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Hello everybody, and welcome to 
the Doctors of Running podcast 

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where we, a group of doctors of 
physical therapy, discuss the 

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art and science of running and 
the stuff that we put on our 

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feet. 
I am feeling extremely honored 

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today because it's not just the 
founder of Doctors of Running, 

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Doctor Matthew Klein and myself.
I'm Nathan who are joining you. 

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We have a very esteemed guest. 
This is somebody that I have had

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the pleasure of knowing for a 
while now, and I was the lucky 

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person and the lucky group of 
people who had this person come 

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in as their first year as a 
professor at the University of 

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Delaware when I was in school. 
So I got to learn from this 

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person and I also got to do a 
fun Swedish tradition where we 

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like, danced in a circle or did 
some hopping in a circle. 

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But I think it was like the 
Midsummer festival or something 

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like that. 
I don't remember the name of the

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dance. 
I can ask you in a second, but 

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the person we have joining us is
Doctor Karen Cybernagel. 

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So, Karen, thank you so much 
for. 

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Joining us. 
Thank you so much. 

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It's an honor to be here, and 
it's amazing to kind of catch up

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with old students and new people
in this kind of format. 

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So thank you. 
Yeah, absolutely. 

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So just a little bit more about 
Karen. 

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Karen is a physical therapist 
and athletic trainer and 

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professor in the Department of 
Physical Therapy at the 

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University of Delaware and is an
internationally recognized 

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clinical scientist. 
And that little phrase I think 

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is extremely important about 
being a clinical scientist 

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because I, as a physical 
therapist, have gleaned so much 

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from your research to be able to
use practically. 

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I also as a professor have been 
able to utilize your research to

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help shape student thinking 
about how they learn about 

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various things. 
So it's so wonderful. 

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So I'm going to keep going. 
And you, Doctor Seibernagel. 

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Karen has over 34 years of 
experience specializing in 

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tendon and ligament injuries. 
She leads influential research 

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on Achilles tendon injuries with
over 180 publications and NIH 

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funded work that has shaped 
international clinical 

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guidelines and advanced 
precision rehabilitation for 

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musculoskeletal injuries. 
So I cannot say enough, Well, I 

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guess I'm kind of winded after 
the intro, but I can't say 

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enough about truly how 
influential your work has been 

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because it's, I got, I had the 
privilege of learning from you 

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in person about the stuff that 
you've spent your whole life 

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studying. 
And so I think our first 

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question for you is how you 
found yourself getting into the 

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lane of researching Achilles 
tendon and ligament injuries and

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how you found your way there. 
Yeah, I'm going to start with 

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that, but first I'm going to 
tell you. 

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So what you did in school was 
the little, little little frog 

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dance. 
So it's a sweet dance when you 

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dance around the maypole in the 
summer, adults and kids, and 

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you're singing that they have no
ears or tails, and then you jump

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around in the classroom. 
So yes. 

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And it's. 
I'll never forget that. 

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It's still a feature in my class
too and the students all 

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remember that, so it's important
things we do in class. 

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And it works. 
It works at in our building too 

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because there's poles that block
certain spaces from seeing the 

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front of the room, so we could 
actually dance around the pole 

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that broke up the middle of the 
room too. 

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But you, you were asking me how 
I kind of got into this. 

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It's kind of correct, right? 
That's where we're going with 

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it. 
So, well, well, it's so long ago

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now, who remembers? 
But anyway, no, I, I actually, 

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so I came to, I'm just born and 
raised in Sweden. 

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I came to United States because 
I wanted to do sports medicine 

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and physical therapy and 
athletic training. 

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So I got both of those. 
I always thought maybe that 

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eventually I wanted to do a PhD 
and things too, but I went back 

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to Sweden also working a sports 
medicine clinic. 

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And one of the things that was 
always for me, like you're 

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trying to do the best for your 
patients, right? 

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And you know, doing research at 
that time was maybe at first go 

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into the library and get 
articles or dial in and try to 

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get articles and things too. 
But one of the things that was 

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the big problem was, you know, 
we never learned about tendon 

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when I was in school. 
Like it was a bit tendon 

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attached with muscle to bone and
it was like an inert rope. 

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And then it wasn't really talked
about again. 

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And then when you started in the
clinic, everybody had 

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tendonitis. 
So it's a rotated cuff 

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tendonitis, supraspinatus 
tendonitis, Patella tendonitis, 

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Achilles tendonitis. 
So it's all of a sudden 

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everybody had pain and itis in 
indicating inflammation of this 

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tendons and painful. 
But we never really learned 

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about it, right? 
There was not anything that we 

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were focused on. 
So I think to to me, it was like

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that disconnect about 
understanding what are tendons, 

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how do we do with these things? 
And you know, when we started 

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working and where I started 
working, every itis was treated 

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with ice, anti-inflammatory and 
rest, which we now is like the 

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complete opposite of what we're 
doing. 

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And then when I was in in 
Sweden, I worked in a sports 

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medicine clinic. 
We also was the questions about 

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how Achilles tendinopathy or 
that we call tendonitis at that 

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point was a very understudied in
sports medicine as well. 

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So that's kind of how my path 
came in and my passion for for 

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attendance. 
And how much time did you spend 

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in Sweden, then practicing and 
then getting into your research 

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before you moved to the United 
States and to Delaware? 

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Yeah. 
So I, you know, apparently I 

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stayed 10 years in each country 
or something, but I wasn't, I 

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was in the US for 10 years when 
I got my, you know, I had a 

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bachelor's in PT and athletic 
training. 

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And I worked down in Baltimore 
in the sports medicine clinic 

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there. 
And we worked, we worked with 

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the Orioles, we worked in sports
medicine and then moved back to 

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Sweden after practicing for six 
years and worked in sports 

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medicine in Sweden. 
And so I went back in Sweden, 

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see 1996 and I started my PhD 
around 2000. 

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So I was working with a really, 
I was working with professional 

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teams and I had a really good 
boss in the clinic that also had

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gotten his PhD and things too, 
and really great orthopedics Dr.

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So that's kind of how my path 
started and I, I really wanted 

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to get answer questions. 
That was really, you know, 

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related to my patients. 
Like they had questions and I 

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couldn't answer them. 
So, you know, you try to ask all

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the experts and nobody else has 
answered. 

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So I'm like, well, somebody's 
got to do it. 

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So that's kind of how I started.
I was really excited about it. 

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That's great. 
Well, since we're going to spend

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time talking about Achilles 
tendinopathy, which is something

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that you've spent so much for 
your career looking at, what we 

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like to usually start with on 
the show and we really talk 

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about specific conditions is a 
little bit of the anatomy. 

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So we'd love to hear your 
perspective on kind of what is 

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going on that makes up the what?
What makes up a tendon? 

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You mentioned it was inert 
tissue. 

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What's the components of that 
and how does that influence how 

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the Achilles tendon functions 
and what it does for us? 

