for those 193 00:08:49,790 --> 00:08:51,470 different groups, how the structure change is going to be 194 00:08:51,470 --> 00:08:52,710 different. But a lot of the way classically 195 00:08:52,710 --> 00:08:55,790 people do it is you'll have these massive workload spikes on 196 00:08:55,790 --> 00:08:57,590 the weekend. And we know that kind of 197 00:08:57,630 --> 00:09:01,110 muscular skeletal system doesn't always do as well with that if 198 00:09:01,110 --> 00:09:02,950 you're not kind of ready for that as opposed to kind of the 199 00:09:02,950 --> 00:09:05,420 more consistent workload throughout the week. 200 00:09:05,420 --> 00:09:07,980 But it's understandable since most people that are doing this, 201 00:09:07,980 --> 00:09:11,020 not the elites maybe, but most people are working during their 202 00:09:11,020 --> 00:09:13,060 week and they only have time. They have to get that long 203 00:09:13,060 --> 00:09:14,900 training running comes in the in the weekend. 204 00:09:15,340 --> 00:09:19,660 So yeah, it kind of goes against the norm of what we might 205 00:09:19,660 --> 00:09:22,420 suggest as opposed to marathon and yeah, you'll frequently have 206 00:09:22,420 --> 00:09:25,820 that long run, but there is some level of consistency without 207 00:09:25,820 --> 00:09:29,220 their week versus the. Yeah. 208 00:09:29,820 --> 00:09:31,060 Go for it. Yeah, Yeah, exactly. 209 00:09:31,060 --> 00:09:32,860 I mean, I think, I think the other part of it too is that 210 00:09:32,860 --> 00:09:35,980 when you run on a trail, you're running much slower And so one 211 00:09:35,980 --> 00:09:39,540 mile on the trail is going to take longer than one mile on the 212 00:09:39,540 --> 00:09:41,140 road. And I don't know if necessarily 213 00:09:41,140 --> 00:09:44,300 if trail runners make that do that calculus in their head. 214 00:09:44,300 --> 00:09:47,140 There also tends to be a lot more elevation gain and loss. 215 00:09:47,820 --> 00:09:50,540 And so if you talk to the serious ultra runners, they're 216 00:09:50,580 --> 00:09:52,780 not only will they be tracking, they're tracking their weekly 217 00:09:52,780 --> 00:09:55,300 mileage or weekly running volume, they're also be tracking 218 00:09:55,300 --> 00:09:59,030 their their weekly vertical. Pervert, you know, so how much 219 00:09:59,030 --> 00:10:01,670 vertical gain and loss that they're also experiencing. 220 00:10:01,670 --> 00:10:04,950 And so I don't know. You know I live in Missoula, Mt 221 00:10:04,950 --> 00:10:07,990 and I I think that it's probably safe to say that Missoula is a 222 00:10:08,030 --> 00:10:10,430 training base for a lot of elite ultra runners. 223 00:10:10,790 --> 00:10:14,990 And so one of the things that is pretty typical is I'll hear some 224 00:10:14,990 --> 00:10:17,550 of the elite ultra runners that I that I treat, they come in, 225 00:10:17,550 --> 00:10:20,830 they're talking about doing 1020 maybe even 30,000 feet of 226 00:10:20,830 --> 00:10:23,950 vertical in a week which is. Which is insane. 227 00:10:23,950 --> 00:10:26,430 I mean that's like just so much volume at 30,000 feet. 228 00:10:26,470 --> 00:10:28,630 I mean that's going up and down Mount Everest. 229 00:10:29,030 --> 00:10:33,470 And so this is the training loads are quite a bit different. 230 00:10:34,230 --> 00:10:37,310 You know we see you know we're talking about overall bone 231 00:10:37,310 --> 00:10:40,510 health and it and you know running in and of itself even 232 00:10:40,510 --> 00:10:44,590 though there is some impact involved, running is not a very 233 00:10:44,590 --> 00:10:47,270 bone stimulating activity. And in fact, when we when we 234 00:10:47,270 --> 00:10:50,350 look at runners, they tend not to have very good bone health. 235 00:10:51,380 --> 00:10:55,460 And they might have regionally higher bone density in certain 236 00:10:55,460 --> 00:11:00,620 areas, but the they tend towards the lower bone density, 237 00:11:00,620 --> 00:11:03,460 particularly more proximately. So if you look at the lumbar 238 00:11:03,460 --> 00:11:06,620 spine, the pelvis, the femoral neck, they tend to have lower 239 00:11:06,620 --> 00:11:09,050 bone densities there. When you're they're looking at 240 00:11:09,050 --> 00:11:12,410 like age match peers who are not, who are not running just 241 00:11:12,410 --> 00:11:14,970 for some of our summer listers are going to list some or not. 242 00:11:15,130 --> 00:11:18,250 What's the difference between bone density and bone health? 243 00:11:18,250 --> 00:11:20,410 I think this is a key point because a lot of runners will 244 00:11:20,410 --> 00:11:23,410 assume, oh, I must have great bone density because I run all 245 00:11:23,410 --> 00:11:25,810 the time. When that doesn't necessarily 246 00:11:25,810 --> 00:11:28,250 mean that's not necessarily true. 247 00:11:28,770 --> 00:11:31,010 Yeah, yeah, exactly. And well, you know, I think bone 248 00:11:31,010 --> 00:11:34,650 density is just one part of of bone health. 249 00:11:35,000 --> 00:11:36,760 You know when we look at bone health, we're also talking about 250 00:11:36,760 --> 00:11:42,080 bone mass as well. So and you know you're when we 251 00:11:42,080 --> 00:11:46,040 run or actually like anytime, we're always turning bone over. 252 00:11:46,040 --> 00:11:48,840 So really slowly breaking bone down and we're replacing it with 253 00:11:48,960 --> 00:11:52,680 with with new bone. And if you're doing, if you're 254 00:11:52,680 --> 00:11:55,320 like different parts of your of your lifespan, you might be 255 00:11:55,320 --> 00:11:57,440 laying down more bone than you're breaking down. 256 00:11:57,440 --> 00:12:00,400 So when you're a young athlete, for instance, like in your your 257 00:12:00,400 --> 00:12:02,470 early teens? You're going to be laying down 258 00:12:02,470 --> 00:12:04,590 more bone mass. And so you kind of accruing bone 259 00:12:04,590 --> 00:12:08,910 mass during your teenage years and that's kind of when we build 260 00:12:08,910 --> 00:12:13,470 up most of our bone mass. And then as we get older, it's 261 00:12:13,590 --> 00:12:16,030 thought that we lose a lot. We kind of slowly lose our bone 262 00:12:16,030 --> 00:12:19,110 mass as we get older. And so it used to be thought 263 00:12:19,110 --> 00:12:22,510 that you couldn't like once you got to be like 25 or 30 years of 264 00:12:22,510 --> 00:12:25,190 age, it was kind of all downhill from there when it came to bone 265 00:12:25,190 --> 00:12:27,030 mass and you just kind of slowly lost it, but. 266 00:12:27,390 --> 00:12:30,590 Some really neat new work coming out of Australia looking at 267 00:12:30,590 --> 00:12:33,870 older individuals who have osteoporosis or osteopenia, and 268 00:12:33,870 --> 00:12:36,390 they're showing that you can reverse that as you get older. 269 00:12:36,550 --> 00:12:38,750 Now granted you can, you can make some changes there. 270 00:12:38,750 --> 00:12:42,310 They're not massive changes, but you can at least start to add 271 00:12:42,310 --> 00:12:45,430 some bone mass later on in life, provided that the exercise is 272 00:12:45,430 --> 00:12:49,190 right, your overall health is is good, and you're eating enough 273 00:12:49,190 --> 00:12:52,870 calories to support your bone Physiology so you can lay down 274 00:12:52,870 --> 00:12:56,830 new bone and when you look at when you look at running. 275 00:12:58,370 --> 00:13:01,650 You basically can get a bone stress injury for two different 276 00:13:01,650 --> 00:13:04,610 reasons. One is you can do a lot of fast 277 00:13:04,610 --> 00:13:10,570 running and bone is very susceptible to to to the accrual 278 00:13:10,570 --> 00:13:12,850 of bone micro damage when you run very fast. 279 00:13:12,850 --> 00:13:18,090 And so it's not like when you when you run 10% faster, it's 280 00:13:18,090 --> 00:13:21,890 not that the bone damage that you accrue is 10% more, it's 281 00:13:21,890 --> 00:13:25,570 actually there's actually there's an exponential effect 282 00:13:25,570 --> 00:13:28,400 that's occurring. And that that exponent is about 283 00:13:28,400 --> 00:13:33,120 6:00, so a factor of 6. So if you increase your load per 284 00:13:33,120 --> 00:13:36,680 step by running maybe 10% faster, you're actually reducing 285 00:13:36,680 --> 00:13:39,640 the number of steps that you can take before you start occurring, 286 00:13:39,640 --> 00:13:42,440 like bone micro damage by a factor of 6. 287 00:13:42,520 --> 00:13:44,600 So it really goes up exponentially. 288 00:13:44,600 --> 00:13:47,480 So that's why fast running can be very you don't want to do too 289 00:13:47,480 --> 00:13:50,240 much fast running because fast running can increase your risk 290 00:13:50,240 --> 00:13:51,640 of developing a bone stress injury. 291 00:13:52,440 --> 00:13:55,280 So that's bone damage. The other side of the spectrum 292 00:13:55,400 --> 00:13:57,880 is running is also very energy intensive. 293 00:13:57,880 --> 00:14:01,000 So if you're running a lot, so a lot of volume, you're going to 294 00:14:01,000 --> 00:14:03,280 be burning a lot of calories. And if you're not replacing 295 00:14:03,280 --> 00:14:07,080 those calories, both from a chloric standpoint but also 296 00:14:07,080 --> 00:14:10,600 consuming of macro nutrients and micronutrients, your body is 297 00:14:10,600 --> 00:14:14,400 going to start turning inward and pulling those macro 298 00:14:14,400 --> 00:14:17,800 nutrients and micronutrients from your bones, for instance, 299 00:14:17,840 --> 00:14:20,960 to start nourishing your body. And so as a result, you start to 300 00:14:20,960 --> 00:14:23,590 lose bone mass over time. And so it's really important 301 00:14:23,590 --> 00:14:25,910 that if you're burning a certain number of calories that you're 302 00:14:25,910 --> 00:14:30,310 replacing those calories with appropriate amount of energy 303 00:14:30,310 --> 00:14:33,030 consumption, but you're also choosing the right kind of 304 00:14:33,030 --> 00:14:36,030 calories to consume as well. And I'm not a registered 305 00:14:36,030 --> 00:14:39,070 dietitian, but we can kind of talk a little bit about that as 306 00:14:39,070 --> 00:14:41,110 we're going along. But you know, lately there's 307 00:14:41,110 --> 00:14:43,110 been, I'd say over the last decade, I think we're starting 308 00:14:43,110 --> 00:14:48,870 to get a much better idea of this idea that bone injuries is 309 00:14:48,870 --> 00:14:50,510 not just because of the way we run. 310 00:14:50,890 --> 00:14:53,810 That has much more to do with our overall bone health and our 311 00:14:53,810 --> 00:14:57,770 Physiology and our physiology's ability to to basically support 312 00:14:57,770 --> 00:15:00,770 a muscoskeletal system and repairs on the damage that we're 313 00:15:00,770 --> 00:15:03,170 accruing when we go out for just a regular training run. 314 00:15:03,410 --> 00:15:05,210 So sounds like there's multiple factors here. 315 00:15:05,210 --> 00:15:09,330 It's like okay, so you are you are choosing activity that 316 00:15:09,330 --> 00:15:13,090 doesn't it's it. It may help to some degree with 317 00:15:13,090 --> 00:15:16,370 bone density in a specific area not your entire body. 318 00:15:16,780 --> 00:15:19,420 But you're also doing some risky things as you're doing something 319 00:15:19,420 --> 00:15:23,540 with a very high caloric expenditure which is also a risk 320 00:15:23,540 --> 00:15:29,300 factor for bone turnover and not like like kind of reabsorption. 321 00:15:29,500 --> 00:15:32,180 So it's not being replaced. It's there's going to weak it 322 00:15:32,180 --> 00:15:34,460 might weaken some of that's probably not the right term. 323 00:15:34,940 --> 00:15:39,090 You have people doing ultra marathons, which typically is 324 00:15:39,090 --> 00:15:42,730 extremely high calorically. It only really loads the lower 325 00:15:42,730 --> 00:15:44,250 extremity. It's not like these individuals 326 00:15:44,250 --> 00:15:45,850 are stopping going. Oh, I need to make sure that I 327 00:15:45,850 --> 00:15:48,250 load my upper extremity or do some stuff for my lumbars might. 328 00:15:48,250 --> 00:15:50,130 No, you're just running it's competed load to the lower 329 00:15:50,130 --> 00:15:55,410 extremity the entire time, plus the high caloric amount that if 330 00:15:55,410 --> 00:15:58,570 you're out there for like 5-6 hours, you really cannot consume 331 00:15:58,570 --> 00:16:01,730 enough calories to compensate for that. 332 00:16:01,730 --> 00:16:04,570 So you have some kind of risk factors starting to accumulate 333 00:16:04,570 --> 00:16:08,760 here combined with you have increased loads and some injury 334 00:16:08,760 --> 00:16:11,480 risks that are you can't kind of get out of the way, right. 335 00:16:11,480 --> 00:16:15,240 So a lot of as you mentioned earlier because masters runners 336 00:16:15,240 --> 00:16:17,640 typically tended to be the more common group here. 337 00:16:17,760 --> 00:16:20,080 There may have been more soft tissue type injuries which 338 00:16:20,080 --> 00:16:23,320 actually was seen in the past as reviewing this tip more common 339 00:16:23,320 --> 00:16:27,280 and previously was like ankle Dorsey flexion irritation, just 340 00:16:27,280 --> 00:16:30,520 what I assumed from like heel strikers and you just overwork 341 00:16:30,520 --> 00:16:32,640 all those extensors and antib makes sense. 342 00:16:32,640 --> 00:16:35,370 But as some of the younger athletes have come in you have 343 00:16:35,370 --> 00:16:38,770 now seen a much higher rate of bone stress injuries. 344 00:16:38,770 --> 00:16:41,170 Knee stuff has started to shift as we've kind of mentioned 345 00:16:41,170 --> 00:16:43,610 beforehand. So it sounds like a perfect 346 00:16:43,610 --> 00:16:46,650 storm and the perfect storm being people aren't eating well 347 00:16:46,650 --> 00:16:48,650 enough. I can guarantee if the a lot of 348 00:16:48,650 --> 00:16:51,770 these individuals be it young ones who a probably don't have a 349 00:16:51,770 --> 00:16:53,610 great sleep schedule to begin with because we got it. 350 00:16:53,610 --> 00:16:55,850 You know sleep is something is that's really important for 351 00:16:55,850 --> 00:16:57,690 recovery. You're older individuals that 352 00:16:57,690 --> 00:17:00,490 probably aren't sleeping well throughout the week because they 353 00:17:00,490 --> 00:17:03,810 work full time and then they just do these peak loads during 354 00:17:03,810 --> 00:17:07,869 the weekend combined with probably not the best nutrition 355 00:17:07,869 --> 00:17:11,589 because runners are whether they might not be eating enough or 356 00:17:11,589 --> 00:17:15,349 not be eating as well to replace or adequately get in micro macro 357 00:17:15,349 --> 00:17:17,750 nutrients. It's not saying this is bad, but 358 00:17:17,750 --> 00:17:21,069 sounds like this is a bit of a perfect storm here and like an 359 00:17:21,069 --> 00:17:23,030 untapped like, well, this makes sense, but we still need to 360 00:17:23,030 --> 00:17:25,550 study it, correct? Yeah, I mean, yeah, I mean 361 00:17:25,630 --> 00:17:28,190 you're you're hitting all the main points and that's that like 362 00:17:28,510 --> 00:17:30,950 it's just so energy intensive and I think you said it really 363 00:17:30,950 --> 00:17:33,150 well earlier that like. So if you're going out for a 364 00:17:33,150 --> 00:17:38,110 four or five hour run, you know you're there's no way you can 365 00:17:38,110 --> 00:17:41,150 consume that number of calories to replace that like when you're 366 00:17:41,150 --> 00:17:42,830 on your feet. And so as a result you're coming 367 00:17:42,830 --> 00:17:45,510 out of that run with an energy deficient state. 