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Yeah, I mean, tendons are. 
I mean, obviously I spent my 

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career. 
I think that's the best tissue 

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ever, right? 
But some, yeah, some people 

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think there's a heart and a 
brain, but I don't know, right? 

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It's, it's mostly tendon that we
work with. 

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But yeah, the the exciting part 
and you guys with running, 

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right? 
And really thinking about this 

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too, is that tendon tissue is 
really well designed to tolerate

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really high forces. 
But if the tendon is too stiff 

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and it's high force, this is 
going to break. 

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If it's too flexible with too 
high forces, it absorbs energy 

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and doesn't recoil, right. 
So it's designed to really do 

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well of absorbing forces, but 
then also recoiling. 

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So you can really use this 
tendon to maximize your output. 

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So the thing with marathon 
runners, right, if they were 

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trying to to run and use the 
muscle at every step, you will, 

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you know, you wouldn't run the 
marathon. 

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You'll be really tired and 
you'll be gone for a little bit.

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But the tendon can be stretched 
out and recoiled. 

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And the reason it can do that is
how it's built. 

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So basically you have collagen 
fibers, you have elastin fibers 

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that kind of build the tendon, 
and you do have blood flow in 

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the tendon, but very less 
because if you had a high blood 

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flow, high turnover in the 
tendon, it also couldn't 

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tolerate load for a very long 
time. 

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So it's like perfectly designed 
to manage the metabolism that it

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needs. 
And then when you're thinking 

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about that, so that's kind of 
how it's built. 

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If you think about from the 
structure and up to and then the

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next thing when you come to the 
Achilles tendon, which actually 

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we just what we got a grant for 
together with Stephanie Cohn 

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that I work with is now starting
to look at the sub tendon of the

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tendons, right? 
So we consider the Achilles 

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tendon, 1 tendon, but now we're 
also trying to figure out, you 

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know, what piece come from the 
medial lateral gastrop, what 

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piece come from the soleus 
because they come together and 

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they're twisted. 
And the way the reason what 

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happens with a really good twist
because if you have something 

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that put perfectly straight and 
it's elastic, it gives it even 

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more stiffer. 
But if you do a twist too, it 

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can absorb even more energy and 
then recoil, right? 

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So the design is absolutely for 
me, absolutely fascinating, 

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right. 
So you have basics of what 

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tendons is that you can 
translate to a lot of other 

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tendons. 
And then each tendon is probably

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more integrated design for its 
purpose than we have thought. 

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And a lot of researchers now 
even from UUK like Hazel screen 

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in the UK and things that people
look at horses talking about, 

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you know, there's a difference 
between probably with upper 

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extremity tendon and lower 
extremity tendon, talk about 

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positional versus, you know, 
energy storing. 

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And so there are kind of designs
beyond the tendon and how it's 

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built. 
So yeah, I'm probably going to 

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talk about that forever. 
But I think it's it's really 

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right. 
It's really important. 

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It's important to understand 
that it's like a really 

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intricate design that works 
really, really well. 

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But it also is that the tendon 
is like, if you're going to win,

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if you're going to get the gold 
medal or if you're going to win 

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a run, right? 
It's it put elite athletes, if 

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you have a good tendon, you are 
going to do really well. 

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If your tendons are affected or 
overloaded, it might be that 

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slight difference and makes, you
know, getting 4th place, the 

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dreaded 4th versus getting on a,
you know, getting a medal and 

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things too. 
So it's athlete really utilizes 

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tendon for performance. 
I mean, we all do, right? 

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But that's kind of like really 
key, I think from my perspective

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that we need to have healthy 
tendons. 

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Sorry that got a little long 
winded. 

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No, that's great. 
And you'd mentioned too that the

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the tendon doesn't work in an 
isolated chamber. 

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It's connected to these muscles 
that connect the tendon to bone.

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Can you talk about with running,
what is the function of the 

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muscle in relation to the tendon
in relation to the bone? 

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Like how do those things work 
together during a more like 

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during a repetitive ballistic 
type movement? 

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I hear you, Matthew there. 
Are you getting tired too? 

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Like. 
No. 

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No, it's, it's more about the 
like I, I think I know where 

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you're going and part of this is
actually really embarrassing 

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because I went most of my career
not understanding what you're 

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about ready to talk about. 
And then I had a couple really 

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smart people that were nice 
enough to come join me in my PhD

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that would give me like just 
brief like things that would 

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blow my mind about how the 
muscles actually interact with 

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tendon, especially running. 
So I'm, I'm, I'm just going 

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here. 
I mean, like, how did I not know

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this? 
So that's that's where my brain.

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Is maybe, maybe you can teach me
something 'cause maybe I'm going

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around the wrong, wrong path 
here too. 

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But you know, it took me a long 
time. 

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I keep on talking about tendon 
and now we're like, Oh yeah, 

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there's a muscle on the other 
end. 

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Like what, what do they do? 
Right? 

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00:11:30,640 --> 00:11:34,040
But I, I think that the so now 
we're really, we can, I can talk

227
00:11:34,040 --> 00:11:36,000
about that forever now too. 
Like it's indicated. 

228
00:11:36,000 --> 00:11:38,600
But what you need to think about
when you are running and like 

229
00:11:38,600 --> 00:11:41,880
the muscle is not going through 
eccentric concentric 

230
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contraction, lifting you for 
every step, because if you were 

231
00:11:44,680 --> 00:11:47,480
doing that, you will run out of 
energy really, really quickly, 

232
00:11:47,480 --> 00:11:49,640
right? 
So the muscle for a lot of times

233
00:11:49,640 --> 00:11:51,440
are just there to kind of hold 
on. 

234
00:11:51,440 --> 00:11:54,640
That's maybe simplified, right? 
But if they're holding on to 

235
00:11:54,640 --> 00:11:58,000
kind of stabilize the tendon, 
then you can quickly stretch the

236
00:11:58,000 --> 00:12:00,920
tendon just like you do a rubber
band and then you get the 

237
00:12:00,920 --> 00:12:02,880
recoil. 
So it's that kind of balance 

238
00:12:02,880 --> 00:12:04,680
that you're getting depending on
what you're doing. 

239
00:12:04,680 --> 00:12:07,240
But for runners, that's going to
be really, really important 

240
00:12:07,920 --> 00:12:10,320
because you, you, I mean, you 
will run out of energy in your 

241
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muscles otherwise, versus the 
tendon has a really low 

242
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metabolism, which means it can 
tolerate stretching out and 

243
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recoil is stretching out and 
recoiling for a very long time. 

244
00:12:20,600 --> 00:12:22,880
And that's how it can help you, 
right? 

245
00:12:22,920 --> 00:12:27,240
The problem with that is when 
the muscles, muscle has much a 

246
00:12:27,240 --> 00:12:30,200
higher, you know, metabolism and
turnover. 

247
00:12:30,200 --> 00:12:31,360
That's why you don't want to use
that. 

248
00:12:31,360 --> 00:12:34,560
But that also means muscle can 
recover much faster from injury.

249
00:12:34,920 --> 00:12:39,040
So tendon has lower metabolism 
and that's also why once it goes

250
00:12:39,040 --> 00:12:42,360
down the path of injury takes a 
lot longer for you to recover. 

251
00:12:42,360 --> 00:12:46,000
So it's like perfectly designed 
for what happens, but it also 

252
00:12:46,000 --> 00:12:49,520
explains why we, you know, why 
does it take time to recover? 

253
00:12:50,280 --> 00:12:52,480
Yeah, that makes sense. 
And oh, go ahead, Matt. 

254
00:12:53,400 --> 00:12:55,640
Can I want to bookmark that 
conversation, Khan? 

255
00:12:55,640 --> 00:12:57,360
I don't know if you know some of
the things that we've talked 

256
00:12:57,360 --> 00:12:59,440
about and I, I think Nate 
mentioned there's this new 

257
00:12:59,440 --> 00:13:02,560
phenomenon out there called 
super running shoes where they 

258
00:13:02,560 --> 00:13:05,640
have these new like very tall 
stack height, these very 

259
00:13:05,640 --> 00:13:09,240
intricate foams plates in this 
unique combination of them. 

260
00:13:09,640 --> 00:13:11,920
And there's a lot of talk about 
these things being like, oh, 

261
00:13:11,920 --> 00:13:13,960
they relate. 
They decrease to late onset 

262
00:13:13,960 --> 00:13:15,960
muscle soreness and there's 
actually some evidence that 

263
00:13:15,960 --> 00:13:18,440
actually made like decrease the 
amount of like muscle tissue 

264
00:13:18,440 --> 00:13:20,120
damage and people are able to 
cover faster. 

265
00:13:20,720 --> 00:13:23,240
The conversations that are not 
happening are about tissues that

266
00:13:23,240 --> 00:13:27,440
do not recover as fast. 1A great
example that you just mentioned.

267
00:13:27,440 --> 00:13:29,120
10 Another one I think about all
the time. 

268
00:13:29,120 --> 00:13:31,880
We don't have the evidence on 
this in relationship to these 

269
00:13:31,880 --> 00:13:33,280
shoes and I'll ask about this 
later. 

270
00:13:33,280 --> 00:13:35,360
But bone is the same thing 
going. 

271
00:13:35,360 --> 00:13:37,720
These things don't, you know, 
heal as fast. 

272
00:13:37,720 --> 00:13:39,840
I think it's very important for 
our listeners to kind of think 

273
00:13:39,840 --> 00:13:41,960
about. 
There's these interesting tools,

274
00:13:41,960 --> 00:13:46,000
but you can't fake your way at a
tissue healing timelines and 

275
00:13:46,000 --> 00:13:47,840
like tendons are one of the 
things where they just take 

276
00:13:47,840 --> 00:13:51,440
longer to adapt and heal for the
reasons you're talking about. 

277
00:13:51,440 --> 00:13:53,280
So I just wanted to bookmark 
that conversation because we'll 

278
00:13:53,280 --> 00:13:53,880
probably go. 
Back. 

279
00:13:53,880 --> 00:13:57,280
Yeah, we'll definitely be coming
back to super shoe conversations

280
00:13:57,280 --> 00:14:01,200
and just getting thoughts on it.
I'm also curious when you talk 

281
00:14:01,200 --> 00:14:04,160
about the function of the muscle
being this kind of in an 

282
00:14:04,160 --> 00:14:06,360
isometric state where it's 
holding on and it's allowing the

283
00:14:06,360 --> 00:14:08,280
tendon to go through this 
elongation. 

284
00:14:09,280 --> 00:14:11,960
When we're in the clinic and 
we're assessing somebody's 

285
00:14:11,960 --> 00:14:15,880
function of their calf complex, 
we're often doing a heel rise 

286
00:14:15,880 --> 00:14:18,920
test or some sort of, especially
in a clinic where we don't have 

287
00:14:18,920 --> 00:14:22,160
lots of equipment. 
Do you think that that's a good 

288
00:14:22,320 --> 00:14:25,160
proxy for understanding how the 
muscle can function during 

289
00:14:25,160 --> 00:14:28,120
running, doing like a maximal 
heel rise test? 

290
00:14:28,320 --> 00:14:31,240
Or what sort of considerations 
do you have for seeing how's the

291
00:14:31,240 --> 00:14:33,640
calf complex doing and its 
readiness to run? 

292
00:14:33,880 --> 00:14:36,480
Yeah, I mean, I think the the 
it's always gets a very 

293
00:14:36,480 --> 00:14:38,240
complicated, right. 
But even if it works 

294
00:14:38,240 --> 00:14:41,000
isometrically, the muscle still 
has to be really strong to kind 

295
00:14:41,000 --> 00:14:43,480
of cover, right. 
So what, what do you evaluate? 

296
00:14:43,480 --> 00:14:46,520
And that's something, you know, 
I spent the better part of my 

297
00:14:46,520 --> 00:14:49,680
career too, trying to figure out
what are the evaluation? 

298
00:14:49,680 --> 00:14:51,000
What are the methods that you 
want to do? 

299
00:14:51,000 --> 00:14:54,800
And I think that the the key is,
and my pet peeve is people want 

300
00:14:54,800 --> 00:14:57,160
to have that one measure. 
And I think that we need to, you

301
00:14:57,160 --> 00:14:58,920
know, I don't probably was 
seeing we're talking about 

302
00:14:58,920 --> 00:15:02,800
tendon domains, like domains of 
tendon health, like all the 

303
00:15:02,880 --> 00:15:07,360
domains need to be properly or 
working properly in order to 

304
00:15:07,360 --> 00:15:11,720
kind of looking at it. 
So when I develop my my for my 

305
00:15:11,720 --> 00:15:16,200
thesis too, we were really 
trying to look at understanding 

306
00:15:16,240 --> 00:15:19,720
muscle endurance, but also 
looking at power, right? 

307
00:15:19,720 --> 00:15:22,760
So we were trying to do 
eccentric and concentric power 

308
00:15:22,840 --> 00:15:27,440
standing with the weight because
I really didn't like the, you 

309
00:15:27,440 --> 00:15:30,400
know, the dynamometer probably 
because we had the kin come at 

310
00:15:30,400 --> 00:15:31,840
that point and didn't work very 
well. 

311
00:15:32,120 --> 00:15:35,560
But trying to look at the ankle 
right in isolation and not 

312
00:15:35,560 --> 00:15:37,600
standing. 
So I'm like, we need to evaluate

313
00:15:37,600 --> 00:15:39,880
it standing. 
So we developed the heel rise 

314
00:15:39,880 --> 00:15:42,960
test to really kind of see how 
many times. 