368 00:17:45,910 --> 00:17:48,390 And so it's going to maybe perhaps take you a couple days 369 00:17:48,390 --> 00:17:53,310 to get back to even keel and so if you're also actively trying 370 00:17:53,310 --> 00:17:56,560 to lose weight along the way. You're just going to perpetuate 371 00:17:56,560 --> 00:17:59,320 that and you get yourself stuck in this low energy availability 372 00:17:59,440 --> 00:18:02,840 state and that's when you start losing bone mass and we see that 373 00:18:02,840 --> 00:18:04,880 that occurs. It doesn't take a lot of time to 374 00:18:04,880 --> 00:18:06,800 do that. It can actually occur over just 375 00:18:06,800 --> 00:18:09,920 a single, over a single week. If you yourself in a state of 376 00:18:09,920 --> 00:18:13,120 low energy availability, well, you're going to start losing 377 00:18:13,120 --> 00:18:16,080 bone mass. And we see that it's very, it's 378 00:18:16,080 --> 00:18:17,760 kind of silent. You don't necessarily know that 379 00:18:17,760 --> 00:18:20,360 that's happening, but. A good rule of thumb is that if 380 00:18:20,360 --> 00:18:24,240 you're losing body mass, you're typically not just losing body 381 00:18:24,240 --> 00:18:27,240 fat, you're also losing body mass somewhere else too. 382 00:18:27,240 --> 00:18:30,280 That can be muscle, can also be bone as well. 383 00:18:30,280 --> 00:18:32,760 And so it's really important to be thinking, thinking a lot 384 00:18:32,760 --> 00:18:34,240 about that. And there's some some a couple 385 00:18:34,240 --> 00:18:36,200 really cool studies that have come out last couple years. 386 00:18:36,200 --> 00:18:39,720 I've looked at like how ultra runners look at running and 387 00:18:39,720 --> 00:18:42,400 their overall mental health picture and and so we see that 388 00:18:42,400 --> 00:18:47,560 like you know up to between 32 and 62% of ultra runners. 389 00:18:48,430 --> 00:18:52,110 Have the signs and symptoms of disordered eating or some sort 390 00:18:52,110 --> 00:18:53,750 of. They're actually been diagnosed 391 00:18:53,750 --> 00:18:56,030 with some form of of an eating disorder. 392 00:18:56,830 --> 00:19:01,710 We know that almost 20% of ultra runners have been diagnosed or 393 00:19:01,950 --> 00:19:05,070 show the signs and symptoms of exercise addiction. 394 00:19:05,830 --> 00:19:09,470 And a really great paper came out of western states from two 395 00:19:09,470 --> 00:19:12,990 years ago and they found that 50% of the males and females 396 00:19:12,990 --> 00:19:14,910 that were running western states. 397 00:19:15,230 --> 00:19:16,950 Are actively trying to lose weight. 398 00:19:17,030 --> 00:19:20,510 So if you're running that much and you're also doing some sort 399 00:19:20,510 --> 00:19:23,590 of caloric restriction that's a real recipe for poor bone health 400 00:19:24,350 --> 00:19:27,150 and you're going to start start to basically start losing this 401 00:19:27,150 --> 00:19:30,230 bone mass. And so when when we look at that 402 00:19:30,230 --> 00:19:33,310 study from Western states from a couple years ago, we see that 403 00:19:33,870 --> 00:19:36,710 you know about 30% of males have low bone density. 404 00:19:36,910 --> 00:19:39,870 So that's a pretty high rate. So one out of three males who 405 00:19:39,870 --> 00:19:41,630 ran Western states two years ago. 406 00:19:41,990 --> 00:19:44,730 Or osteopenic. Or perhaps even in the 407 00:19:44,730 --> 00:19:47,610 osteoporotic range, females, which was a little bit 408 00:19:47,610 --> 00:19:48,810 surprising, was a little bit lower. 409 00:19:48,810 --> 00:19:52,650 That was about 16% for females for the same the same measures 410 00:19:52,650 --> 00:19:55,890 of of of bone density. But the other thing too we see 411 00:19:55,890 --> 00:20:00,370 is that over one out of three females have had a bone stress 412 00:20:00,370 --> 00:20:02,290 injury in the past. And that's that's actually 413 00:20:02,290 --> 00:20:05,290 really concerning because when we look at the number one risk 414 00:20:05,290 --> 00:20:07,210 factor for if you're going to have a bone stress injury in the 415 00:20:07,210 --> 00:20:09,530 future is if you've had one in the past and if you've had one 416 00:20:09,530 --> 00:20:12,770 in the past. You have a 600% increased risk 417 00:20:12,770 --> 00:20:15,770 of having a subsequent one and there's there's some really 418 00:20:15,770 --> 00:20:18,130 important reasons for that. But the number one reason is, is 419 00:20:18,130 --> 00:20:21,490 that those risk factors that set you up for that first one are 420 00:20:21,490 --> 00:20:24,290 likely unresolved and those. So since those risk factors are 421 00:20:24,290 --> 00:20:27,410 still present, you're going to probably get another bone stress 422 00:20:27,410 --> 00:20:29,370 injury in the future and that could be anywhere else in your 423 00:20:29,370 --> 00:20:30,650 body. So if you've had a tibial bone 424 00:20:30,650 --> 00:20:33,090 stress injury in the past, that doesn't necessarily mean that 425 00:20:33,090 --> 00:20:35,370 your next bone stress injury is going to be in your other tibia. 426 00:20:35,730 --> 00:20:38,570 It might be somewhere else, your sacrum or your femoral neck or a 427 00:20:38,570 --> 00:20:41,850 metatarsal. So if you've had a bone stress 428 00:20:41,850 --> 00:20:44,170 injury the past, I think it's important not to just pat just 429 00:20:44,170 --> 00:20:47,410 to pass it off as just like a random occurrence. 430 00:20:47,410 --> 00:20:49,890 You probably should, you know, think long and hard about what 431 00:20:49,890 --> 00:20:53,170 led to that bone stress injury and make sure that you're not 432 00:20:53,170 --> 00:20:55,290 just waiting for that bone stress injury to heal so you can 433 00:20:55,290 --> 00:20:57,130 get back to running as quickly as possible. 434 00:20:57,730 --> 00:21:00,050 But take some time. And you know, and particularly 435 00:21:00,050 --> 00:21:02,410 if it's one of these boy considered to be high risk bone 436 00:21:02,410 --> 00:21:04,450 stress injuries. So that would be a bone stress 437 00:21:04,450 --> 00:21:07,530 injury of the sacrum, bone stress, bone stress injury, the 438 00:21:07,530 --> 00:21:11,380 femoral neck, navicular anterior tibia. 439 00:21:11,380 --> 00:21:14,740 If you've had one of those, it's really important for you to meet 440 00:21:15,380 --> 00:21:18,140 with a registered dietitian so you can make sure that you're 441 00:21:18,180 --> 00:21:21,420 meeting the energy and the macro nutrient and micro nutrient 442 00:21:21,420 --> 00:21:24,940 demands of your sport. Yeah, I can see this as being a 443 00:21:25,140 --> 00:21:27,140 huge issue, and it's interesting that. 444 00:21:28,360 --> 00:21:30,600 Like, food is probably one of the more interesting things to 445 00:21:30,600 --> 00:21:33,200 me in ultra marathoning. So when my wife was doing the 446 00:21:33,200 --> 00:21:36,480 US100K championship, that was all we did is it was just 447 00:21:36,480 --> 00:21:39,120 learning how to eat. I did not run that with her. 448 00:21:39,120 --> 00:21:40,760 I just joined her for all her training ones. 449 00:21:40,760 --> 00:21:43,520 And I have to say that I kind of maxed out when she's like, can 450 00:21:43,520 --> 00:21:45,680 you do a 30 mile run with me? I'm like, I think this is the 451 00:21:45,680 --> 00:21:48,360 limit of what I'm willing to do. Even though I love you like I 452 00:21:48,400 --> 00:21:51,000 even I like running, I don't know if I like running that 453 00:21:51,000 --> 00:21:53,440 much. So learning to eat on the run 454 00:21:53,440 --> 00:21:55,680 was really interesting because you have to go and it's. 455 00:21:56,090 --> 00:21:59,370 For us, especially for her as a pro, it was not an option of oh, 456 00:21:59,370 --> 00:22:02,730 I just try not to eat was I have to eat or you're going to stop, 457 00:22:02,730 --> 00:22:04,010 you're going to, you're not going to finish. 458 00:22:04,450 --> 00:22:07,890 But it's challenging again to kind of some of the stereotypes, 459 00:22:07,890 --> 00:22:10,570 and I apologize for anybody that gets offended with this, is some 460 00:22:10,570 --> 00:22:12,730 of the stereotypes about runners and people having, like you 461 00:22:12,730 --> 00:22:15,290 said, some of the disordered eating you're if you have 462 00:22:15,290 --> 00:22:17,570 disordered eating, you're have, you need to get help because 463 00:22:17,570 --> 00:22:20,250 you're having a problem with one of the most important parts of 464 00:22:20,250 --> 00:22:24,210 performance for endurance sport is food if you don't have 465 00:22:24,210 --> 00:22:25,980 enough. You're not going to make to the 466 00:22:25,980 --> 00:22:29,260 finish line and if you don't continue to fuel you're the 467 00:22:29,500 --> 00:22:31,460 evidence is clear. Your body's going to breakdown 468 00:22:31,460 --> 00:22:35,540 be it now or later and this it's not just about oh eating it's 469 00:22:35,860 --> 00:22:38,900 this is you have to eat for performance like this is about 470 00:22:38,900 --> 00:22:41,780 survival and for those that have done ultras know you do get 471 00:22:41,780 --> 00:22:43,740 that's viable. But there's another level that I 472 00:22:43,740 --> 00:22:46,380 think long term we might not be thinking about. 473 00:22:46,420 --> 00:22:49,940 And this, this talk is not to demonize ultra marathoning and 474 00:22:49,940 --> 00:22:52,430 say you shouldn't be doing it. But it's to go. 475 00:22:52,430 --> 00:22:54,630 I think there's a better way for people to be able to approaching 476 00:22:54,630 --> 00:22:56,630 this, especially with the research coming out saying, 477 00:22:56,910 --> 00:23:01,270 yeah, one in three people is having low, like basically signs 478 00:23:01,270 --> 00:23:04,030 of poor bone health, which you would not expect in people 479 00:23:04,030 --> 00:23:06,510 running a hundred 150 miles a week. 480 00:23:06,510 --> 00:23:09,590 But I guess we could say the opposite, that we are missing 481 00:23:09,590 --> 00:23:12,390 some things and if these athletes can want to continue to 482 00:23:12,390 --> 00:23:15,550 do this, there might need to be some changes. 483 00:23:15,980 --> 00:23:17,540 Correct. Yeah, yeah, exactly. 484 00:23:17,540 --> 00:23:19,500 I mean I think there are a lot of ways to look at statistics. 485 00:23:19,500 --> 00:23:23,060 I think you know it's it's easy and and I as a researcher I'm, 486 00:23:23,220 --> 00:23:25,980 I'm trying to justify studies and so I might say well you know 487 00:23:25,980 --> 00:23:29,380 one out of three ultra runners have poor bone health and 488 00:23:29,380 --> 00:23:31,820 they've got low bone density. But I I also think it's 489 00:23:31,820 --> 00:23:35,220 important to point out that two out of three ultra runners have 490 00:23:35,220 --> 00:23:38,220 normal bone health. And so it's very possible to do 491 00:23:38,220 --> 00:23:40,220 the sport and it's actually quite possible to do the sport 492 00:23:40,220 --> 00:23:42,920 in a very healthy manner. And I think we also need to be 493 00:23:42,920 --> 00:23:46,560 thinking a lot about how those other individuals are doing this 494 00:23:46,560 --> 00:23:49,120 and doing so in a very healthy and safe manner. 495 00:23:50,200 --> 00:23:53,760 And I, you know, I think that at the same time though I think we 496 00:23:53,760 --> 00:23:59,880 really need to be thinking a lot about those 103 because you know 497 00:23:59,880 --> 00:24:02,840 those those people are going to have probably some lifelong bone 498 00:24:02,840 --> 00:24:06,080 health issues that are going to, it's going to extend long beyond 499 00:24:06,650 --> 00:24:09,650 just their their inability to perhaps run 100 miles without 500 00:24:09,810 --> 00:24:12,410 getting some sort of injury in the training process leading up 501 00:24:12,410 --> 00:24:14,810 to that event. So yeah, I I do think that 502 00:24:14,810 --> 00:24:17,010 there's there's probably a lot more that that we can learn 503 00:24:17,010 --> 00:24:18,570 there. We don't, we don't necessarily 504 00:24:19,650 --> 00:24:21,930 know exactly why, but I I don't know. 505 00:24:21,930 --> 00:24:24,250 I can tell you in my own clinical practice that this is a 506 00:24:24,250 --> 00:24:25,650 group that I end up treating a lot. 507 00:24:25,650 --> 00:24:29,250 I see a lot of ultra runners, I see a lot of elite ultra owners, 508 00:24:30,130 --> 00:24:32,170 a lot of them are dealing with bone stress injuries. 509 00:24:32,250 --> 00:24:35,650 And for me it's really led me to kind of ask the question like 510 00:24:35,650 --> 00:24:37,650 why, why are we starting to see more of these. 511 00:24:38,130 --> 00:24:40,610 And you know I think part of that too is I think that we're 512 00:24:40,610 --> 00:24:45,410 starting to see more, more more fad diets and more dietary 513 00:24:45,410 --> 00:24:48,810 restrictions And and and I think too I think the the average 514 00:24:48,890 --> 00:24:52,650 person probably just you know I think under fueling is probably 515 00:24:52,650 --> 00:24:55,050 unintentional and a good number of people and we see that in 516 00:24:55,050 --> 00:24:59,370 about 50% of people who have some low energy availability 517 00:24:59,930 --> 00:25:01,370 status. And so. 518 00:25:01,450 --> 00:25:03,850 So I think it's just it's just really hard to understand like 519 00:25:03,850 --> 00:25:06,810 how many calories you you truly are burning when you're out 520 00:25:06,810 --> 00:25:09,450 running. And I think too it's easy when 521 00:25:09,450 --> 00:25:12,410 we start thinking a lot about well you know I'm going to start 522 00:25:12,410 --> 00:25:14,930 going out and doing ultra running and I'm going to go out 523 00:25:14,930 --> 00:25:18,290 and it's going to not be on the roads and it's going to be you 524 00:25:18,290 --> 00:25:20,330 know running the hills. And so I'm going to maybe start 525 00:25:20,650 --> 00:25:24,130 looking at some different diets and and so you like one of the 526 00:25:24,130 --> 00:25:27,820 more popular ones that I run into is either like an athlete 527 00:25:27,820 --> 00:25:33,900 who is who's like on a low carb diet, so high fat diet and they 528 00:25:33,900 --> 00:25:37,260 may be under the the idea that hey I'm running very slow and so 529 00:25:37,260 --> 00:25:39,860 I'm burning a lot of fat and because I need to be consuming 530 00:25:40,620 --> 00:25:42,620 less carbohydrates, I don't need to be eating as many 531 00:25:42,620 --> 00:25:45,740 carbohydrates. But bone is actually very is 532 00:25:45,740 --> 00:25:49,900 very carb intensive structure. And so if you've ever tried to 533 00:25:49,900 --> 00:25:55,070 do like like like intermittent fasting or you put yourself on 534 00:25:55,070 --> 00:25:57,030 it like some sort of low carb diet, you know that you get a 535 00:25:57,030 --> 00:26:00,350 little bit of like this brain fuzz, you know, where you can't 536 00:26:00,350 --> 00:26:03,150 concentrate quite as well. And the big reason for that is 537 00:26:03,150 --> 00:26:07,190 that your brain primarily operates off glucose and so you 538 00:26:07,190 --> 00:26:10,590 can feel that right away. Well, your bones also primarily 539 00:26:10,590 --> 00:26:13,910 also operate off glucose. They are very carb intensive, 540 00:26:14,030 --> 00:26:17,030 you know, structure. And so if you're not consuming 541 00:26:17,030 --> 00:26:19,990 enough carbohydrates, one of the things is some really neat work 542 00:26:20,030 --> 00:26:23,140 out of Australia looking at race walkers who they put them on 543 00:26:23,140 --> 00:26:28,220 these these high fat diets, low carb diets and they found that 544 00:26:28,220 --> 00:26:30,380 almost immediately they start shedding more bone. 545 00:26:30,380 --> 00:26:32,860 And it's not that you. So it's not like it when you, 546 00:26:32,860 --> 00:26:34,940 when you start restricting the amount of calories you're 547 00:26:34,940 --> 00:26:37,500 eating. It's not or you're or you're 548 00:26:37,500 --> 00:26:39,220 reducing the amount of carbohydrates you're eating. 