315
00:15:42,960 --> 00:15:45,360
Well, we could also measure the 
height and the total amount of 

316
00:15:45,360 --> 00:15:49,560
work based on your body weight. 
And we also did it in the weight

317
00:15:49,560 --> 00:15:52,000
machine when you had the weights
over your shoulder. 

318
00:15:52,000 --> 00:15:54,080
So we tried to get different 
weights because you couldn't 

319
00:15:54,080 --> 00:15:56,560
evaluate power by adding 
weights, right? 

320
00:15:56,560 --> 00:15:59,880
So at one point your power 
decreases because the weight is 

321
00:15:59,880 --> 00:16:01,400
too much. 
You can kind of find that 

322
00:16:01,400 --> 00:16:03,920
balance. 
So we did starting from 

323
00:16:03,920 --> 00:16:07,080
concentric power and then we did
eccentric concentric power 

324
00:16:07,080 --> 00:16:10,120
because we were thinking, OK, 
the tendon is more active in the

325
00:16:10,160 --> 00:16:13,080
eccentric concentric. 
So now we can evaluate the, the,

326
00:16:13,120 --> 00:16:16,760
the tendon more. 
And then we added on plyometric 

327
00:16:16,760 --> 00:16:19,840
like hopping that really used 
the tendon more of the bouncing 

328
00:16:19,840 --> 00:16:23,080
and those kind of things too. 
So we've kind of abandoned the 

329
00:16:23,360 --> 00:16:25,200
concentric and eccentric 
concentric. 

330
00:16:25,200 --> 00:16:28,040
So it's really hard to because 
there's a lot of repetitions 

331
00:16:28,040 --> 00:16:29,720
they have to do. 
And then you have the weight 

332
00:16:29,720 --> 00:16:32,280
through the shoulders and then 
people have shoulder problems, 

333
00:16:32,280 --> 00:16:34,480
back problems, and those kind of
things too. 

334
00:16:34,960 --> 00:16:37,480
So we went into what we've done 
more of the jumping and all that

335
00:16:37,480 --> 00:16:39,640
too. 
So that's a long story to say 

336
00:16:39,640 --> 00:16:43,360
that basically what we know, one
of the risk factors might be for

337
00:16:43,520 --> 00:16:46,320
Achilles tendinopathy and what 
we now see in actually kids 

338
00:16:46,560 --> 00:16:48,880
might they were done in master 
athletes. 

339
00:16:48,880 --> 00:16:51,520
I'm really interested in young 
kids with Achilles tendon too. 

340
00:16:52,160 --> 00:16:55,120
And what we see is that one of 
the risk factors is probably 

341
00:16:55,120 --> 00:16:57,040
some kind of calf weakness, 
right? 

342
00:16:57,040 --> 00:17:00,400
So if you have weakness, even if
you have a good tendon, you 

343
00:17:00,400 --> 00:17:03,160
probably can develop over you. 
So there needs to be a balance. 

344
00:17:03,160 --> 00:17:05,720
So you need to have some kind of
measure of the strength. 

345
00:17:06,200 --> 00:17:09,520
But strength is not or endurance
is not the pure thing that you 

346
00:17:09,520 --> 00:17:11,200
need to evaluate. 
You get really excited. 

347
00:17:11,200 --> 00:17:15,040
What were you thinking? 
I I was curious about the the 

348
00:17:15,040 --> 00:17:18,240
type you were mentioning, like 
strength or like force out of 

349
00:17:18,240 --> 00:17:20,720
weakness. 
What type of weakness? 

350
00:17:20,720 --> 00:17:22,839
I'm curious, is there a 
particular one or does it go 

351
00:17:22,839 --> 00:17:25,079
across all the domains? 
Sorry to take this off the 

352
00:17:25,079 --> 00:17:28,200
rails, I just get excited. 
No, I mean, I, I, I don't know 

353
00:17:28,200 --> 00:17:31,840
all of like we, right? 
Because we do, we do, We do 

354
00:17:32,680 --> 00:17:35,560
right now we do our endurance 
test and then we do the jump 

355
00:17:35,560 --> 00:17:38,560
test too. 
Now we have the Humax. 

356
00:17:38,560 --> 00:17:41,800
So now we're doing the Mbic's 
and I did the Mbic's in my 

357
00:17:41,800 --> 00:17:44,920
postdoc too, right. 
But I don't, I have a problem 

358
00:17:44,920 --> 00:17:48,040
with understanding we can go 
down this path to like the 

359
00:17:48,040 --> 00:17:51,920
problem with plantar flexion is 
the plantar flexion is not the 

360
00:17:51,920 --> 00:17:55,120
calf and the Achilles plantar 
flexion torque is you have 

361
00:17:55,120 --> 00:17:58,080
flexor halas as long as flex 
dictator and longest TBL is 

362
00:17:58,080 --> 00:18:02,480
posterior peroneals, right. 
So sometimes, you know, one of 

363
00:18:02,480 --> 00:18:06,960
some of the research we are 
looking into now is if you think

364
00:18:06,960 --> 00:18:10,640
that's purely load on the 
Achilles and then on calf, we 

365
00:18:10,640 --> 00:18:13,240
might go down the wrong path 
when we're testing really long 

366
00:18:13,240 --> 00:18:16,000
strength and things too. 
So you know, because you have 

367
00:18:16,000 --> 00:18:18,360
the inhibition of those muscle 
and you're compensating with 

368
00:18:18,360 --> 00:18:21,320
others. 
So I'm thinking that Max Mbic's 

369
00:18:21,360 --> 00:18:24,320
was really exciting, but now I'm
like, well, maybe they actually 

370
00:18:24,320 --> 00:18:26,960
the endurance is better because 
you might use more of the calf 

371
00:18:26,960 --> 00:18:28,440
and things too. 
So I don't really know, but I 

372
00:18:28,440 --> 00:18:30,320
can tell you more of some of the
research we're doing. 

373
00:18:31,160 --> 00:18:34,240
Yeah, that makes me feel better 
because I had no idea. 

374
00:18:34,240 --> 00:18:36,400
And that was what with my 
research when I was looking at 

375
00:18:36,400 --> 00:18:40,480
master's owners, I thought for 
sure that looking at like Max, 

376
00:18:40,480 --> 00:18:44,480
like isokinetic or like 
isometric force output would 

377
00:18:44,480 --> 00:18:45,840
definitely find what I was 
looking for. 

378
00:18:45,840 --> 00:18:49,720
And I didn't find any difference
between those with Achilles 

379
00:18:49,720 --> 00:18:51,080
synopathy and those that were 
healthy. 

380
00:18:51,080 --> 00:18:53,680
And I'm like, that's that. 
There's no way. 

381
00:18:53,680 --> 00:18:56,440
And the only thing I was able to
find, even the running mechanics

382
00:18:56,440 --> 00:18:58,080
weren't actually significantly 
different. 

383
00:18:58,080 --> 00:19:01,200
It was only until I actually 
made them hop that I started 

384
00:19:01,200 --> 00:19:02,840
seeing differences. 
And then I felt dumb because I 

385
00:19:02,840 --> 00:19:05,360
just did concentric and 
eccentric and I didn't do like a

386
00:19:05,360 --> 00:19:07,720
drop jump test, which now I'm 
much more familiar with going, 

387
00:19:08,320 --> 00:19:10,280
yeah, why didn't I do that? 
So I was just curious from a, 

388
00:19:10,320 --> 00:19:12,320
from one of the experts to go, 
hey, is there something I need 

389
00:19:12,320 --> 00:19:14,640
to be paying attention to more? 
I mean, I think hearing, I don't

390
00:19:14,640 --> 00:19:16,840
know is is is also. 
Yeah. 

391
00:19:16,840 --> 00:19:19,520
I mean, I think one of the 
things that we really looked at 

392
00:19:19,520 --> 00:19:23,360
and I, I work, you know, 
sometimes with a lot of elite 

393
00:19:23,360 --> 00:19:27,280
runners and things too, and you 
tell them to do heel rises and 

394
00:19:27,280 --> 00:19:29,400
they don't listen to the pain or
whatever. 

395
00:19:29,400 --> 00:19:33,600
But one of the things that they 
send me and I get videos of is 

396
00:19:33,760 --> 00:19:35,840
hopping. 
I want you to do single leg 

397
00:19:35,840 --> 00:19:38,480
hopping on the injured side and 
single leg hopping on the other 

398
00:19:38,480 --> 00:19:40,400
side. 
And The thing is, what we 

399
00:19:40,400 --> 00:19:42,640
haven't talked about, maybe we 
can address too. 

400
00:19:42,640 --> 00:19:45,040
Like I describe it to people 
when you're thinking about a 

401
00:19:45,040 --> 00:19:47,480
healthy tendon, a healthy tendon
is like a basketball. 

402
00:19:47,480 --> 00:19:49,200
I don't know if you heard my 
analogy, but it's like a 

403
00:19:49,200 --> 00:19:52,240
basketball with good air, right?
So you're bouncing that 

404
00:19:52,240 --> 00:19:54,160
basketball up and down it coming
up. 

405
00:19:54,160 --> 00:19:55,760
You don't need to use a lot of 
energy. 

406
00:19:55,760 --> 00:19:57,840
So the muscle doesn't need to 
use a lot of energy. 

407
00:19:58,440 --> 00:20:00,040
The basketball is bouncing up 
and down. 

408
00:20:00,040 --> 00:20:02,920
But when you have an injured 
tendon, you're starting, it's 

409
00:20:02,920 --> 00:20:04,880
like having a basketball with 
less air, right? 

410
00:20:04,880 --> 00:20:06,600
You can still bounce it up and 
down. 

411
00:20:06,600 --> 00:20:09,040
You can still have the strength.
You can still do it, but now you

412
00:20:09,040 --> 00:20:12,040
need a lot of energy to kind of 
bounce it up and down. 

413
00:20:12,040 --> 00:20:15,640
And if what you can do single 
leg hopping just visually and we

414
00:20:15,640 --> 00:20:19,280
can measure it too with, with 
jump height and contact time. 

415
00:20:19,280 --> 00:20:21,640
But what you can see is like 
they're jumping one leg, they're

416
00:20:21,640 --> 00:20:24,040
jumping on like a flat. 
Tendon, right? 

417
00:20:24,040 --> 00:20:26,880
It's like they need a lot more 
so the shoulders jump up with 

418
00:20:26,880 --> 00:20:29,680
every hop, but on the leg that 
they have a healthy tendon 

419
00:20:29,960 --> 00:20:32,960
shoulders and things are relaxed
and they can just kind of bounce

420
00:20:33,000 --> 00:20:35,120
on the ankle, right. 
So that's one of the things that

421
00:20:35,120 --> 00:20:39,680
we really use and I used a lot 
when I consulted people. 

422
00:20:39,680 --> 00:20:42,640
It's like, oh, can you help me 
or send me a send me a video of 

423
00:20:42,640 --> 00:20:44,800
you hopping and I can tell you 
what's going on. 

424
00:20:44,800 --> 00:20:48,920
Like those kind of things too. 
And do you have the, is it like 

425
00:20:48,920 --> 00:20:51,080
a Pogo hop where you're like 
having them hop in place? 

426
00:20:51,080 --> 00:20:52,560
Is it a forward hop? 
Does it matter? 

427
00:20:52,560 --> 00:20:54,760
OK, got it. 
We do, we do the Pogo hop just 

428
00:20:54,760 --> 00:20:57,480
up and down on one, one leg 
because it's easiest to see too,

429
00:20:57,480 --> 00:21:00,200
right? 
There might be some more forward

430
00:21:00,200 --> 00:21:02,320
and we've seen some other 
loading, but it's, you know, 

431
00:21:02,560 --> 00:21:05,320
sometimes you have to. 
I think we go back to the sync 

432
00:21:05,320 --> 00:21:09,160
simple thing, paint on palpation
and hopping qualities like back 

433
00:21:09,160 --> 00:21:11,240
to basics and you can tell a lot
from that. 

434
00:21:11,960 --> 00:21:14,680
Yeah, that's fantastic. 
And you, you also started 

435
00:21:14,680 --> 00:21:17,920
mentioning like risk factors for
developing pain in the Achilles.

436
00:21:18,160 --> 00:21:20,840
And you'd also previously talked
about how we always called it 

437
00:21:21,160 --> 00:21:23,720
tendonitis, now we tend to call 
it tendinopathy. 

438
00:21:24,160 --> 00:21:27,760
Can you just talk about what is 
happening at the tendon when 

439
00:21:27,760 --> 00:21:30,600
somebody developing pain there? 
Yeah, I'm trying. 

440
00:21:30,600 --> 00:21:33,320
I'm trying not to get too 
excited and go off track too 

441
00:21:33,320 --> 00:21:35,840
much, right? 
But you know, I can talk about 

442
00:21:35,840 --> 00:21:37,720
this too. 
I can talk about this forever. 

443
00:21:37,720 --> 00:21:41,880
But so basically, I mean, the 
more I learn, the more I feel 

444
00:21:41,880 --> 00:21:44,120
like I have no idea in that kind
of sense too. 

445
00:21:44,120 --> 00:21:47,760
But from the basic perspective 
is thinking about it that the, 

446
00:21:47,960 --> 00:21:50,080
the tendon you're really loading
it, right? 

447
00:21:50,080 --> 00:21:53,520
So you have this kind of tendon 
has turnover and we think maybe 

448
00:21:53,520 --> 00:21:56,960
you have certain areas that have
more turnover than others. 

449
00:21:57,680 --> 00:22:00,560
But a healthy tendon doesn't 
require a lot of turnover. 