549 00:26:39,220 --> 00:26:43,100 It's not that you are not laying down new bone, which you're not. 550 00:26:43,300 --> 00:26:46,540 But the other thing too is that the amount that you of your bone 551 00:26:46,540 --> 00:26:48,420 that you're breaking down actually accelerates. 552 00:26:48,420 --> 00:26:51,500 So when you when you took, when you take a look at 2 athletes, 1 553 00:26:51,500 --> 00:26:53,620 athlete is consuming enough calories and they're eating a 554 00:26:53,620 --> 00:26:57,140 very high carbohydrate diet. And then you look at another 555 00:26:57,220 --> 00:26:59,860 athlete who is perhaps restricting the amount of 556 00:26:59,860 --> 00:27:02,060 carbohydrates that they're eating and perhaps in a low 557 00:27:02,060 --> 00:27:06,340 energy state. What we see is that the athlete 558 00:27:06,340 --> 00:27:10,340 who has adequate calories is breaking down some bone and then 559 00:27:10,340 --> 00:27:12,940 they're going to lay down new bone and all that stuff is 560 00:27:12,940 --> 00:27:15,180 great. But the other athlete, they're 561 00:27:15,180 --> 00:27:17,540 actually breaking down bone at a higher rate. 562 00:27:17,620 --> 00:27:19,980 And because the reason for that is because they're trying to 563 00:27:20,550 --> 00:27:22,390 clear out some of that micro damage that's naturally 564 00:27:22,390 --> 00:27:25,670 occurring, but then because they're not consuming enough 565 00:27:25,990 --> 00:27:28,790 nutrients, they're also essentially mining their own 566 00:27:28,790 --> 00:27:31,390 bones for those nutrients. And so you're breaking down, 567 00:27:31,390 --> 00:27:35,070 you're basically consuming yourself and then they're not 568 00:27:35,070 --> 00:27:39,510 also then having that that subsequent replacement of new 569 00:27:39,510 --> 00:27:41,790 bone, that bone formation that's occurring too. 570 00:27:41,790 --> 00:27:46,190 So they're actually losing bone and at this accelerated rate and 571 00:27:46,190 --> 00:27:48,230 they're not replacing that bone either. 572 00:27:48,270 --> 00:27:50,790 And those those studies out of Australia are really fascinating 573 00:27:50,790 --> 00:27:55,110 because they had the they took a group of these elite race 574 00:27:55,110 --> 00:27:57,870 walkers and they divided them into three different groups. 575 00:27:57,870 --> 00:28:02,070 One group had a high carbohydrate, high calorie diet. 576 00:28:02,430 --> 00:28:06,390 They had another group who had a high calorie but high fat diet 577 00:28:06,390 --> 00:28:08,510 and they restricted the amount of carbohydrates they had. 578 00:28:09,000 --> 00:28:12,640 And then they had a third group who was on a caloric deficient 579 00:28:12,640 --> 00:28:15,840 diet but still was on a high carbohydrate diet. 580 00:28:16,320 --> 00:28:21,800 And what they found was that the high calorie, low carb group 581 00:28:21,920 --> 00:28:26,360 lost more bone than the low energy availability group who 582 00:28:26,360 --> 00:28:29,810 had a high carbohydrate diet. So that tells you that carbs are 583 00:28:30,090 --> 00:28:32,810 are, are very important. They're actually even more 584 00:28:32,810 --> 00:28:36,330 important than consuming enough calories, which is still really 585 00:28:36,330 --> 00:28:38,370 important of course. But it seems like the 586 00:28:38,370 --> 00:28:41,330 carbohydrate part is is really very, very important. 587 00:28:41,330 --> 00:28:43,970 So if you're an ultra runner, it's really important that 588 00:28:43,970 --> 00:28:48,330 you're not looking to go onto a high or this high fat diet, low 589 00:28:48,330 --> 00:28:51,890 carb diet that you're not running in a fasted state. 590 00:28:51,890 --> 00:28:54,170 Because we know that that also kind of accelerates bone 591 00:28:54,170 --> 00:28:57,270 breakdown. And again, it used to be thought 592 00:28:57,270 --> 00:28:58,990 that like, we were like, oh, well, people get bone stress 593 00:28:58,990 --> 00:29:01,670 injuries because they don't have the right running biomechanics, 594 00:29:01,670 --> 00:29:03,150 they're not running in the right shoes. 595 00:29:03,150 --> 00:29:05,710 But more and more now we're, we're beginning to realize that 596 00:29:05,710 --> 00:29:09,190 this is much more of a, A, an athlete's Physiology is not able 597 00:29:09,190 --> 00:29:11,910 to support the sport that they're doing. 598 00:29:12,030 --> 00:29:13,870 And as a result, they're starting to get tissue 599 00:29:13,870 --> 00:29:15,270 breakdown. In this case, we're talking 600 00:29:15,270 --> 00:29:18,470 about bone breakdown. So it's not surprising again we 601 00:29:18,470 --> 00:29:22,510 hear that it's never one factor of no, it's not only your 602 00:29:22,510 --> 00:29:25,590 footwear, it's not only your foot strike or your running 603 00:29:25,590 --> 00:29:27,710 form, it's all these factors together. 604 00:29:27,910 --> 00:29:31,670 But especially looking at your Physiology going, let's go back 605 00:29:31,670 --> 00:29:33,390 to the basics. So for all the students out 606 00:29:33,390 --> 00:29:36,030 there, when we tell you get your foundations versus what we're 607 00:29:36,030 --> 00:29:38,790 talking about is a great example of do you, are you consuming 608 00:29:38,790 --> 00:29:42,010 enough calories? Just to support the training 609 00:29:42,010 --> 00:29:44,650 that you're doing, does the training that you're doing match 610 00:29:44,650 --> 00:29:47,650 your caloric expenditure enough that it's things are balanced 611 00:29:47,650 --> 00:29:51,170 out and your body can recover from what you're asking of it? 612 00:29:51,170 --> 00:29:54,330 And I think you hit on this earlier where I don't know if 613 00:29:54,330 --> 00:29:57,090 people, not that it's bad, I don't know if people know how 614 00:29:57,090 --> 00:30:00,250 much load is going through the body when they do ultras, right. 615 00:30:00,250 --> 00:30:02,490 I think a lot of people the the master centers that I work with 616 00:30:02,490 --> 00:30:04,590 right now. When I'm some of them that are 617 00:30:04,590 --> 00:30:07,270 coming in for Achilles stuff that I'm testing, a lot of them 618 00:30:07,270 --> 00:30:09,590 are ultra marathoners. They think, oh, my body feels so 619 00:30:09,590 --> 00:30:12,630 much better than it did when I was doing Rd. marathons. 620 00:30:12,630 --> 00:30:14,510 Now I'm doing like marathons of the trail. 621 00:30:14,670 --> 00:30:17,190 I feel better. It must be less load and I think 622 00:30:17,190 --> 00:30:19,790 the answer is, well no. It might be different, it might 623 00:30:19,790 --> 00:30:21,790 be coming at different angles given where there's more 624 00:30:21,790 --> 00:30:24,510 variety, but it's not necessarily less and it's not 625 00:30:24,510 --> 00:30:26,670 that. Again, if you use only the mile 626 00:30:26,670 --> 00:30:29,870 metric, miles take much longer on the on the trail. 627 00:30:30,330 --> 00:30:31,610 And that may not be the best metric. 628 00:30:31,610 --> 00:30:34,330 So again, might contribute to people being confused of how 629 00:30:34,330 --> 00:30:38,770 much do they really need and are they eating and training enough 630 00:30:38,770 --> 00:30:41,050 that they can recover. And it sounds like for some 631 00:30:41,050 --> 00:30:43,490 portion of the population there's a mismatch there, but 632 00:30:43,490 --> 00:30:45,170 not all of them because they're you mentioned we have to be 633 00:30:45,170 --> 00:30:46,770 positive a little bit because there is some resource 634 00:30:46,770 --> 00:30:50,130 suggesting that yes, in some ultra marathoners there's a 635 00:30:50,130 --> 00:30:52,450 fairly high level of bone turnover initially, but if 636 00:30:52,450 --> 00:30:54,490 they're adequately recovering and training. 637 00:30:54,890 --> 00:30:57,130 And eating, there's actually bone density can actually, and 638 00:30:57,130 --> 00:31:01,490 health can actually improve over time if they do this correctly. 639 00:31:01,490 --> 00:31:04,570 But how to do that correctly is, I think, where the kind of key 640 00:31:04,570 --> 00:31:06,090 is? Am I on the right track with 641 00:31:06,090 --> 00:31:08,450 that? Yeah, I mean, I think so. 642 00:31:08,450 --> 00:31:11,450 I think what I would say is, I don't know. 643 00:31:11,450 --> 00:31:17,890 I don't know if anybody's ever shown that bone health really 644 00:31:17,890 --> 00:31:21,090 improves a lot by running more. God, I think it probably does a 645 00:31:21,090 --> 00:31:23,690 pretty good job of maintaining it right. 646 00:31:23,690 --> 00:31:25,650 I think that. We're adapting to it. 647 00:31:25,650 --> 00:31:27,890 Yeah, adapting to it, Yeah. There's some adaptation that's 648 00:31:27,890 --> 00:31:31,330 occurring. So and but as far as like 649 00:31:31,490 --> 00:31:35,730 building building new bone, that part I think we don't, we don't 650 00:31:35,730 --> 00:31:39,170 really know that very well. So there's a really nice study. 651 00:31:39,290 --> 00:31:41,410 Well, First off, we know that people who tend to do more 652 00:31:41,410 --> 00:31:45,460 impact type sports that that that seems to be very 653 00:31:45,460 --> 00:31:47,700 protective. And so particularly if you do it 654 00:31:47,700 --> 00:31:50,700 between the ages of nine and 14 years of age. 655 00:31:50,700 --> 00:31:54,660 So if you played soccer, if you played tennis and basketball, 656 00:31:54,660 --> 00:31:57,300 those are kind of the big sports that people have studied a lot. 657 00:31:57,940 --> 00:32:01,180 We see that even when you get to college, if you're a Division 658 00:32:01,180 --> 00:32:03,860 One collegiate athlete and you're running track and running 659 00:32:03,860 --> 00:32:07,940 cross country, you have a 400% lower risk of sustaining some 660 00:32:07,940 --> 00:32:10,060 sort of stress fracture when you're in college. 661 00:32:10,520 --> 00:32:13,400 And what's really cool is that they've followed some of these 662 00:32:13,400 --> 00:32:16,480 soccer players and basketball players and tennis players later 663 00:32:16,480 --> 00:32:17,840 on into life. And then when you get into your 664 00:32:17,840 --> 00:32:23,120 40s and 50s, you have like a 60% reduction, A reduced risk and 665 00:32:23,120 --> 00:32:26,200 having any sort of fracture from a fall or what have you. 666 00:32:26,200 --> 00:32:28,800 So let's say you, you're no longer participating in sports. 667 00:32:28,800 --> 00:32:31,200 When you're in your 50s or whatever that you're like, your 668 00:32:31,200 --> 00:32:33,520 likelihood of sustaining some sort of fracture comes down 669 00:32:33,520 --> 00:32:37,600 considerably because you played soccer for two to three years in 670 00:32:37,600 --> 00:32:40,280 between the ages of nine and 14, which is, which is really, 671 00:32:40,280 --> 00:32:42,480 really cool. And that is a really important 672 00:32:42,480 --> 00:32:44,600 statistic, I think, from a public health standpoint. 673 00:32:44,600 --> 00:32:46,640 And one of the big reasons why that's really important, I think 674 00:32:46,640 --> 00:32:49,440 too is when you look at, you know, our society today is 675 00:32:49,440 --> 00:32:53,880 that's when athletes start to drop out of sports or they start 676 00:32:53,880 --> 00:32:57,040 to specialize more. And so we know too that when 677 00:32:57,040 --> 00:33:00,810 you, when you do the same sport year round, one of the things 678 00:33:00,810 --> 00:33:04,090 that happens is that your bones start to become very numb to 679 00:33:04,090 --> 00:33:08,450 that type of loading and you you don't adapt quite as well. 680 00:33:08,450 --> 00:33:11,930 So if you're running year round, whether you're a high school 681 00:33:11,930 --> 00:33:16,010 athlete or you're a middle age athlete, your your bones are 682 00:33:16,010 --> 00:33:19,090 like okay, I get it, you're running a lot and you're doing 683 00:33:19,090 --> 00:33:22,650 this sort of load. It's very repetitive and as a 684 00:33:22,650 --> 00:33:25,370 result the bone kind of stops to adapt over time. 685 00:33:25,450 --> 00:33:29,760 And so it's really important to to to work into your year some 686 00:33:29,760 --> 00:33:32,720 periods of of deloading where you know you have you're 687 00:33:32,720 --> 00:33:35,160 dividing your year up into several different basically 688 00:33:35,160 --> 00:33:39,040 seasons and you you back off a little bit and perhaps and 689 00:33:39,040 --> 00:33:43,280 perhaps do some do some other sports and or even just take it 690 00:33:43,280 --> 00:33:45,880 kind of easy, you know, just let yourself recharge and and 691 00:33:45,880 --> 00:33:47,960 rebuild for a little bit, just maybe a couple weeks. 692 00:33:48,280 --> 00:33:53,120 That allows your bones to kind of resensitize to load and then 693 00:33:53,120 --> 00:33:56,200 it'll have a better chance of of actually responding and and 694 00:33:56,200 --> 00:33:58,880 building back up when you start running again. 695 00:33:59,710 --> 00:34:03,110 The other thing that can be really important too is let's 696 00:34:03,110 --> 00:34:05,990 say soccer and basketball are just not your jam and you're, 697 00:34:06,230 --> 00:34:08,389 you know, like if you're like me you're more likely to get hurt 698 00:34:08,389 --> 00:34:10,350 playing basketball. And if you're going for a walk 699 00:34:10,350 --> 00:34:12,790 or something like that. So you decide to go to the gym 700 00:34:12,790 --> 00:34:14,949 and start doing some weightlifting or jumping or 701 00:34:14,949 --> 00:34:17,270 plyometric activities, which is what you really should be doing. 702 00:34:17,270 --> 00:34:18,630 You really should be mixing things up. 703 00:34:18,949 --> 00:34:22,790 And the whole goal here is to do some sort of activity that is 704 00:34:23,550 --> 00:34:26,750 essentially building your bones up for stronger than what you 705 00:34:26,750 --> 00:34:29,270 actually need them to be. So when we look at who has 706 00:34:29,270 --> 00:34:32,070 really strong bones, we know that soccer players have really 707 00:34:32,070 --> 00:34:33,670 strong bones. You know, basketball players 708 00:34:33,670 --> 00:34:35,750 have really strong bones as well as tennis players. 709 00:34:35,949 --> 00:34:38,190 And so you essentially want to have the bones of a basketball 710 00:34:38,190 --> 00:34:41,110 player as an ultra runner. And the best way to do that is 711 00:34:41,110 --> 00:34:44,230 to do some sort of jumping type sport or jumping activity. 712 00:34:44,230 --> 00:34:47,909 So play metrics can be really helpful but one of the things 713 00:34:47,909 --> 00:34:50,190 that's really important is it is when you do those jumping 714 00:34:50,190 --> 00:34:54,000 activities matters a lot. And so you know again the best 715 00:34:54,000 --> 00:34:56,800 time to do that is when you're between the ages of nine and 14, 716 00:34:57,280 --> 00:34:59,280 OK and you're probably listening like OK that's great. 717 00:34:59,280 --> 00:35:03,400 But I'm 35 now I'm that's that's long past you can still do some 718 00:35:03,400 --> 00:35:06,480 jumping activities and and working that into your your week 719 00:35:06,480 --> 00:35:08,080 is going to be a really important thing to do. 720 00:35:08,080 --> 00:35:13,560 And and and jumping seems to be a great way to add some really 721 00:35:13,560 --> 00:35:15,840 good bone stimulus. And you don't have to do very 722 00:35:15,840 --> 00:35:18,970 many repetitions. And in fact again you're like 723 00:35:18,970 --> 00:35:21,690 the more you, the more reps you do, your bone becomes less and 724 00:35:21,690 --> 00:35:24,250 less responsive to it. And so you really only only need 725 00:35:24,250 --> 00:35:27,450 to do about 45 jumps. So let's say you do three sets 726 00:35:27,450 --> 00:35:32,130 of 15 drop jumps off of a box that's going to, your bones are 727 00:35:32,130 --> 00:35:35,730 going to respond really well to that and bones tend to respond 728 00:35:35,730 --> 00:35:39,370 to loading that is done very, very fast and where the bone 729 00:35:39,370 --> 00:35:43,400 kind of gets stretched and bent and twisted and it's going to 730 00:35:43,440 --> 00:35:45,800 respond to that. Tendon is kind of the opposite 731 00:35:45,800 --> 00:35:47,480 tendon. If you've ever had some sort of 732 00:35:47,480 --> 00:35:50,600 tendonopathy, you know that you're a therapist puts you on 733 00:35:50,600 --> 00:35:53,440 some sort of lifting program, at least hopefully put you on a 734 00:35:53,440 --> 00:35:56,040 lifting program where you were doing some heavy slow resistance 735 00:35:56,040 --> 00:35:58,760 training where you're lifting something very heavy and you 736 00:35:58,760 --> 00:36:01,720 were doing like maybe 3 seconds on the concentric or the raising 737 00:36:01,720 --> 00:36:03,800 phase and three seconds on your lowering phase. 738 00:36:04,140 --> 00:36:05,980 Bone is exactly the opposite of that. 739 00:36:05,980 --> 00:36:08,380 Bone still likes really high loads, but it likes to be loaded 740 00:36:08,380 --> 00:36:10,260 very, very quickly. And so that's why the jumping 741 00:36:10,260 --> 00:36:13,300 part is is is is super helpful to do. 742 00:36:14,420 --> 00:36:17,700 But what you want to do is think about doing that type of jumping 743 00:36:17,700 --> 00:36:20,820 or or loading type activity before you go for the run. 744 00:36:21,220 --> 00:36:23,980 And you want to do it before the run, not after. 745 00:36:24,020 --> 00:36:26,740 And the reason for that is that if you wait until after the run, 746 00:36:26,780 --> 00:36:29,900 your bone has desensitized and it's not going to respond to 747 00:36:29,900 --> 00:36:32,310 that load as much. You're still going to break down 748 00:36:32,310 --> 00:36:34,750 bone because you're you're, you're going to be accruing some 749 00:36:34,750 --> 00:36:38,350 sort of bone micro damage. But the osteoblast which lay 750 00:36:38,350 --> 00:36:40,150 down new bone are not going to respond to it. 751 00:36:40,150 --> 00:36:42,950 So it's really important to do this three times per week before 752 00:36:42,950 --> 00:36:46,150 your runs. Or more like even better is to 753 00:36:46,150 --> 00:36:48,670 do it like when you're totally fresh, perhaps first thing in 754 00:36:48,670 --> 00:36:51,350 the morning and then maybe do your run later on and then I 755 00:36:51,350 --> 00:36:53,470 don't know, some sometime in the afternoon, it's going to be the 756 00:36:53,470 --> 00:36:56,800 best way to do that. So, but you know, and I think 757 00:36:57,080 --> 00:37:00,280 too the when you're thinking about like targeting different 758 00:37:00,280 --> 00:37:01,640 parts of your body, you can do that. 759 00:37:01,640 --> 00:37:03,880 So jumps are going to be really good for your foot and ankle and 760 00:37:03,880 --> 00:37:07,320 for your tibia, for your lumbar spine. 761 00:37:07,720 --> 00:37:12,080 By the time that kind of that, that force from hitting the 762 00:37:12,080 --> 00:37:15,040 ground works its way up to your lumbar spine, it's already been 763 00:37:15,040 --> 00:37:17,360 kind of dampened by your foot and ankle and your knee. 764 00:37:17,640 --> 00:37:19,480 And so you're just not going to get that much load on your 765 00:37:19,480 --> 00:37:21,640 lumbar spine. So one of the best exercises you 766 00:37:21,640 --> 00:37:25,000 can do is some sort of of heavy squat activity. 767 00:37:25,000 --> 00:37:29,720 So go to the gym, get into a squat rack, do your lifting with 768 00:37:29,720 --> 00:37:31,400 both legs. And the reason why you want to 769 00:37:31,400 --> 00:37:34,320 lift with both legs is because you're going to be able to put 770 00:37:34,320 --> 00:37:36,480 more weight on your back. And by doing that, you're going 771 00:37:36,480 --> 00:37:38,760 to be using more muscles and the muscles are going to pull on 772 00:37:38,760 --> 00:37:43,000 your bones more and you're going to get a better stimulus to your 773 00:37:43,000 --> 00:37:45,880 lumbar spine and your pelvis and your sacrum, which is a very 774 00:37:45,880 --> 00:37:48,680 common spot for getting bone stress surgeries and ultra 775 00:37:48,680 --> 00:37:50,560 runners. And. 776 00:37:50,880 --> 00:37:52,440 Yeah, right. So like runners, they really 777 00:37:52,440 --> 00:37:55,080 like doing things in their I'm like this is a single leg 778 00:37:55,080 --> 00:37:56,360 activity. So I'm going to do a lot of 779 00:37:56,360 --> 00:37:58,920 unilateral squats or one legged squats. 780 00:37:59,280 --> 00:38:02,200 But it really, the more weight you can lift, the better. 781 00:38:02,200 --> 00:38:05,360 And when it comes to bone health, that's always the answer 782 00:38:05,360 --> 00:38:08,640 to the question is how can I lift more weight and how can I 783 00:38:08,640 --> 00:38:11,520 lift more weight faster. And that's going to give you a 784 00:38:11,520 --> 00:38:15,170 much more stimulating activity when it comes to overall bone 785 00:38:15,170 --> 00:38:16,490 health. So those would be the kind of 786 00:38:16,490 --> 00:38:18,850 ways that I would do is is doing some sort of jumping activity 787 00:38:18,850 --> 00:38:23,250 three times per week, do some some squats with some 788 00:38:23,250 --> 00:38:25,490 heavyweight. And the best way to do that 789 00:38:25,490 --> 00:38:28,690 squat is to lower down slowly and then explode upward. 790 00:38:28,690 --> 00:38:31,050 So lift, lift that weight as quickly as you can. 791 00:38:31,490 --> 00:38:33,810 And again by doing that, you're going to get the greatest amount 792 00:38:33,810 --> 00:38:37,730 of strain on the bone and the bone is going to then respond 793 00:38:37,730 --> 00:38:39,050 and hopefully lay down at new bone. 794 00:38:39,050 --> 00:38:41,530 And there's been some really great work looking at female 795 00:38:41,530 --> 00:38:45,680 athletes and they're when they're in their 20s and having 796 00:38:45,680 --> 00:38:48,920 them do these very, they only had them do like just fast 797 00:38:48,920 --> 00:38:51,360 squats. And just by doing that, they're 798 00:38:51,360 --> 00:38:54,720 seeing 3 to 5 to 7% increases in overall bone density, 799 00:38:54,720 --> 00:38:57,040 particularly in the lumbar spine and also femoral neck. 800 00:38:57,480 --> 00:39:00,400 So that's great. So I So what I'm hearing and I'm 801 00:39:00,400 --> 00:39:03,440 going to go in a slightly different direction with this is 802 00:39:03,440 --> 00:39:05,920 I think it's kind of the stereotype we as PTS we're 803 00:39:05,920 --> 00:39:08,560 always telling runners. So hey, you got to do some kind 804 00:39:08,560 --> 00:39:10,200 of strength where you got to do something. 805 00:39:10,560 --> 00:39:12,600 And I'm hoping that this gives our listeners a little bit 806 00:39:12,600 --> 00:39:14,600 better background to go well. This is why. 807 00:39:14,600 --> 00:39:16,320 This is why you have to do something a little bit different 808 00:39:16,320 --> 00:39:19,440 if you can run, but there's some things you need to do to support 809 00:39:19,440 --> 00:39:22,440 your running. A heavier lifting the stimulus 810 00:39:22,440 --> 00:39:25,440 is so different because if you could do something fast or 811 00:39:25,440 --> 00:39:28,640 heavy, that's the kind of stimulus that maintains better 812 00:39:28,640 --> 00:39:31,430 bone health. Versus like you said, I I don't. 813 00:39:31,550 --> 00:39:33,510 That analogy is great. It's going to stick with me 814 00:39:33,510 --> 00:39:36,310 forever is that when you have a repeated stimulus, your bone 815 00:39:36,310 --> 00:39:39,190 gets numb to it and if anything just stops responding, which is 816 00:39:39,270 --> 00:39:41,390 pretty classic for your body. If you do something enough 817 00:39:41,390 --> 00:39:44,030 times, a lot of times there's a lot of tissues that go out. 818 00:39:44,470 --> 00:39:47,710 I don't need to, I can't respond to this anymore and that might 819 00:39:47,710 --> 00:39:50,630 start going the opposite way. So doesn't matter if you're 820 00:39:50,630 --> 00:39:54,430 running 100 miles or one. You need to be working on 821 00:39:54,430 --> 00:39:57,310 strength strength training of some kind. 822 00:39:57,310 --> 00:39:58,990 Be at plyometrics high level load. 823 00:39:59,320 --> 00:40:01,960 What's funny is and I have to give Rich, I don't know you 824 00:40:01,960 --> 00:40:05,040 don't know this, but your paper with Max by the way on the 825 00:40:05,040 --> 00:40:08,160 Physiology and changes of the masters runner that inspired by 826 00:40:08,160 --> 00:40:10,560 dissertation that I'm working on right now. 827 00:40:10,560 --> 00:40:11,000 Cool. So. 828 00:40:11,200 --> 00:40:13,080 All the stuff on the calf and Achilles, I didn't tell. 829 00:40:13,080 --> 00:40:14,320 I didn't tell Rich this beforehand. 830 00:40:15,160 --> 00:40:18,200 But it's funny that what I'm seeing in Masters runners 831 00:40:18,200 --> 00:40:22,080 actually mimics this, but for different reasons, is that as 832 00:40:22,360 --> 00:40:24,880 masters runners, which again is a large population for ultra 833 00:40:24,880 --> 00:40:27,960 marathon. As we get older, we start losing 834 00:40:28,000 --> 00:40:30,640 muscle mass, we start losing more strength than we lose 835 00:40:30,640 --> 00:40:32,800 muscle mass, and then we start losing more power than we lose 836 00:40:32,800 --> 00:40:34,640 strength. So it's interesting that what 837 00:40:34,640 --> 00:40:38,120 you're saying for bone is, is mirroring some of the changes 838 00:40:38,120 --> 00:40:41,440 that we see, that runners don't do a good job of maintaining 839 00:40:41,440 --> 00:40:45,520 muscle mass, strength or power. And so, not just from a bone 840 00:40:45,520 --> 00:40:48,080 standpoint, but from a muscular scale standpoint, if you want to 841 00:40:48,080 --> 00:40:51,400 talk about longevity in your sport, I think these things 842 00:40:51,400 --> 00:40:54,760 aren't negotiable that at least two to three times a week. 843 00:40:55,020 --> 00:40:56,220 You've got to be doing something. 844 00:40:56,220 --> 00:40:59,460 It doesn't have to be fancy. It can be fast drop squats. 845 00:40:59,460 --> 00:41:03,180 It can be a heavy squat or, like correct me if I'm wrong, would a 846 00:41:03,180 --> 00:41:05,940 heavy deadlift load probably load the spine? 847 00:41:05,940 --> 00:41:08,180 Similar? Yeah, exactly. 848 00:41:08,380 --> 00:41:10,700 Yeah. And you do that bilaterally, so 849 00:41:10,700 --> 00:41:11,820 you got you keep, right? Yeah. 850 00:41:11,820 --> 00:41:14,900 Don't do a single leg remaining deadlift to a bilateral 851 00:41:14,900 --> 00:41:17,940 deadlift. Hex bar deadlift is going to be 852 00:41:17,980 --> 00:41:20,400 a great way to do that. Right, exactly. 853 00:41:20,600 --> 00:41:22,720 So you don't have to worry about balance problems, right. 854 00:41:22,720 --> 00:41:25,120 This is something you just load it up really heavy and it you 855 00:41:25,120 --> 00:41:28,480 don't do three sets of 10, my students make fun of me for kind 856 00:41:28,480 --> 00:41:30,960 of trying to get them off the like three sets for everything. 857 00:41:30,960 --> 00:41:34,920 Lower reps with higher weight or higher intensity is what really 858 00:41:34,920 --> 00:41:36,600 creates this. Not there's anything wrong with 859 00:41:36,600 --> 00:41:40,840 three sets of 10, but that is just a different stimulus that 860 00:41:40,880 --> 00:41:44,320 we're not discussing right now. It has its place, but it's. 861 00:41:45,200 --> 00:41:47,120 It's funny how it's mirroring this and there's so many things, 862 00:41:47,120 --> 00:41:49,800 like if you're a runner, whether you're mile or especially if 863 00:41:49,800 --> 00:41:52,400 you're ultra marathoner, these are things you should do. 864 00:41:52,400 --> 00:41:54,400 You should have a heavier weight, you should be moving a 865 00:41:54,400 --> 00:41:57,840 little quicker because you're not getting that on your run. 866 00:41:57,920 --> 00:41:59,960 And if you want to talk about health and your overall 867 00:41:59,960 --> 00:42:02,360 function, these are the things that you're missing that you 868 00:42:02,360 --> 00:42:05,480 need to make sure you have in addition to nutrition, sleep and 869 00:42:05,480 --> 00:42:08,360 all those other components of keeping some kind of balance in 870 00:42:08,360 --> 00:42:10,870 a very unbalanced sport, right. Yeah. 871 00:42:10,870 --> 00:42:13,470 And I think one of the things that's important though for the 872 00:42:13,470 --> 00:42:15,950 ultra runner and particularly to think about and this also goes 873 00:42:15,950 --> 00:42:17,950 for the any sort of elite athlete. 874 00:42:17,950 --> 00:42:22,110 So if you're, if you're a high school athlete who's who's a 875 00:42:22,110 --> 00:42:23,590 really good cross country runner, you're running 876 00:42:23,710 --> 00:42:26,110 relatively high volume for his high school runner, don't forget 877 00:42:26,110 --> 00:42:28,390 you're also growing a lot. At the same time, you're still 878 00:42:28,390 --> 00:42:29,910 going through a lot of physical maturation. 879 00:42:29,910 --> 00:42:33,190 So you have to consider that from your overall energy demands 880 00:42:34,330 --> 00:42:36,930 and when you look at the college runner, but then also for the 881 00:42:36,930 --> 00:42:39,810 ultra runner, these are people that are they're they're burning 882 00:42:39,810 --> 00:42:42,450 a lot of calories. So their overall total energy 883 00:42:42,450 --> 00:42:46,050 expenditure is very high. And as a result, you really want 884 00:42:46,050 --> 00:42:49,290 to focus in on what is your minimally effective dose. 885 00:42:49,820 --> 00:42:51,820 In other words, you don't want to go to the weight room and 886 00:42:51,820 --> 00:42:54,100 spend a lot of time there. Your goal is to get in and get 887 00:42:54,100 --> 00:42:57,140 out as quickly as possible, make your program as efficient as 888 00:42:57,140 --> 00:42:59,140 possible. And so you're not spending a lot 889 00:42:59,140 --> 00:43:01,020 of time doing other activities because we're doing other 890 00:43:01,020 --> 00:43:03,020 activities, you're burning more calories and that could 891 00:43:03,020 --> 00:43:06,260 potentially be digging a bigger hole for you. 892 00:43:06,740 --> 00:43:10,260 And so you know again I think if you were thinking about, I mean 893 00:43:10,260 --> 00:43:13,300 let's just say like you're three sets of 10 example, it is much 894 00:43:13,300 --> 00:43:19,480 better to do one set of 10 three times per day rather than three 895 00:43:19,480 --> 00:43:22,880 sets of 10 all in one workout. And the reason for that again is 896 00:43:22,880 --> 00:43:25,680 because you start to lose sensitivity of the bone the more 897 00:43:25,680 --> 00:43:28,720 reps that you do. With that said, you don't as a 898 00:43:28,720 --> 00:43:31,920 runner you're not going to have the ability to do one set of 10, 899 00:43:31,920 --> 00:43:34,960 three set three times per day. So the thing to do is go in and 900 00:43:34,960 --> 00:43:38,560 make that one set count, make it very heavy of course, do an 901 00:43:38,560 --> 00:43:41,240 appropriate warm up and then get out of there and don't mess 902 00:43:41,240 --> 00:43:43,970 around. When it comes to lifts you want 903 00:43:43,970 --> 00:43:47,970 to do some compound lifts lifts and I and I think that doing 904 00:43:47,970 --> 00:43:50,130 some sort of you know a lot of runners have very tight 905 00:43:50,130 --> 00:43:54,170 hamstrings so doing like a like a trap bar deadlift, I think 906 00:43:54,170 --> 00:43:59,090 it's a great exercise to do. Doing like a some sort of 907 00:43:59,090 --> 00:44:01,690 weighted back squad I think is another good alternative to 908 00:44:01,690 --> 00:44:02,890 that. But if if I had to, like 909 00:44:02,890 --> 00:44:05,250 probably if I had to put together like a minimally 910 00:44:05,250 --> 00:44:09,050 effective dose for an athlete, for an ultra runner, I would say 911 00:44:09,770 --> 00:44:13,410 get into the, you know, go in there and do some sort of heavy 912 00:44:13,570 --> 00:44:16,050 calf raises on a Smith machine. And the reason why you want to 913 00:44:16,050 --> 00:44:17,850 do it on a Smith machine is because then you don't have to 914 00:44:17,850 --> 00:44:20,810 worry about balancing and you can, you can put more weight on 915 00:44:20,810 --> 00:44:22,370 yourself. And so you've got this weight on 916 00:44:22,370 --> 00:44:24,970 you, you've got it, you're loading your axial spine. 