450
00:22:00,560 --> 00:22:03,080
But as soon as you start 
overloading it and you've kind 

451
00:22:03,080 --> 00:22:05,920
of loaded it in a tendon because
like anything like you, you, you

452
00:22:05,920 --> 00:22:08,960
train not, you don't necessarily
get better from the training, 

453
00:22:08,960 --> 00:22:11,360
You get better from the recovery
from the training, right? 

454
00:22:11,800 --> 00:22:14,760
So when you have the tendon and 
you have the overload and then 

455
00:22:14,760 --> 00:22:18,120
the tendon try to recover and 
the tendon can also get stronger

456
00:22:18,120 --> 00:22:22,200
and bigger and better designed. 
But if you're starting to kind 

457
00:22:22,200 --> 00:22:26,440
of get something that tips you 
over from not having enough 

458
00:22:26,440 --> 00:22:29,640
recovery and that can be the, 
the biggest risk factor is 

459
00:22:29,640 --> 00:22:32,400
training overload and training, 
right, Not having enough 

460
00:22:32,400 --> 00:22:34,560
recovery days. 
You see that in master athletes,

461
00:22:34,560 --> 00:22:35,920
right? 
The ones that had more running 

462
00:22:35,920 --> 00:22:38,240
for a longer period of time, 
they are going to get injured. 

463
00:22:38,640 --> 00:22:41,800
So somehow the tendon can't keep
up for that kind of recovery. 

464
00:22:41,800 --> 00:22:42,880
And that's kind of the big 
thing. 

465
00:22:42,880 --> 00:22:46,720
And when you start doing that, 
you're, you're starting to break

466
00:22:46,720 --> 00:22:49,880
it down and it's probably like a
tipping point when you start 

467
00:22:49,880 --> 00:22:53,360
seeing that there is not enough 
recovery and people can manage 

468
00:22:53,360 --> 00:22:56,600
and then they're tipping over. 
And now you're starting to get 

469
00:22:56,600 --> 00:22:59,440
these changes and the tendons 
become more compliant, like the 

470
00:22:59,440 --> 00:23:01,720
basketball. 
You can start seeing smell 

471
00:23:01,720 --> 00:23:03,960
swelling. 
The tendon is getting bigger, 

472
00:23:03,960 --> 00:23:07,240
more disorganized. 
If the disorgan, when I started,

473
00:23:07,240 --> 00:23:10,160
we thought the disorganization 
was like the, the fibers were 

474
00:23:10,160 --> 00:23:13,040
breaking apart in some areas. 
Now we can more think that they 

475
00:23:13,040 --> 00:23:15,320
are more separating. 
You get swelling and so they 

476
00:23:15,800 --> 00:23:18,880
break apart separation, but 
maybe not in full length. 

477
00:23:18,880 --> 00:23:22,120
So there are some changes and 
swelling might be part of that 

478
00:23:22,120 --> 00:23:23,960
too, right? 
So now you have a tendon that's 

479
00:23:23,960 --> 00:23:26,720
like more compliant, you see 
more fluid. 

480
00:23:26,720 --> 00:23:30,440
You can see ingrown blood 
vessels and kind of things in 

481
00:23:30,440 --> 00:23:32,800
that area. 
So that that when you're looking

482
00:23:32,800 --> 00:23:35,640
at that with imaging or do 
biopsies and things to see, 

483
00:23:35,640 --> 00:23:38,560
that's what we call tendinosis. 
It used to be called tendonitis,

484
00:23:38,560 --> 00:23:42,640
but there's really no high 
activity of acute inflammatory 

485
00:23:42,640 --> 00:23:44,920
process. 
There's always some kind of 

486
00:23:44,920 --> 00:23:47,160
inflammation because we need 
inflammation and it could be 

487
00:23:47,160 --> 00:23:49,320
part of that. 
This process doesn't have enough

488
00:23:49,320 --> 00:23:51,760
inflammation either, right? 
Because inflammation is part of 

489
00:23:51,760 --> 00:23:54,680
kind of the initial and then you
have the recovery. 

490
00:23:54,680 --> 00:23:57,440
So it's kind of those pieces 
when you're kind of thinking 

491
00:23:57,440 --> 00:23:59,440
about that, you have it as a 
tipping point. 

492
00:23:59,440 --> 00:24:01,720
And I think what's important 
when we're thinking of people 

493
00:24:02,040 --> 00:24:05,640
training is the key one that we 
see that especially runners and 

494
00:24:05,640 --> 00:24:07,560
things too, they don't have a 
lot of other things. 

495
00:24:07,560 --> 00:24:10,760
But it also what we've learned 
in our studies too is that there

496
00:24:10,760 --> 00:24:14,640
are other things that might give
you the tipping point, which is 

497
00:24:14,920 --> 00:24:18,040
metabolic risk factors, right 
people, pre diabetes, 

498
00:24:18,040 --> 00:24:21,200
cholesterol. 
So there's a lot of other things

499
00:24:21,200 --> 00:24:25,360
that might also 'cause somebody 
to have that kind of not 

500
00:24:25,360 --> 00:24:29,280
tolerate the normal running. 
It could be you're have a runner

501
00:24:29,280 --> 00:24:33,800
and then they've been sick, the 
body is not recovering as well 

502
00:24:33,800 --> 00:24:36,800
and the training the same. 
So some of those kind of things,

503
00:24:36,800 --> 00:24:40,040
you can really see what went on 
on the tangent again, sorry. 

504
00:24:40,560 --> 00:24:42,360
That's great. 
No, no, this is great. 

505
00:24:42,360 --> 00:24:44,680
This is great. 
Not a tangent. 

506
00:24:44,680 --> 00:24:47,120
It was beautiful. 
What do you think when it comes 

507
00:24:47,120 --> 00:24:50,080
to, you mentioned a couple risk 
factors already, the calf 

508
00:24:50,080 --> 00:24:52,400
strength being one of them, 
training errors being another 

509
00:24:52,400 --> 00:24:53,840
one. 
Are there other things? 

510
00:24:53,840 --> 00:24:55,880
And I guess you just talked 
about metabolic conditions too. 

511
00:24:55,880 --> 00:24:58,040
Are there any others that if 
people are, because a lot of 

512
00:24:58,040 --> 00:25:00,480
people listen to this are like, 
OK, I don't want this to happen 

513
00:25:00,480 --> 00:25:02,760
to me, How can I minimize my 
risk factors? 

514
00:25:02,760 --> 00:25:05,720
Are there any other of those 
kind of controllable risk 

515
00:25:05,720 --> 00:25:08,920
factors that you know of that 
would be good for people to 

516
00:25:08,920 --> 00:25:10,640
think about? 
I mean, I think there are, we're

517
00:25:10,640 --> 00:25:13,800
really concerned with certain 
medications, right? 

518
00:25:13,800 --> 00:25:16,480
We've always been 
fluoroquinolones and ruptures. 

519
00:25:16,600 --> 00:25:19,680
I have somebody now that looked 
at it too and maybe it's not 

520
00:25:19,680 --> 00:25:22,920
quite as bad, but some people 
can react to fluoroquinolones 

521
00:25:23,240 --> 00:25:26,400
within 8 days and increase the 
risk of ruptures, right? 