917 00:44:25,210 --> 00:44:26,490 So you've got that part taken care of. 918 00:44:26,490 --> 00:44:29,690 And again, you want to be doing, maybe not initially, but 919 00:44:29,690 --> 00:44:31,130 eventually you want to get to yourself. 920 00:44:31,130 --> 00:44:34,130 You're down to like maybe doing three sets of eight repetitions 921 00:44:34,130 --> 00:44:36,010 where there it's it's pretty heavy and you have a hard time 922 00:44:36,010 --> 00:44:39,500 finishing that last repetition and then doing some sort of like 923 00:44:39,500 --> 00:44:43,740 trap bar deadlift and then also doing some sort of ply metric 924 00:44:43,820 --> 00:44:45,980 where you're doing you're working on maximal jump height 925 00:44:47,020 --> 00:44:49,660 and then get out of there. There's no need to do anymore. 926 00:44:49,740 --> 00:44:53,380 And if you have a a pass injury history that's significant, 927 00:44:53,380 --> 00:44:55,580 maybe you need to do another exercise that's a good 928 00:44:55,580 --> 00:44:57,460 maintenance exercise. So let's say you like you've got 929 00:44:57,460 --> 00:44:59,620 a pass injury history of of Patella femoral pain. 930 00:44:59,620 --> 00:45:02,420 Maybe it's time to do some quadricep exercises like on the 931 00:45:02,420 --> 00:45:04,580 knee extension machine and then get out of there. 932 00:45:04,580 --> 00:45:06,860 But I would really encourage people not to spend a lot of 933 00:45:06,860 --> 00:45:10,900 time in the weight room. I I think that we're not you 934 00:45:10,900 --> 00:45:13,220 know ultra runners and runners in general are not weight 935 00:45:13,220 --> 00:45:15,220 lifters. And so the the, you know the 936 00:45:15,220 --> 00:45:17,380 goal there is to do some lifting that's going to support your 937 00:45:17,380 --> 00:45:20,180 overall musculoskeletal health but also improve your overall 938 00:45:20,180 --> 00:45:23,940 performance. And and and I think you know I 939 00:45:23,940 --> 00:45:26,180 think the other part of it too that's really important. 940 00:45:26,180 --> 00:45:28,060 This is one of the things I'm I'm starting to get a lot of 941 00:45:28,060 --> 00:45:32,460 questions coming my way via e-mail or or Instagram what have 942 00:45:32,460 --> 00:45:37,600 you as look I've got low bone density and I have red S and we 943 00:45:37,600 --> 00:45:41,040 haven't really used that term at all yet today which is relative 944 00:45:41,040 --> 00:45:45,040 energy deficiency sport and what that is is that is a a a 945 00:45:45,040 --> 00:45:49,080 prolonged state of low energy availability So I I I'm dealing 946 00:45:49,080 --> 00:45:52,480 with some red S issues I've got low bone density what are some 947 00:45:52,480 --> 00:45:56,240 ply what's a ply metric program that I can do and it it always 948 00:45:56,240 --> 00:46:00,640 comes back to your Physiology is is is if your Physiology cannot 949 00:46:00,640 --> 00:46:03,720 support your bones ability to adapt to the loads that you're 950 00:46:03,720 --> 00:46:07,270 experiencing all you're going to do is break down more bone And 951 00:46:07,270 --> 00:46:10,310 so it's really important to make sure that first and foremost 952 00:46:10,670 --> 00:46:14,510 that you're hitting those energy demands of your activity then 953 00:46:14,550 --> 00:46:17,150 figure out how to build your bone mass back up with some sort 954 00:46:17,150 --> 00:46:19,830 of exercise and I think this probably is is maybe a good way 955 00:46:19,830 --> 00:46:22,750 to think about it is you can't deal with exercising too much by 956 00:46:22,750 --> 00:46:26,510 exercising even more you need to 1st deal with meeting your 957 00:46:26,510 --> 00:46:29,770 energy demands of your sport. So there's a priority list here 958 00:46:29,770 --> 00:46:31,370 of going. Just because I have this 959 00:46:31,370 --> 00:46:34,250 pathology doesn't mean I can exercise my way out of it. 960 00:46:34,410 --> 00:46:36,210 There is a priority list of going OK. 961 00:46:36,210 --> 00:46:39,850 The problem maybe the reason I got here was a low energy energy 962 00:46:39,850 --> 00:46:42,010 deficiency, so that has to be addressed first. 963 00:46:42,250 --> 00:46:46,410 I cannot adapt to strength training and plyometrics if that 964 00:46:46,410 --> 00:46:48,450 is addressed first, so that's priority one. 965 00:46:48,770 --> 00:46:51,610 Priority two is OK once I've addressed that, and I've also 966 00:46:51,610 --> 00:46:53,210 addressed maybe some training errors. 967 00:46:53,550 --> 00:46:55,590 I could then I can start thinking about strength and 968 00:46:55,590 --> 00:46:56,790 stuff. But I'm going to quote Jack 969 00:46:56,790 --> 00:47:00,710 Daniels on this is a coach from Stanford from and several other 970 00:47:00,710 --> 00:47:05,670 places that always said only train them as much as you need. 971 00:47:05,710 --> 00:47:08,390 You never want to do more than is necessary because you want to 972 00:47:08,390 --> 00:47:11,310 just do what you need to get the stimulus and like you said, then 973 00:47:11,310 --> 00:47:12,710 get out. And so it's the same thing for 974 00:47:12,710 --> 00:47:15,710 the gym is that runners are not weight, are not weight lifters, 975 00:47:15,710 --> 00:47:17,110 you know. So I personally don't go to the 976 00:47:17,110 --> 00:47:19,190 gym. I have my poor wife and the 977 00:47:19,190 --> 00:47:22,150 delivery guys had to deliver 200 pound kettle bells. 978 00:47:22,870 --> 00:47:25,390 To my place and they're great. I got them on sale because 979 00:47:25,390 --> 00:47:28,030 people were like, oh, I don't want this in the COVID era, but 980 00:47:28,190 --> 00:47:31,230 I just messed with those couple times a week and it doesn't. 981 00:47:31,230 --> 00:47:34,670 It takes me maybe 10-15 minutes Max and it's done because that's 982 00:47:34,670 --> 00:47:37,830 really kind of as much you want to do the minimum necessary to 983 00:47:37,830 --> 00:47:40,030 get the Max stimulus without having to overdo it. 984 00:47:40,070 --> 00:47:42,350 And as you said, more exercise isn't better. 985 00:47:42,350 --> 00:47:45,270 It's being strategic with getting the most you can out of 986 00:47:45,270 --> 00:47:48,480 as little as possible. So you can recover and you don't 987 00:47:48,480 --> 00:47:51,440 go back into those same issues of energy deficiency and just 988 00:47:51,440 --> 00:47:53,280 continue that cycle. Exactly. 989 00:47:53,360 --> 00:47:55,520 That makes sense. So we've heard a couple things. 990 00:47:55,520 --> 00:47:59,000 It sounds like there are ways to treat this, but you got to make 991 00:47:59,000 --> 00:48:02,040 sure you treat the source, which a lot of times for not everyone 992 00:48:02,040 --> 00:48:04,160 but a lot of people. A priority thing is, are you 993 00:48:04,160 --> 00:48:08,080 eating enough Once you've gotten that, so eating enough calories, 994 00:48:08,320 --> 00:48:11,120 recognizing that your body essentially goes numb to 995 00:48:11,120 --> 00:48:14,320 excessive stimulus like ultra marathing, like running, stuff 996 00:48:14,320 --> 00:48:16,300 like that. Once you've addressed those 997 00:48:16,300 --> 00:48:19,500 issues, it would be helpful be a master's runner or younger 998 00:48:19,500 --> 00:48:22,980 runner, ultra marathoner, any runner really, to start thinking 999 00:48:22,980 --> 00:48:26,780 about doing some faster strength plyometric stuff. 1000 00:48:26,980 --> 00:48:30,380 But less is more, right? Three sets of 10? 1001 00:48:30,620 --> 00:48:32,740 What if 20? Whatever, it's get in and get 1002 00:48:32,740 --> 00:48:36,020 out, right? Higher load, less reps, less 1003 00:48:36,020 --> 00:48:38,220 sets, get the stimulus we need and move on. 1004 00:48:38,500 --> 00:48:40,700 The minimum dosage for some of the research I've seen is like 1005 00:48:40,820 --> 00:48:44,460 one to two times a week. Is at least and you can get 1006 00:48:44,460 --> 00:48:46,260 quite a bit out of that, especially for your masters 1007 00:48:46,260 --> 00:48:48,700 runners. I would, I have to ask you on 1008 00:48:48,700 --> 00:48:52,140 this part because given we do be given especially my background, 1009 00:48:52,420 --> 00:48:56,260 do you think footwear has any place to play into this or is 1010 00:48:56,260 --> 00:48:58,220 that something that's kind of one of those factors where we 1011 00:48:58,220 --> 00:49:01,020 used to focus out on a lot and now it's a, you know what you 1012 00:49:01,020 --> 00:49:04,780 got to wear, what's comfortable for you or is there any stuff. 1013 00:49:04,780 --> 00:49:07,020 And the reason I asked this is because footwear, especially in 1014 00:49:07,020 --> 00:49:09,820 the ultra marathoning world, has changed so much. 1015 00:49:10,370 --> 00:49:13,250 In the last couple years from we us going through a very high 1016 00:49:13,250 --> 00:49:16,210 like traditional, very minimalist and now we're in 1017 00:49:16,210 --> 00:49:19,450 these extreme maximal issues that as we've kind of seen 1018 00:49:19,850 --> 00:49:21,050 aren't necessarily as protective. 1019 00:49:21,050 --> 00:49:24,090 A lot of Christine Pollard's work out of Oregon State showed, 1020 00:49:24,090 --> 00:49:27,330 yeah, we actually still have some high loading internally 1021 00:49:27,330 --> 00:49:29,810 maybe if you're landing on the force plate, not necessarily as 1022 00:49:29,810 --> 00:49:33,210 much, but internally, what piece do you think footwear has to 1023 00:49:33,210 --> 00:49:37,250 play in this, if any? Yeah, I mean, yeah, this, I 1024 00:49:37,250 --> 00:49:40,180 mean, footwear is such a fascinating topic. 1025 00:49:40,220 --> 00:49:42,820 And yeah, I mean, I love, I love talking about it. 1026 00:49:42,820 --> 00:49:45,140 I think too. It's one of the weird things 1027 00:49:45,140 --> 00:49:49,380 that it seems to be one of the more polarizing topics. 1028 00:49:49,740 --> 00:49:53,140 And I don't always understand why that, why that is. 1029 00:49:54,860 --> 00:49:57,820 And I, I don't know. For me, I I see shoes as being 1030 00:49:58,260 --> 00:50:02,860 basically like an adjunct or just like anything else like 1031 00:50:03,340 --> 00:50:06,820 it's some some way to modify loading on someone. 1032 00:50:07,610 --> 00:50:10,210 So you know I think let's let's take a step back and take A and 1033 00:50:10,210 --> 00:50:12,730 think about bone stress injuries first. 1034 00:50:12,770 --> 00:50:15,650 And like you know whether or not biomechanics actually play a 1035 00:50:15,650 --> 00:50:18,210 role. So a really good rule of thumb 1036 00:50:18,210 --> 00:50:21,370 is the further you get away from the ground, the less 1037 00:50:21,370 --> 00:50:24,210 biomechanics matters when it comes to bone stress injury. 1038 00:50:24,450 --> 00:50:27,050 So if you have a femoral bone stress injury, if you have a 1039 00:50:27,050 --> 00:50:31,210 sacral bone stress injury or a lumbar spine bone stress injury, 1040 00:50:32,250 --> 00:50:36,330 I can almost 100% assure you that you're running bio 1041 00:50:36,330 --> 00:50:40,330 mechanics do not, did not factor into you getting that injury. 1042 00:50:40,650 --> 00:50:44,330 And the reason for that is that those bone sites are very 1043 00:50:45,010 --> 00:50:49,250 trabecularly rich bone sites and trabecular bone is a spongy bone 1044 00:50:49,250 --> 00:50:52,490 that's a very kind of metabolically active and 1045 00:50:52,490 --> 00:50:56,370 demanding type of bone. And so when you're restricting 1046 00:50:56,370 --> 00:50:59,010 your calories or you're you're burning more calories than 1047 00:50:59,010 --> 00:51:03,550 you're consuming you, that's the first place that you start to 1048 00:51:03,550 --> 00:51:05,270 see this. And so sometimes I'll see 1049 00:51:05,270 --> 00:51:08,990 runners who will go get a bone density examination and they'll 1050 00:51:08,990 --> 00:51:11,990 come and they'll be like well look I have low bone density in 1051 00:51:11,990 --> 00:51:15,030 my lumbar spine but my femur looks pretty good. 1052 00:51:15,030 --> 00:51:17,550 But I'm but it actually starts in your lumbar spine. 1053 00:51:17,550 --> 00:51:19,790 That's when you start losing your bone density when it you're 1054 00:51:19,790 --> 00:51:23,030 in a this this low energy availability state for a long 1055 00:51:23,030 --> 00:51:25,510 period of time which is this this red ass that we were 1056 00:51:25,510 --> 00:51:28,040 starting to hear more and more about and clinicians should be 1057 00:51:28,040 --> 00:51:31,880 really familiar with how to how to screen for that we can we can 1058 00:51:31,880 --> 00:51:34,720 come back to that later But you know back to your question as 1059 00:51:34,720 --> 00:51:37,760 far as shoes go so the closer you get to the ground the more 1060 00:51:37,760 --> 00:51:39,560 you're running biomechanics are probably going to matter. 1061 00:51:39,560 --> 00:51:44,000 That doesn't mean that this the red ass is is is not an issue 1062 00:51:44,000 --> 00:51:47,720 When we talk about distal bone stress injuries it certainly is 1063 00:51:47,720 --> 00:51:50,560 but we we still need to take a good look at our runners 1064 00:51:50,560 --> 00:51:53,320 biomechanics when it comes to foot and ankle and and lower leg 1065 00:51:53,320 --> 00:51:56,400 bone stress injuries. So when when we look at those I 1066 00:51:56,400 --> 00:51:59,520 think it's worth first thinking about what what creates extra 1067 00:51:59,520 --> 00:52:03,120 load on a bone and there's this is something this is an area 1068 00:52:03,120 --> 00:52:06,600 that's that this really changed a lot in the last five years. 1069 00:52:07,280 --> 00:52:09,960 We used to think that impact forces really made a big 1070 00:52:09,960 --> 00:52:14,200 difference in bone stress injuries, but that's not really 1071 00:52:14,200 --> 00:52:17,400 when what we see and what it really is the biggest 1072 00:52:17,400 --> 00:52:21,190 contributor, not your impact forces but the muscle that is 1073 00:52:21,190 --> 00:52:24,390 attached to the bone and that contributes the most. 1074 00:52:24,390 --> 00:52:27,870 So when we look at tibial bone force, which is in our lab, we 1075 00:52:27,870 --> 00:52:30,390 model tibial bone force. And you know when you're running 1076 00:52:30,390 --> 00:52:34,710 along at let's say a 7 1/2 minute mile pace, you're the the 1077 00:52:34,710 --> 00:52:38,910 actual tibial compressive force ends up being around 9 body 1078 00:52:38,910 --> 00:52:40,950 weights. And I think most of us have 1079 00:52:40,950 --> 00:52:44,910 heard that the ground reaction force when we run is about 2 1/2 1080 00:52:44,910 --> 00:52:47,700 times our body weight. So we've got 9 Body weights of 1081 00:52:47,700 --> 00:52:51,180 tibial bone force, but we've got 2 1/2 Body weights of Ground 1082 00:52:51,180 --> 00:52:55,380 reaction force. Where's that extra 6 1/2 Body 1083 00:52:55,380 --> 00:52:57,660 weights coming from? And it's coming from the muscle 1084 00:52:57,660 --> 00:52:59,740 that attaches to your tibia, which is going to be your 1085 00:52:59,740 --> 00:53:02,100 plantar flexors through Solis and your gastrocnemius 1086 00:53:02,100 --> 00:53:05,260 musculature. And so whatever increases your 1087 00:53:05,260 --> 00:53:09,340 plantar flexor muscle force is going to be the easiest thing to 1088 00:53:09,340 --> 00:53:12,740 manipulate when it comes to how we can control tibial bone 1089 00:53:12,740 --> 00:53:15,370 forces. And so if you take a step back 1090 00:53:15,370 --> 00:53:18,010 and then take a look at shoes, what type of shoe designs 1091 00:53:18,010 --> 00:53:22,850 increase tibial bone force? And the other way to probably 1092 00:53:22,890 --> 00:53:24,970 the better way to ask that question is what shoe designs 1093 00:53:24,970 --> 00:53:27,010 increase planner flexor muscle force. 1094 00:53:27,410 --> 00:53:29,490 And I think we all kind of know the answer that and that's going 1095 00:53:29,490 --> 00:53:32,210 to be minimalist type shoes. So shoe that has a zero drop to 1096 00:53:32,210 --> 00:53:36,090 it is going to really increase our plantar flexor demands. 1097 00:53:36,090 --> 00:53:39,290 And and if you've ever tried making that move to a minimalist 1098 00:53:39,290 --> 00:53:42,290 shoe or a zero drop shoe, you you already know the answer to 1099 00:53:42,290 --> 00:53:43,370 this. And that's because you probably 1100 00:53:43,370 --> 00:53:46,130 experienced a lot of extra plantar flexor soreness and 1101 00:53:46,130 --> 00:53:48,250 that's because you're asking a lot more of your plantar 1102 00:53:48,250 --> 00:53:50,770 flexors. Also, different types of running 1103 00:53:50,850 --> 00:53:52,970 really include and really contribute to high plantar 1104 00:53:52,970 --> 00:53:56,450 flexor forces, and that would be running uphill a lot, which 1105 00:53:56,530 --> 00:54:00,170 obviously ultra runners do a lot of that and also running fast. 1106 00:54:00,170 --> 00:54:03,810 So when you start to run faster, one of your biggest contributors 1107 00:54:03,810 --> 00:54:07,610 to faster running are your plantar flexors, who start to 1108 00:54:07,610 --> 00:54:11,210 push off a lot harder. And so those things are going to 1109 00:54:11,210 --> 00:54:16,570 really contribute a lot to extra tibial bone forces when we look 1110 00:54:16,570 --> 00:54:21,850 at the metatarsals, when you when you think about and you 1111 00:54:21,890 --> 00:54:23,850 know a lot of pen here. I know this is a video 1112 00:54:23,850 --> 00:54:26,210 podcaster, it's all audio, but it's. 1113 00:54:26,250 --> 00:54:28,050 Both. So for for those of those people 1114 00:54:28,050 --> 00:54:31,850 listening on Spotify, we'll try to describe what's what's 1115 00:54:31,850 --> 00:54:32,330 happening. Yeah. 1116 00:54:32,330 --> 00:54:34,970 So I'm going to hold up this this pen here and imagine this 1117 00:54:34,970 --> 00:54:37,170 is your, this is one of your metatarsals. 1118 00:54:37,610 --> 00:54:40,730 And so if you're when you're when you push off, this is the 1119 00:54:40,730 --> 00:54:44,070 ball of your foot. When you push off it's going, 1120 00:54:44,070 --> 00:54:46,230 you're going to get this bending force on your metatarsal. 1121 00:54:46,230 --> 00:54:49,150 So this is a you pretend like your metatarsal is perfectly 1122 00:54:49,150 --> 00:54:52,790 horizontal with the ground. And if you're in a high drop 1123 00:54:52,790 --> 00:54:56,630 shoe, what's happened there is now you're now your foot, your 1124 00:54:56,630 --> 00:55:00,430 metatarsal is more vertical and as a result you've actually 1125 00:55:00,430 --> 00:55:02,030 shortened the bone up quite a bit. 1126 00:55:02,030 --> 00:55:03,830 And so your bending force is a lot less. 1127 00:55:03,830 --> 00:55:06,670 And you can even try this by just taking a pen and doing this 1128 00:55:06,670 --> 00:55:08,790 and you see that more of the force is going to be delivered 1129 00:55:09,360 --> 00:55:13,280 axially or along the shaft of the your your metatarsal, so it 1130 00:55:13,280 --> 00:55:15,760 stiffens it up. So a low drop shoe actually 1131 00:55:15,760 --> 00:55:18,120 increases metatarsal bone stresses considerably. 1132 00:55:18,120 --> 00:55:21,400 We know that when you go into a shoe that has even a moderate 1133 00:55:21,400 --> 00:55:25,480 drop so like say 5 to 7 millimeters of a drop as that 1134 00:55:25,480 --> 00:55:28,840 has all behind him there, we know that the metatarsal bending 1135 00:55:28,840 --> 00:55:32,440 forces come down considerably. And so if you've had a a 1136 00:55:33,320 --> 00:55:35,720 metatarsal bone stress injury in the past that might be something 1137 00:55:35,720 --> 00:55:39,200 really important for you to think about is that or a tibial 1138 00:55:39,200 --> 00:55:41,360 bone stress injury is you really really want to think about 1139 00:55:41,640 --> 00:55:45,200 controlling this plantar flexor forces and one of the easiest 1140 00:55:45,200 --> 00:55:48,400 ways to do that is with a higher with a higher drop shoe. 1141 00:55:48,440 --> 00:55:51,800 Now if you're trail running it a high drop shoe doesn't 1142 00:55:51,800 --> 00:55:54,200 necessarily make a lot of sense because when you start to run 1143 00:55:54,200 --> 00:55:57,080 downhill your your ankle becomes is less stable. 1144 00:55:57,080 --> 00:55:59,280 And so that's one of the reasons why when you see trail running 1145 00:55:59,280 --> 00:56:02,160 shoes they tend to be their drop tends to be much more in the 1146 00:56:02,160 --> 00:56:04,600 moderate range. They tend to be, you know this 5 1147 00:56:04,600 --> 00:56:08,260 to 5 to 8 millimeters of of drop because you're not pitched 1148 00:56:08,260 --> 00:56:10,260 forward so much when you're running downhill where you feel 1149 00:56:10,260 --> 00:56:12,220 unstable, but the same time when you're when you're running 1150 00:56:12,220 --> 00:56:15,580 uphill, it's a little bit easier on your planter flexors and so 1151 00:56:15,620 --> 00:56:18,180 they tend to be a much more moderate level of a shield. 1152 00:56:19,060 --> 00:56:21,740 The other type of shoe design that that really will, if you 1153 00:56:21,740 --> 00:56:24,300 really want to reduce your planter Flexor forces is a shoe 1154 00:56:24,300 --> 00:56:27,580 that has some sort of a rock or soul to it, which is which is 1155 00:56:27,580 --> 00:56:30,140 what you're holding up there and I think that So Hoka is a good 1156 00:56:30,140 --> 00:56:31,660 example of that. But I think that probably the 1157 00:56:31,660 --> 00:56:34,020 shoe that I end up putting runners in a lot, particularly 1158 00:56:34,020 --> 00:56:38,790 even Rd. runners, is the North, one of The North Face Vector 1159 00:56:39,310 --> 00:56:40,430 shoes. Yes, yeah. 1160 00:56:40,430 --> 00:56:42,070 It has a really nice rocker to it. 1161 00:56:42,390 --> 00:56:46,150 And what that rocker does is it, it moves going back to this, 1162 00:56:46,590 --> 00:56:48,710 this metatarsal if you will. So we, you know, of course we 1163 00:56:48,710 --> 00:56:51,310 tend to toe off of off of our second metatarsal head. 1164 00:56:51,710 --> 00:56:55,230 What it does is that rocker moves that pivot point more 1165 00:56:55,230 --> 00:56:58,270 proximal, so it shifts it back and so it essentially shortens 1166 00:56:58,270 --> 00:57:01,420 your metatarsal length up the other thing that it does. 1167 00:57:01,420 --> 00:57:03,780 And so of course then it's not going to your your moment arm 1168 00:57:03,900 --> 00:57:05,940 that's going to cause that bending torque on your 1169 00:57:05,940 --> 00:57:09,020 metatarsal becomes less. The other thing that that rocker 1170 00:57:09,020 --> 00:57:12,820 does is that it moves that pivot point closer to your ankle joint 1171 00:57:12,820 --> 00:57:16,980 center and then because of that your demand on your plantar 1172 00:57:16,980 --> 00:57:21,780 flexors reduces by about 15%. Now if we go back to what I said 1173 00:57:21,780 --> 00:57:27,130 earlier that for every 1% that you reduce your plantar flexor 1174 00:57:27,130 --> 00:57:30,130 forces or your load which is going to load reduce your load 1175 00:57:30,130 --> 00:57:33,930 on your bone by about 1% as well, you're increasing the 1176 00:57:33,930 --> 00:57:38,650 distance that you can run by a factor of 6 before you start 1177 00:57:38,650 --> 00:57:41,730 occurring bone micro damage. So for every 1% that you're 1178 00:57:41,730 --> 00:57:44,850 reducing your plantar flexor loads, you're reducing the load 1179 00:57:44,970 --> 00:57:48,290 or the damage that you're going to accrue in your tibia by 6%. 1180 00:57:48,610 --> 00:57:51,850 And so very small changes in plantar flexor forces result in 1181 00:57:51,850 --> 00:57:56,580 very large reductions in the overall bone damage that you 1182 00:57:56,580 --> 00:57:58,140 might be accruing. And that's one of the reasons 1183 00:57:58,140 --> 00:58:00,900 why doing something as simple as increasing your running cadence 1184 00:58:00,900 --> 00:58:04,540 for, for instance, is while it doesn't reduce your load per 1185 00:58:04,540 --> 00:58:08,060 step by a whole bunch, it reduces the amount of damage 1186 00:58:08,060 --> 00:58:09,700 that you're occurring. There's a big difference between 1187 00:58:09,700 --> 00:58:12,020 biomechanical load and actual tissue damage. 1188 00:58:12,460 --> 00:58:18,340 And so a 10% reduction in load per step increases the number of 1189 00:58:18,820 --> 00:58:22,060 steps that you can take before you start getting breakdown of 1190 00:58:22,060 --> 00:58:25,830 bone or tendon by almost 50%. So we see this really this 1191 00:58:25,830 --> 00:58:28,390 exponential effect that it's that's occurring there and the 1192 00:58:28,390 --> 00:58:31,310 same thing happens with shoes as well. 1193 00:58:31,310 --> 00:58:34,310 So if you're if you're looking to if you've had a metatarsal 1194 00:58:34,310 --> 00:58:37,230 bone stress injury or you've had a tibial bone stress injury and 1195 00:58:37,230 --> 00:58:40,480 perhaps you got that as a as a competitive runner you you might 1196 00:58:40,480 --> 00:58:42,760 be sitting there thinking oh wait a minute now I I kind of 1197 00:58:42,760 --> 00:58:45,360 this is kind of starting to make sense and hopefully it is that a 1198 00:58:45,360 --> 00:58:47,200 lot of times we see those injuries when people start 1199 00:58:47,200 --> 00:58:49,640 running and racing flats a lot or start making that transition 1200 00:58:49,640 --> 00:58:52,720 to track spikes because again those shoes tend to have very 1201 00:58:52,720 --> 00:58:55,400 little drop to them. There's been some really neat 1202 00:58:55,400 --> 00:58:58,160 work done by a colleague of mine is we've written a couple of 1203 00:58:58,160 --> 00:59:00,760 papers going on Brent Edwards he's at University of Calgary 1204 00:59:00,760 --> 00:59:04,000 and and he's looked at different shoe designs and and how that 1205 00:59:04,000 --> 00:59:07,630 increases the probability of sustaining a a tibial bone 1206 00:59:07,630 --> 00:59:10,110 stress injury or a metatarsal bone stress injury. 1207 00:59:10,430 --> 00:59:13,630 So if I had to if I had an athlete who came in who had a 1208 00:59:13,630 --> 00:59:17,150 history of metatarsal bone stress injuries or tibial bone 1209 00:59:17,150 --> 00:59:20,510 stress injury, the the shoe that I would probably recommend them 1210 00:59:20,510 --> 00:59:22,950 to go into some as a shoe that probably has some sort of a rock 1211 00:59:22,950 --> 00:59:26,550 or sold to them. I would definitely try to steer 1212 00:59:26,550 --> 00:59:31,830 them away from AA0 drop shoe because again, that's going to 1213 00:59:31,830 --> 00:59:33,790 really increase loads in that in that region. 1214 00:59:33,790 --> 00:59:36,410 So that you might be saying to yourself, well wait a minute, if 1215 00:59:36,410 --> 00:59:39,890 I if I just spend a lot of time and I transition into the zero 1216 00:59:39,890 --> 00:59:42,090 drop shoe, I'll be able to adapt. 1217 00:59:42,490 --> 00:59:45,930 And you're you're right, partially, and that's that your 1218 00:59:45,930 --> 00:59:48,930 muscles will adapt quite well, your tendons will adapt as well. 1219 00:59:48,930 --> 00:59:51,010 But remember, bone doesn't adapt as quickly. 1220 00:59:51,730 --> 00:59:54,850 And there's also probably a ceiling on how much your bones 1221 00:59:55,050 --> 00:59:58,290 can adapt as, like, once you get it out outside of your teenage 1222 00:59:58,290 --> 01:00:02,180 years. And so, you know, I'm not saying 1223 01:00:02,180 --> 01:00:05,060 that minimal shoes are necessarily a, you know, I would 1224 01:00:05,060 --> 01:00:07,380 never say that like this is a bad shoe and this is a good 1225 01:00:07,380 --> 01:00:08,940 shoe. But I would say that there are 1226 01:00:08,940 --> 01:00:11,300 some shoes that are probably better choices for some runners 1227 01:00:11,700 --> 01:00:15,220 than others. So, do you mind if I challenge 1228 01:00:15,220 --> 01:00:16,260 you on something? Go for it. 1229 01:00:17,100 --> 01:00:20,340 So I hear you right and that makes sense that if you're 1230 01:00:20,340 --> 01:00:24,060 having injuries in this area and the metatarsals in the, in this, 1231 01:00:24,100 --> 01:00:27,340 in the tibia that perhaps a minimal issue might not work 1232 01:00:27,340 --> 01:00:28,740 best for you. I'm coming this, by the way, 1233 01:00:28,740 --> 01:00:31,980 that I think shoes are tools and each human being is going to 1234 01:00:31,980 --> 01:00:34,060 find something that's completely different for them and there's 1235 01:00:34,060 --> 01:00:36,900 no such thing as a best shoe even for each individual. 1236 01:00:36,900 --> 01:00:39,020 It's just different tools for different opportunities. 1237 01:00:39,500 --> 01:00:43,100 If we start switching people that again as you mentioned, 1238 01:00:43,100 --> 01:00:45,140 this is assuming we've addressed all the other things we've 1239 01:00:45,140 --> 01:00:48,000 talked about. A rocker shoe doesn't 1240 01:00:48,000 --> 01:00:51,160 necessarily get rid of forces, it just changes them and force 1241 01:00:51,160 --> 01:00:52,880 isn't the right term for this right now. 1242 01:00:52,880 --> 01:00:56,720 It changes the workload because while you're the plantar flexors 1243 01:00:56,720 --> 01:01:01,680 don't have to work as much your knee, your hip hamstrings, quads 1244 01:01:01,680 --> 01:01:03,480 that those areas have to work more. 1245 01:01:03,680 --> 01:01:05,560 And you mentioned one of the things that creates a lot of 1246 01:01:05,560 --> 01:01:09,160 tensile load on the bones is actually the muscle contraction. 