522
00:25:26,400 --> 00:25:29,840
So that is a it's an immediate 
and some people don't have that 

523
00:25:29,840 --> 00:25:31,800
kind of change. 
So some of the medications might

524
00:25:31,800 --> 00:25:35,440
affecting the health of the 
tendon and people are, you know,

525
00:25:35,440 --> 00:25:40,880
people with other comorbidities 
and diseases obviously affect 

526
00:25:40,880 --> 00:25:43,000
the tendon. 
You see that lesson in the in 

527
00:25:43,000 --> 00:25:45,000
the runners. 
But even when you talked about 

528
00:25:45,000 --> 00:25:48,440
the masters runners too, right, 
being able to control things 

529
00:25:48,440 --> 00:25:51,480
like cholesterol and and pre 
diabetes is what we're really 

530
00:25:51,480 --> 00:25:53,960
interested in right now and 
looking at might be really 

531
00:25:53,960 --> 00:25:56,960
really, you know, of relevance. 
But then the other thing for the

532
00:25:56,960 --> 00:26:01,360
key for the runners is we 
probably don't have enough 

533
00:26:01,440 --> 00:26:03,360
recovery. 
I think that that's the key, 

534
00:26:03,360 --> 00:26:07,000
right, You and that it one of 
the things I've seen with the 

535
00:26:07,240 --> 00:26:11,280
with the elite, with the elite 
runners or the elite athletes is

536
00:26:11,840 --> 00:26:13,440
thinking about this basketball, 
right? 

537
00:26:13,440 --> 00:26:16,720
You have a basketball now and 
not bouncing, meaning you were 

538
00:26:16,720 --> 00:26:20,400
running and you're now and 
you're like, I'm not doing as 

539
00:26:20,400 --> 00:26:22,840
well as I did. 
Like I'm, I'm half a second 

540
00:26:22,840 --> 00:26:25,680
slower or I'm not getting the 
time. 

541
00:26:25,680 --> 00:26:29,080
And and the problem is people 
then train more instead of 

542
00:26:29,080 --> 00:26:31,720
recovery, right? 
So now you're going to run. 

543
00:26:31,840 --> 00:26:34,840
Yeah, you're going to do more 
and more and more and then 

544
00:26:35,080 --> 00:26:37,200
you're getting worse and worse 
and worse, right? 

545
00:26:37,200 --> 00:26:39,680
So instead of thinking about 
like when, you know, if I'm 

546
00:26:39,680 --> 00:26:43,000
going down, I need to recover 
and I need to take more time. 

547
00:26:43,000 --> 00:26:46,960
And I think for me, working with
a lot of runners is me telling 

548
00:26:46,960 --> 00:26:50,960
them you will be fine not 
running 10 miles a day, right? 

549
00:26:51,360 --> 00:26:54,240
Take the recovery time. 
And I think that goes in with 

550
00:26:54,240 --> 00:26:56,400
the other, with the other risk 
factors, right? 

551
00:26:56,400 --> 00:27:00,040
Because you need to sleep all 
the students, you need to sleep,

552
00:27:00,080 --> 00:27:03,280
eat, you know, rest. 
All of those are equally 

553
00:27:03,280 --> 00:27:06,920
important, not just the running.
I think that's it's absolutely 

554
00:27:06,920 --> 00:27:09,720
the hardest thing with runners 
to kind of figure out, I think. 

555
00:27:10,520 --> 00:27:12,760
Yeah, absolutely. 
That's great. 

556
00:27:12,760 --> 00:27:16,280
And now that's kind of shift 
from the like preventative side 

557
00:27:16,280 --> 00:27:19,960
to like, hey, now I know I have 
this or I think I have this 

558
00:27:19,960 --> 00:27:22,560
because I have pain when I 
squeeze my Achilles. 

559
00:27:22,560 --> 00:27:24,400
It hurts to run, it hurts to 
jump, whatever. 

560
00:27:25,280 --> 00:27:28,160
What kind of things can people 
do for this? 

561
00:27:28,160 --> 00:27:30,720
What's kind of the best practice
for management? 

562
00:27:30,960 --> 00:27:34,880
And you can kind of circle in 
when can people work on this on 

563
00:27:34,880 --> 00:27:37,160
their own versus when do they 
need to see somebody to help 

564
00:27:37,160 --> 00:27:38,600
them out in your perspective on 
that? 

565
00:27:39,360 --> 00:27:41,640
Yeah, I, I looked at you had 
sent that to me too. 

566
00:27:41,640 --> 00:27:43,920
And I'm really thinking about it
too, because we just finished a 

567
00:27:43,920 --> 00:27:47,120
study, I don't know if you saw 
that with Adam 1040 in, in 

568
00:27:47,120 --> 00:27:49,160
Boston. 
And we finished a study looking 

569
00:27:49,160 --> 00:27:52,840
at, you know, our exercise 
program that we've done and the 

570
00:27:52,840 --> 00:27:56,960
pain pain monitoring model along
with Shockwave and those kind of

571
00:27:56,960 --> 00:27:58,640
things too. 
We can talk specifically about 

572
00:27:58,640 --> 00:28:01,520
the results too. 
But a lot of that was also 

573
00:28:01,920 --> 00:28:05,160
managed on their own, like they 
had a few visits with a physical

574
00:28:05,160 --> 00:28:07,200
therapist and managed on their 
own, right. 

575
00:28:07,200 --> 00:28:11,640
And what we do in my practice, 
I, I would say in one of the 

576
00:28:11,640 --> 00:28:15,400
studies we've finished now, I 
probably see the patients 8 to 

577
00:28:15,400 --> 00:28:19,760
12 times, but that's not twice a
week for, you know, for a 

578
00:28:19,760 --> 00:28:22,440
certain period of time that's 
usually across over a year. 

579
00:28:22,640 --> 00:28:26,240
So having said that, right, So I
think a lot of this because this

580
00:28:26,240 --> 00:28:29,760
there is no quick fix, right? 
There is none of those things. 

581
00:28:29,760 --> 00:28:33,480
So I do think I would argue that
everybody, I mean, I, I treat 

582
00:28:33,480 --> 00:28:37,320
people sometimes via e-mail or 
talk to them and via Zoom and 

583
00:28:37,320 --> 00:28:40,040
those kind of things too. 
But I would argue that the best 

584
00:28:40,040 --> 00:28:44,280
practice would be to go and see 
somebody that is well versed in 

585
00:28:44,280 --> 00:28:47,040
in running injuries and Achilles
and Neopathy because you want to

586
00:28:47,040 --> 00:28:50,680
make sure that you somebody can 
evaluate what the differential 

587
00:28:50,680 --> 00:28:52,960
diagnosis these are, right? 
You want to make sure that this 

588
00:28:52,960 --> 00:28:55,280
is the diagnosis. 
Once you're sure that this is 

589
00:28:55,280 --> 00:29:00,360
the diagnosis and somebody can 
measure where are your deficits?