1247 01:01:09,160 --> 01:01:12,090 So while you're having to contract muscles less at the 1248 01:01:12,090 --> 01:01:14,850 foot and ankle, you are having to do it more at the hip and 1249 01:01:14,850 --> 01:01:17,130 femur. So are we just shifting loads 1250 01:01:17,410 --> 01:01:19,690 for people when we still need to make sure this is kind of 1251 01:01:19,690 --> 01:01:22,530 obvious, But like if there it's the same concept of changing 1252 01:01:22,530 --> 01:01:26,410 mileage or the X-rays part, if they still have a energy like 1253 01:01:26,730 --> 01:01:30,010 deficit, going to rocker shoe isn't going to solve this 1254 01:01:30,010 --> 01:01:32,330 because you're just shifting load into a new area that now 1255 01:01:32,330 --> 01:01:35,610 has an equal risk of some kind of bone stress injury. 1256 01:01:35,610 --> 01:01:37,690 Is that true or am I missing something? 1257 01:01:38,260 --> 01:01:41,860 Yeah, I mean well of course what you're saying is that 100% 1258 01:01:41,860 --> 01:01:45,460 accurate that we don't really, you know as long as you don't 1259 01:01:45,460 --> 01:01:50,060 change your running speed or you don't change your your cadence, 1260 01:01:50,100 --> 01:01:52,820 you're all you're doing is you're just moving load around. 1261 01:01:53,020 --> 01:01:56,300 So whether you're put a heel drop in or heel lift in 1262 01:01:56,300 --> 01:02:00,220 someone's shoe, or you know if you put a someone in a high drop 1263 01:02:00,220 --> 01:02:02,140 shoe, of course it's going to shift more loads up to the knee. 1264 01:02:02,580 --> 01:02:04,420 Put them in a zero drop shoe, it's going to shift more loads 1265 01:02:04,420 --> 01:02:08,970 down to the planter flexors. And yeah, I mean I think I think 1266 01:02:08,970 --> 01:02:16,170 that that's you know pretty well established now do higher, how 1267 01:02:16,170 --> 01:02:20,410 much does that increase your like your knee loads if you go 1268 01:02:20,410 --> 01:02:25,210 into a higher drop shield, I would say it's not a one to one 1269 01:02:25,250 --> 01:02:27,410 ratio there. I would say that like 1%. 1270 01:02:28,590 --> 01:02:31,230 Loss of lower load at the foot and ankle doesn't necessarily 1271 01:02:31,230 --> 01:02:34,030 mean a 1% gain up there and that of course that's because we have 1272 01:02:34,030 --> 01:02:36,470 moment arms and the moment arms are different when it comes to 1273 01:02:36,590 --> 01:02:39,150 muscles and and and so it's not quite as simple and 1274 01:02:39,150 --> 01:02:41,790 straightforward as that. But with that said, we do know 1275 01:02:41,790 --> 01:02:45,710 with a rocker sole shoe, a higher drop shoe, we do see some 1276 01:02:45,790 --> 01:02:49,470 higher, some higher knee loads as well. 1277 01:02:49,910 --> 01:02:52,590 If you've never had a knee injury before, that's not a 1278 01:02:52,590 --> 01:02:54,830 problem, you know? And I think that, I think that 1279 01:02:54,830 --> 01:02:56,460 works. I I would say though too, I 1280 01:02:56,460 --> 01:02:58,900 think it's really important for people to run in the shoe that's 1281 01:02:58,900 --> 01:03:01,300 most comfortable for them and it's going to fit well for them 1282 01:03:01,300 --> 01:03:04,140 and and for me, that's what I always start with now when I'm 1283 01:03:04,140 --> 01:03:05,220 having. When I have an athlete who's 1284 01:03:05,220 --> 01:03:07,900 coming back from an injury, we spend a lot of time thinking a 1285 01:03:07,900 --> 01:03:10,020 lot about being very smarter with footwear, because I think 1286 01:03:10,020 --> 01:03:14,340 that that can really be a really important adjunct to improving 1287 01:03:14,340 --> 01:03:16,620 one's ability to get back to running in a very seamless 1288 01:03:16,620 --> 01:03:19,090 manner. And and and hopefully not have 1289 01:03:19,090 --> 01:03:22,930 any hiccups along the way but once we get past that then I let 1290 01:03:22,930 --> 01:03:24,450 them kind of go back to their to their shoes. 1291 01:03:24,450 --> 01:03:27,330 I tend to be very agnostic. I think I hope, I'm, I hope I'm 1292 01:03:27,330 --> 01:03:29,010 coming off as agnostic. I tried it right. 1293 01:03:29,130 --> 01:03:31,730 I tried to think about that when it comes to shoes and I would 1294 01:03:31,730 --> 01:03:33,610 agree. I look at them only as a tool. 1295 01:03:34,520 --> 01:03:38,560 When we when we look more proximately, it's not it's not 1296 01:03:38,560 --> 01:03:41,560 always the it's not the muscle forces that have been really 1297 01:03:41,880 --> 01:03:44,760 thought to relate to bone stress injuries proximately. 1298 01:03:44,760 --> 01:03:46,920 It's much more apologize that I misinterpreted. 1299 01:03:46,920 --> 01:03:49,200 That yeah, no, it's much more, yeah, more proximately. 1300 01:03:49,200 --> 01:03:53,360 It's what causes those bones bone stress injuries really 1301 01:03:53,720 --> 01:03:57,400 tends to be much more of some sort of an energy deficiency. 1302 01:03:58,400 --> 01:04:02,320 And we we see that and then and then and those data have been 1303 01:04:02,320 --> 01:04:05,680 around for for a while and I think that we we see that 1304 01:04:05,680 --> 01:04:08,880 trabecular rich bone sites, these more proximal bone sites 1305 01:04:08,880 --> 01:04:14,480 which are your spongy bone sites tend to be affected or if you 1306 01:04:14,480 --> 01:04:17,720 have one of those bone stress injuries you tend to have more 1307 01:04:17,720 --> 01:04:22,640 indicators that you are in a state of red ass or and the. 1308 01:04:23,100 --> 01:04:26,420 The precursor to this before Red Ass came around was the female 1309 01:04:26,460 --> 01:04:30,260 and the male athlete triad. And so those triad risk factors 1310 01:04:30,540 --> 01:04:33,540 tend to go up. If if you have those, those 1311 01:04:33,540 --> 01:04:36,540 sorts of of of bone stress injuries and if you've ever had 1312 01:04:36,540 --> 01:04:39,060 one of those bone stress injuries more so than a 1313 01:04:39,060 --> 01:04:41,340 metatarsal bone stress injury, it's really important you don't 1314 01:04:41,340 --> 01:04:45,660 dismiss that because that is that that's simply going to be 1315 01:04:45,660 --> 01:04:47,860 that you just haven't really been, just haven't really been 1316 01:04:47,860 --> 01:04:50,620 consuming enough. What I'm hearing is priority 1317 01:04:50,620 --> 01:04:55,290 wise in terms of going, yes, shoes may change where forces 1318 01:04:55,290 --> 01:04:56,890 happen. But if if things are happening 1319 01:04:56,890 --> 01:04:59,970 up higher, I think the priority is obviously going to be energy 1320 01:04:59,970 --> 01:05:03,290 consumption and making sure moderate, moderate energy 1321 01:05:03,290 --> 01:05:05,490 consumption with appropriate training and make sure there's a 1322 01:05:05,490 --> 01:05:07,730 balance. We are not on our priority list 1323 01:05:07,730 --> 01:05:12,570 as concerned of OK, yeah, if you put on a really rockered shoe, 1324 01:05:12,570 --> 01:05:15,410 I'm not worried now about shifting a stress fracture or a 1325 01:05:15,410 --> 01:05:19,090 fracture from my metatarsals now up to my femoral neck. 1326 01:05:19,090 --> 01:05:20,650 That's not how this is going to work. 1327 01:05:20,650 --> 01:05:24,490 It's not that straightforward. It's more of like there. 1328 01:05:24,650 --> 01:05:27,010 Yeah, there's some more important things to think about. 1329 01:05:27,050 --> 01:05:27,610 Here. Yeah. 1330 01:05:27,610 --> 01:05:29,530 And I think it's really important too to think about 1331 01:05:29,530 --> 01:05:31,010 injuries. Not just bone stress injuries, 1332 01:05:31,010 --> 01:05:34,850 but any injury and what we call some sort of a causal framework. 1333 01:05:34,890 --> 01:05:38,090 And that is that these injuries are multifactorial and that when 1334 01:05:38,090 --> 01:05:40,650 you change one variable, it changes other things. 1335 01:05:41,370 --> 01:05:43,770 And it's not just like I got these shoes and I got this 1336 01:05:43,770 --> 01:05:46,570 injury and so. You know, you can see people 1337 01:05:46,570 --> 01:05:49,570 continuing to fall for that error of like trying to put the 1338 01:05:49,570 --> 01:05:52,050 blame on one thing and it really isn't like that. 1339 01:05:52,050 --> 01:05:55,090 And so the the most recent example are like the the Super 1340 01:05:55,090 --> 01:05:56,490 shoes. So there's the editorials in 1341 01:05:56,490 --> 01:05:58,570 British Journal Sports Medicine recently and said, hey, like 1342 01:05:58,690 --> 01:06:03,370 we're starting to see more mid foot bone stress injuries and 1343 01:06:03,370 --> 01:06:06,090 avacular, yeah. Exactly with the people who are 1344 01:06:06,090 --> 01:06:10,440 running and and and super shoes. And I would be like and actually 1345 01:06:10,520 --> 01:06:12,480 a couple of my colleagues and I, we've kind of kicked around the 1346 01:06:12,480 --> 01:06:15,880 idea of writing a counter editorial to this because I I 1347 01:06:15,880 --> 01:06:18,440 think we need to just just tap the brakes a little bit because 1348 01:06:20,200 --> 01:06:23,600 let's take a look at who who is more likely to run it in a super 1349 01:06:23,600 --> 01:06:25,960 shoe. And we see that they tended to 1350 01:06:25,960 --> 01:06:28,000 be faster runners who are going to get more bone stress 1351 01:06:28,000 --> 01:06:29,960 injuries, more bone damage because of that. 1352 01:06:30,400 --> 01:06:32,680 They're going to be one of the things that we do know with 1353 01:06:32,680 --> 01:06:38,490 super shoes. Is it we kind of was anecdotally 1354 01:06:38,490 --> 01:06:40,850 and also in some studies that are are going to be coming out 1355 01:06:40,850 --> 01:06:45,210 soon we see less muscle swornness And if you've if 1356 01:06:45,210 --> 01:06:47,930 you've ever run in them and and I know a lot of runners who have 1357 01:06:47,930 --> 01:06:52,490 I I haven't that they they report, they report that they 1358 01:06:52,490 --> 01:06:56,370 can they recover quicker and that they can turn around and 1359 01:06:56,370 --> 01:06:59,730 run more higher more sessions in a week at a higher intensity if 1360 01:06:59,730 --> 01:07:01,490 they're training in these types of shoes. 1361 01:07:01,970 --> 01:07:05,890 And so again, we know that higher, higher running speeds 1362 01:07:05,890 --> 01:07:09,930 increases our likelihood of of accumulating bone micro damage. 1363 01:07:10,410 --> 01:07:14,570 And then the other thing too is if you're the type of runner who 1364 01:07:14,570 --> 01:07:18,570 is looking for that 1% that you're going to be running, 1365 01:07:18,570 --> 01:07:20,770 you're going to be actually training in a shoe that was 1366 01:07:20,770 --> 01:07:24,330 originally designed to be done as used only in a race. 1367 01:07:25,290 --> 01:07:27,730 You're also probably that type of runner who's looking for 1368 01:07:27,730 --> 01:07:30,650 other places where you might be looking to gleam a little bit 1369 01:07:30,650 --> 01:07:32,810 more out of yourself and that perhaps might be that you're 1370 01:07:33,050 --> 01:07:35,650 you're quote UN quote eating a little clean. 1371 01:07:35,970 --> 01:07:38,650 Are you working on eating cleaner And we see that that 1372 01:07:39,250 --> 01:07:41,530 increases. The athletes have a tendency to 1373 01:07:41,610 --> 01:07:44,290 eat quote UN quote, try to eat cleaner when the closer they get 1374 01:07:44,290 --> 01:07:46,770 to a race. And they also tend to tighten up 1375 01:07:46,770 --> 01:07:50,090 other things too and tend to do more speed work as they're 1376 01:07:50,090 --> 01:07:52,290 leading up to a race. So that's and they tend to run 1377 01:07:52,290 --> 01:07:53,690 more on these shoes. So I think that. 1378 01:07:54,150 --> 01:07:57,270 I think that when we see a shoe and we see someone saying, well 1379 01:07:57,630 --> 01:07:59,950 if you're running that type of run, this bulky maximal shoe, 1380 01:07:59,950 --> 01:08:01,870 you're going to get more mid foot injuries. 1381 01:08:02,150 --> 01:08:04,710 I would be like how it's probably a lot more complicated 1382 01:08:04,710 --> 01:08:06,350 than that. And then I think it's important 1383 01:08:06,350 --> 01:08:11,750 for us to take a long hard look at all the different factors. 1384 01:08:11,750 --> 01:08:15,670 And so when we design studies, it's important for us to account 1385 01:08:15,670 --> 01:08:17,750 for all these different things. It's important when we're 1386 01:08:17,750 --> 01:08:20,350 looking at bone stress injuries, they'll be known to say who ran 1387 01:08:20,350 --> 01:08:22,830 in the shoe and who didn't, who got bone stress injuries and who 1388 01:08:22,830 --> 01:08:24,790 didn't. We should also be collecting 1389 01:08:24,790 --> 01:08:28,750 other metrics such as the triad questionnaire that looks at 1390 01:08:28,750 --> 01:08:32,390 different risk factors like things like you know have you 1391 01:08:32,390 --> 01:08:34,950 been diagnosed with low bone density, have you had a bone 1392 01:08:34,950 --> 01:08:37,350 stress in the past and how many of those have you had and how 1393 01:08:37,350 --> 01:08:39,510 many were high risk bone stress injuries. 1394 01:08:40,630 --> 01:08:44,470 All these different factors and you know so that we can you can 1395 01:08:44,590 --> 01:08:47,470 control for those confounders that are really important when 1396 01:08:47,470 --> 01:08:51,270 it comes to determining you know is there actually a. 1397 01:08:52,729 --> 01:08:54,890 Some sort of cause that's occurring here and we always 1398 01:08:54,890 --> 01:08:56,810 have to be careful about that when we're thinking about these 1399 01:08:56,810 --> 01:08:58,370 kind of these prospective designs. 1400 01:08:58,850 --> 01:09:01,010 So I think from this point on when my students asked me a 1401 01:09:01,010 --> 01:09:03,529 question, I'm not going to say it depends anymore, I'm just 1402 01:09:03,529 --> 01:09:06,250 going to say it's multifactorial just to redirect them for a 1403 01:09:06,250 --> 01:09:07,290 second until we get tired of that. 1404 01:09:07,290 --> 01:09:09,970 But I think that's really true and I want for all of our 1405 01:09:09,970 --> 01:09:12,170 listeners to bring to the fact that Rich has used the term 1406 01:09:12,210 --> 01:09:15,649 adjunct quite a bit. Is that and I I kind of teased 1407 01:09:15,649 --> 01:09:19,200 at this even knowing the answer is that yeah, we can try to pin 1408 01:09:19,200 --> 01:09:22,319 things on footwear. We can try to pin things on 1409 01:09:22,319 --> 01:09:24,600 running form, we can try to pin it on this and that. 1410 01:09:24,600 --> 01:09:26,760 But there are some priorities and going back to the bases 1411 01:09:26,760 --> 01:09:31,120 going are you supporting your Physiology with these things. 1412 01:09:31,120 --> 01:09:34,399 And when you start focusing on these extraneous kind of farther 1413 01:09:34,399 --> 01:09:36,880 down the road variables, you might be missing the picture 1414 01:09:36,880 --> 01:09:39,359 which is when in research which I am learning, Rich is the 1415 01:09:39,359 --> 01:09:41,319 expert on and I am being in a pH. 1416 01:09:41,319 --> 01:09:43,040 D program trying to finish my pH. 1417 01:09:43,040 --> 01:09:44,910 D and learning. Did I choose the right 1418 01:09:44,910 --> 01:09:46,430 variables? Is these the right things to 1419 01:09:46,430 --> 01:09:48,149 focus? Just just panic I guess is 1420 01:09:48,149 --> 01:09:50,149 apparently normally even though I'm freaking out as it gets to 1421 01:09:50,149 --> 01:09:52,229 the end of this thing, you have to ask yourself, are you 1422 01:09:52,229 --> 01:09:56,670 focusing on the right things? And I think shoes have a place 1423 01:09:56,670 --> 01:09:58,310 and they have some very big complexity. 1424 01:09:58,310 --> 01:10:01,550 Especially I might have to get your address and get you in a 1425 01:10:01,550 --> 01:10:03,830 pair of the Super shoes if you haven't haven't tried a pair. 1426 01:10:03,870 --> 01:10:07,590 So yeah, I haven't run on them yet, but no, that's fine. 1427 01:10:07,870 --> 01:10:10,730 We might have to change that, but there's still a lot we don't 1428 01:10:10,730 --> 01:10:12,730 know in terms of what's actually happening. 1429 01:10:12,730 --> 01:10:15,210 Are we reducing forces? Why are people less sore? 1430 01:10:15,410 --> 01:10:17,690 There's some very good theories, some very some good good 1431 01:10:17,690 --> 01:10:20,410 researchers that are working on this right now to try to figure 1432 01:10:20,410 --> 01:10:22,850 this out. But we don't know yet And he's 1433 01:10:23,010 --> 01:10:25,970 as we start seeing those type of shoes go onto trail and ultra 1434 01:10:25,970 --> 01:10:29,770 marathon, we don't necessarily know yet, but again we do know 1435 01:10:29,770 --> 01:10:33,290 from basic Physiology. You do have to address the basic 1436 01:10:33,290 --> 01:10:35,010 things. Are you eating enough? 1437 01:10:35,450 --> 01:10:37,930 Are you balancing your training well enough that your body can 1438 01:10:37,930 --> 01:10:41,050 actually recover from it? Which means appropriate food, 1439 01:10:41,170 --> 01:10:43,970 you know, calories, appropriate sleep, making sure you're 1440 01:10:43,970 --> 01:10:47,410 recovering appropriately? And then once you've done that 1441 01:10:47,410 --> 01:10:49,690 going, Are you actually balancing your body in a way, 1442 01:10:49,730 --> 01:10:52,410 understanding that your body doesn't adapt the way you might 1443 01:10:52,410 --> 01:10:55,770 think it does, and that with excess at continuous loads, your 1444 01:10:55,770 --> 01:10:59,170 body stops responding after a fairly short period? 1445 01:10:59,170 --> 01:11:01,450 Like, I can't remember if I learned that heard this from you 1446 01:11:01,910 --> 01:11:04,630 or where I learned this from was like you only really get benefit 1447 01:11:04,670 --> 01:11:07,550 like bone benefit from a run like for the first few minutes 1448 01:11:07,550 --> 01:11:10,270 and that's it, then you lose it, right. 1449 01:11:10,270 --> 01:11:14,030 So it's OK Once you've gotten all these factors in line, then 1450 01:11:14,030 --> 01:11:18,350 you start thinking about, hey, can you do a couple like higher 1451 01:11:18,350 --> 01:11:22,470 intensity jumps or maybe some higher weight couple times a 1452 01:11:22,470 --> 01:11:25,230 week minimum. Once you've checked off all 1453 01:11:25,230 --> 01:11:28,640 those variables, then you can start thinking about footwear. 1454 01:11:28,640 --> 01:11:30,840 Then you can start thinking about these other extraneous 1455 01:11:30,840 --> 01:11:32,280 things. But you've got to go back to the 1456 01:11:32,280 --> 01:11:35,080 basics first. And instead of instead of saying 1457 01:11:35,080 --> 01:11:37,160 it depends, I'll just say it's multifactorial. 1458 01:11:37,160 --> 01:11:40,360 Got to make focus on the right variables first before you get 1459 01:11:40,360 --> 01:11:41,720 anywhere else. Yeah. 1460 01:11:41,720 --> 01:11:44,240 Is that a pretty good sorry? So far, yeah, yeah, I think so, 1461 01:11:44,240 --> 01:11:46,440 definitely. I think, I think anytime that 1462 01:11:46,440 --> 01:11:50,720 we're you're looking at an injury and trying to understand 1463 01:11:50,720 --> 01:11:53,760 why that's occurring and of course you have to do that 1464 01:11:53,760 --> 01:11:55,760 somewhat to come up with a reasonable. 1465 01:11:56,770 --> 01:12:00,570 Some sort of intervention or risk mitigation program, some 1466 01:12:00,730 --> 01:12:02,250 sort of prevention program, if you will. 1467 01:12:03,490 --> 01:12:06,050 You know, I don't know that you really need to kind of think 1468 01:12:06,050 --> 01:12:08,370 about the athlete as a whole. And I think that's really 1469 01:12:08,370 --> 01:12:09,930 important. That's what like these, you 1470 01:12:09,930 --> 01:12:12,530 know, thinking about things more in these causal frameworks or 1471 01:12:12,570 --> 01:12:15,370 it's like connecting variables rather than saying, well, I've 1472 01:12:15,370 --> 01:12:18,090 got this person, they've got all these risk factors and then you 1473 01:12:18,090 --> 01:12:20,410 know and out the other end spits a bone stress injury. 1474 01:12:20,730 --> 01:12:23,290 It's like, well, how does one affect the other? 1475 01:12:23,410 --> 01:12:25,490 And so you know a good example this would be. 1476 01:12:25,780 --> 01:12:27,460 Let's just kind of hypothetically you think about a 1477 01:12:27,460 --> 01:12:30,420 study. Let's say you've got you, you 1478 01:12:30,420 --> 01:12:32,780 want to, so you've listened to this podcast or maybe you've 1479 01:12:32,780 --> 01:12:34,460 read some papers and you you're like okay. 1480 01:12:34,460 --> 01:12:36,620 Well, strength training is what I want to be doing with 1481 01:12:36,620 --> 01:12:37,980 athletes. And I I'm going to go into a 1482 01:12:37,980 --> 01:12:39,900 high school and maybe you're a clinician, you're like I'm going 1483 01:12:39,900 --> 01:12:42,380 to go into high school and I'm going to develop it this bone, 1484 01:12:42,380 --> 01:12:45,340 this bone loading program for my high school athletes. 1485 01:12:45,340 --> 01:12:49,420 I'm going to have them lift very heavy and get them doing this 1486 01:12:49,420 --> 01:12:51,060 and then they're going to, you know, keep doing their regular 1487 01:12:51,060 --> 01:12:54,610 running program. And and I'm going to reduce 1488 01:12:54,610 --> 01:12:56,250 everybody's risk of getting a bone stress injury. 1489 01:12:56,690 --> 01:12:59,290 You have to be a little bit careful here too because you 1490 01:12:59,290 --> 01:13:01,890 have to think about who's on the receiving in the as an ass. 1491 01:13:01,890 --> 01:13:05,210 The athlete will tell me about what you think if I have you 1492 01:13:05,210 --> 01:13:07,210 lift very heavy. What do you think about lifting 1493 01:13:07,210 --> 01:13:09,730 heavy? And they might tell you a couple 1494 01:13:09,730 --> 01:13:11,770 different things that the one thing they might tell you is 1495 01:13:11,770 --> 01:13:13,930 they might say, well, look I'm really worried about lifting 1496 01:13:13,930 --> 01:13:16,690 heavy because I'm worried about it affecting my ability to run a 1497 01:13:16,690 --> 01:13:20,010 lot and run and do my workouts. You know really well and. 1498 01:13:20,430 --> 01:13:22,550 That comes back to that issue of like, it's really important to 1499 01:13:22,550 --> 01:13:25,270 make sure that you're planning your program with minimal, the 1500 01:13:25,270 --> 01:13:27,790 minimal effective dose. So now if you if you're carrying 1501 01:13:27,790 --> 01:13:29,710 a lot of fatigue into your next run, that usually means you have 1502 01:13:29,710 --> 01:13:32,310 too much volume. But more importantly, if you ask 1503 01:13:32,310 --> 01:13:37,070 any runner who's maybe not up, who hasn't, who hasn't read some 1504 01:13:37,110 --> 01:13:39,350 some different articles about weightlifting and stuff like 1505 01:13:39,350 --> 01:13:40,510 that. If you say I'm going to have you 1506 01:13:40,510 --> 01:13:43,030 lift a lot of heavy weights, what are they going to be 1507 01:13:43,030 --> 01:13:45,070 worried about? They're probably going to be 1508 01:13:45,070 --> 01:13:46,870 worried about gaining muscle mass. 1509 01:13:46,870 --> 01:13:48,430 They're going to be worried about bulking up. 1510 01:13:48,880 --> 01:13:52,680 And so if you go into a high school cross country program, 1511 01:13:52,680 --> 01:13:54,120 you say, I'm going to have everybody here left really 1512 01:13:54,120 --> 01:13:56,280 heavy. You're going to have some 1513 01:13:56,280 --> 01:13:57,520 athletes who are going to be into that. 1514 01:13:57,520 --> 01:13:58,640 They're going to be okay, this is cool. 1515 01:13:58,640 --> 01:14:00,240 And you have other athletes are going to be like, I'm really 1516 01:14:00,240 --> 01:14:02,480 worried about bulking up and they're either not going to do 1517 01:14:02,480 --> 01:14:05,040 the exercises to the intensity that you're asking them to do 1518 01:14:05,040 --> 01:14:09,240 it, or they're going to perhaps do some some other, some 1519 01:14:09,240 --> 01:14:11,040 caloric, some extra caloric restriction. 1520 01:14:11,340 --> 01:14:15,180 To keep themselves from from from, from bulking up. 1521 01:14:15,340 --> 01:14:18,340 Or they might not be consuming the extra calories that they 1522 01:14:18,340 --> 01:14:20,540 need because now you've added that more exercise to their 1523 01:14:20,540 --> 01:14:23,300 program and they're you've actually increased the risk of 1524 01:14:23,300 --> 01:14:25,220 getting your bone stress energy because you added a very 1525 01:14:25,220 --> 01:14:28,900 intensive muscle strength in your program, which as we know 1526 01:14:29,460 --> 01:14:32,260 is also very energy intensive, just the same as running as. 1527 01:14:32,610 --> 01:14:34,570 And so it it's really important to kind of think about all those 1528 01:14:34,570 --> 01:14:36,850 things and I say if you don't strength train you're going to 1529 01:14:36,850 --> 01:14:38,570 get injured. It it it's you really have to 1530 01:14:38,570 --> 01:14:39,850 think about the athlete as a whole. 1531 01:14:39,850 --> 01:14:41,850 How do they view the activity that you're doing? 1532 01:14:42,450 --> 01:14:46,090 How does it fit within the other risk factors and and how do 1533 01:14:46,090 --> 01:14:48,690 these risk factors connect with one another because when you 1534 01:14:48,730 --> 01:14:51,530 change one, it's going to have an effect downstream on on other 1535 01:14:51,530 --> 01:14:53,090 ones. And you need to count for all 1536 01:14:53,090 --> 01:14:56,890 that, both in your your program, but also in any sort of 1537 01:14:56,890 --> 01:14:59,170 education that you might be doing with your athletes. 1538 01:14:59,490 --> 01:15:00,810 That was the most intense example. 1539 01:15:00,890 --> 01:15:02,970 Of it depends. Or it's multifactorial. 1540 01:15:02,970 --> 01:15:05,650 I think I've ever heard this I have to make fun of Rich for 1541 01:15:05,650 --> 01:15:08,570 this as as as someone who's because you you finished your 1542 01:15:08,570 --> 01:15:14,090 PhD with Irene Davis in 2011 thousand 11 right this this is 1543 01:15:14,090 --> 01:15:17,170 the off topic as someone who is in this Rob listing going oh 1544 01:15:17,170 --> 01:15:19,690 this is what an experienced researcher sounds like when they 1545 01:15:19,690 --> 01:15:22,050 have going. I've gotten all these variables 1546 01:15:22,210 --> 01:15:23,930 as opposed to the newer researcher going oh, I never 1547 01:15:24,450 --> 01:15:26,770 thought about that so this is great. 1548 01:15:26,810 --> 01:15:30,170 Well, Rich, thank you so much. I really appreciate your time on 1549 01:15:30,170 --> 01:15:32,490 this and talking about not only bone stress injuries, but I 1550 01:15:32,490 --> 01:15:35,010 think what I'm getting from this is understanding the athlete. 1551 01:15:35,010 --> 01:15:37,890 Whether that's you that you're trying to figure out what's 1552 01:15:37,890 --> 01:15:40,130 going on with you or if you're working with an athlete going, 1553 01:15:40,130 --> 01:15:44,730 make sure you look at the whole picture and try not to get like 1554 01:15:45,050 --> 01:15:48,170 cordoned off into one section. It's really an it's a puzzle 1555 01:15:48,170 --> 01:15:49,170 piece. Each person is totally 1556 01:15:49,170 --> 01:15:50,970 different. Just like we talked about, each 1557 01:15:50,970 --> 01:15:53,050 person might need a completely different shoe. 1558 01:15:53,250 --> 01:15:55,290 We all have different needs. There are some basic 1559 01:15:55,290 --> 01:15:57,730 physiological principles that you do have to pay attention to, 1560 01:15:57,730 --> 01:16:00,330 especially when it comes to bone stress injuries, but make sure 1561 01:16:00,330 --> 01:16:02,610 you're looking at the whole individual, not just trying to 1562 01:16:02,610 --> 01:16:06,380 pin out one little thing so we really appreciate that. 1563 01:16:06,380 --> 01:16:09,700 I do want to give Rich a shout out if you have not followed him 1564 01:16:09,700 --> 01:16:11,780 on social media. If you're not following the 1565 01:16:11,780 --> 01:16:14,540 Montana run lab, you definitely should because they're always 1566 01:16:14,540 --> 01:16:17,980 dropping stuff and I hear if you haven't already, correct me for 1567 01:16:17,980 --> 01:16:21,140 mine, you have a course coming up that anybody who we do or 1568 01:16:21,380 --> 01:16:22,700 can. Yeah, we do. 1569 01:16:22,700 --> 01:16:25,980 We do have a, we have an online course coming up soon and we 1570 01:16:25,980 --> 01:16:27,300 have a we're going to be in New York City. 1571 01:16:27,300 --> 01:16:29,900 I'm going to be teaching in New York City at the end of May. 1572 01:16:29,900 --> 01:16:31,580 So we're just kind of working on. 1573 01:16:32,220 --> 01:16:36,780 I ran out those details, but yeah I do some on like in person 1574 01:16:36,780 --> 01:16:40,940 courses, but most I'm trying to get a lot of this online and so 1575 01:16:40,940 --> 01:16:42,380 people can access it whenever they got it. 1576 01:16:42,420 --> 01:16:45,380 So yeah, if you go to University of Montana running lab, it's 1577 01:16:45,540 --> 01:16:48,620 great website, very well done. I will say there's online 1578 01:16:48,620 --> 01:16:50,900 courses right there if you have not taken if there's something 1579 01:16:50,900 --> 01:16:52,780 you're interested, I would highly encourage it. 1580 01:16:52,940 --> 01:16:55,780 Is there any other social media or online places you would 1581 01:16:55,780 --> 01:16:58,020 suggest that people can find you to be able to either ask 1582 01:16:58,020 --> 01:17:00,380 questions or learn more? No, I think that's that's the 1583 01:17:00,380 --> 01:17:03,300 best place to go so. So you can if you want. 1584 01:17:03,300 --> 01:17:05,180 If you have some specific questions, you're welcome to 1585 01:17:05,180 --> 01:17:10,860 e-mail me at rich dot Willy Willy at E Montana dot Edu and 1586 01:17:11,100 --> 01:17:12,700 make sure you mention this podcast and I'll. 1587 01:17:12,700 --> 01:17:15,540 I'll get back to you. Awesome, Rich, thank you. 1588 01:17:15,700 --> 01:17:18,060 We really appreciate your time. And again, listeners, you can 1589 01:17:18,060 --> 01:17:21,540 always find us in a variety of places, be it on Instagram, 1590 01:17:21,540 --> 01:17:24,300 Spotify, YouTube, all the usual classic places. 1591 01:17:24,300 --> 01:17:26,860 Bach as always does a wonderful job of keeping up LinkedIn, so 1592 01:17:26,860 --> 01:17:28,340 that's another great place you could find us. 1593 01:17:28,900 --> 01:17:31,180 And as always, if you have questions, please let us know at 1594 01:17:31,180 --> 01:17:34,860 doctorsrunning@gmail.com we will have a lot of cool stuff coming 1595 01:17:34,860 --> 01:17:36,420 up. Rich is not the only one, Rich. 1596 01:17:36,460 --> 01:17:38,620 I'm probably going to have to bug you to come back on some at 1597 01:17:38,620 --> 01:17:40,060 some point cuz I've had a lot of fun. 1598 01:17:40,300 --> 01:17:41,900 I hope you've had just as much and we really. 1599 01:17:41,900 --> 01:17:42,820 Appreciate your time. Yeah. 1600 01:17:42,820 --> 01:17:44,180 Thanks a lot. It's been great to be here. 1601 01:17:44,500 --> 01:17:45,900 So thanks for the invitation. It's.