590
00:29:00,360 --> 00:29:03,360
Are there any other things that 
kind of thing too, then I think 

591
00:29:03,360 --> 00:29:05,120
you can really start with the 
rehab program. 

592
00:29:05,120 --> 00:29:07,880
But we can get into specifically
what the rehab program because 

593
00:29:07,880 --> 00:29:12,240
the tendon, the tendon needs 
loading to recover and the 

594
00:29:12,240 --> 00:29:15,560
running loading is that really 
fast, high speed, it's a little 

595
00:29:15,560 --> 00:29:16,600
different. 
And when you're going to 

596
00:29:16,600 --> 00:29:19,920
stimulate the cells to recover, 
you want to do this heavier 

597
00:29:19,920 --> 00:29:22,560
strengthening. 
You want to strain the tendon 

598
00:29:22,560 --> 00:29:25,800
over time to kind of activate 
the cells to recover. 

599
00:29:26,360 --> 00:29:28,600
So the training program is 
strengthening and then it's 

600
00:29:28,600 --> 00:29:32,040
really trying to figure out how 
do we moderate the, the loading.

601
00:29:32,040 --> 00:29:33,880
So you have recovery and things 
too. 

602
00:29:34,200 --> 00:29:37,680
And a lot of that we do with 
training Diaries like we, we, 

603
00:29:37,840 --> 00:29:41,040
it's more like, I think the 
question kind of is when do you 

604
00:29:41,040 --> 00:29:44,320
can you do it on your own and 
when can you have help, right? 

605
00:29:44,320 --> 00:29:46,800
It's the same thing as like, if 
I'm going to be a good runner, 

606
00:29:46,800 --> 00:29:49,840
when do I need a running coach 
and when do I not need a running

607
00:29:49,840 --> 00:29:51,560
coach? 
A little bit of that is kind of 

608
00:29:51,560 --> 00:29:53,720
the same, right? 
But having somebody that guides 

609
00:29:53,720 --> 00:29:57,000
you and I've had people with 
Achilles centinopathy and 

610
00:29:57,000 --> 00:30:00,160
runners and they do really well.
And then they've kind of stopped

611
00:30:00,160 --> 00:30:02,440
doing their exercises. 
And then they started running 

612
00:30:02,440 --> 00:30:04,920
and they hurt and they called me
and can you, can I come back to 

613
00:30:04,920 --> 00:30:06,240
you? 
So you tell me to do the 

614
00:30:06,240 --> 00:30:08,480
exercises. 
I'm like, well, you know, but 

615
00:30:08,480 --> 00:30:10,880
it's like, I, I need you to tell
me. 

616
00:30:10,880 --> 00:30:15,320
And we do training Diaries too. 
So we're very adamant about you 

617
00:30:15,320 --> 00:30:18,880
write down what exercises did 
you do, did, how was your 

618
00:30:18,880 --> 00:30:22,880
morning pain, worst pain, How 
much running did you do? 

619
00:30:22,880 --> 00:30:26,920
And then I really look at that. 
I still use paper ones, but I 

620
00:30:26,920 --> 00:30:29,520
really look at that like I have.
The template that you gave us. 

621
00:30:29,560 --> 00:30:31,360
Except I still use that 
template, right? 

622
00:30:31,360 --> 00:30:34,960
Because it's, it's not what you 
did today that relates to the 

623
00:30:34,960 --> 00:30:36,880
pain. 
It's like the pattern over the 

624
00:30:36,880 --> 00:30:39,960
weeks that helps me guide, 
especially for runners. 

625
00:30:39,960 --> 00:30:42,040
It's like, OK, you want to run 
20 mile. 

626
00:30:42,320 --> 00:30:44,960
I think we can do it this day, 
but then you need 2 recovery 

627
00:30:44,960 --> 00:30:46,520
days. 
And then we can get a shorter, 

628
00:30:46,520 --> 00:30:50,680
faster run in like starting to 
build that puzzle together. 

629
00:30:50,680 --> 00:30:53,840
And I, you know, I'm not that 
I'm not a running coach, but I 

630
00:30:53,840 --> 00:30:57,640
do work on those pieces and then
I work with the running coaches 

631
00:30:57,640 --> 00:31:00,720
and the runner to try to kind of
figure out the pattern. 

632
00:31:01,440 --> 00:31:04,000
That's great. 
And I want to actually, if 

633
00:31:04,000 --> 00:31:06,120
you're up for diving a little 
deeper on one of the things you 

634
00:31:06,120 --> 00:31:08,840
mentioned, you said the type of 
loading that you get from 

635
00:31:08,840 --> 00:31:12,320
running is different than the 
heavier resistance training, 

636
00:31:12,320 --> 00:31:16,560
slower movements and one of them
stimulates the kind of 

637
00:31:16,560 --> 00:31:18,040
regeneration of the tendon, the 
other one doesn't. 

638
00:31:18,040 --> 00:31:19,960
Can you just talk about the why 
behind that and what's 

639
00:31:19,960 --> 00:31:21,200
happening? 
Yeah. 

640
00:31:21,200 --> 00:31:23,400
I mean, I mean, you have to ask 
the tendon if you want to know 

641
00:31:23,400 --> 00:31:29,880
the why, but I don't know, maybe
it's something it's something in

642
00:31:29,880 --> 00:31:32,640
the design. 
No, but I but I think if you're 

643
00:31:33,920 --> 00:31:38,440
sorry it's late here, my watch, 
my watch already put me to 

644
00:31:38,440 --> 00:31:40,640
sleep. 
So it said you're in sleep mode.

645
00:31:42,920 --> 00:31:45,520
The basically if you're thinking
about it too, right, it's the 

646
00:31:45,720 --> 00:31:49,440
you have the cells like actually
sits within the collagen and 

647
00:31:49,440 --> 00:31:51,440
things too. 
And what we've seen and Aram 

648
00:31:51,440 --> 00:31:54,280
Putzas in, in Europe is done a 
lot of the studies and healthy, 

649
00:31:54,280 --> 00:31:59,240
like what kind of load builds 
the tendon to be bigger and 

650
00:31:59,240 --> 00:32:01,120
stronger. 
And that seems to be that if 

651
00:32:01,120 --> 00:32:04,240
you're loading with heavier 
load, you're going to strain a 

652
00:32:04,240 --> 00:32:08,880
little bit more, you'll probably
get more activity from the cells

653
00:32:09,160 --> 00:32:11,200
and they're going to respond to 
that, right? 

654
00:32:11,200 --> 00:32:14,080
Versus running. 
Is that really fast loading? 

655
00:32:14,080 --> 00:32:17,360
They probably need to train too.
But it's a very different input.

656
00:32:17,360 --> 00:32:21,640
And the way I, I put it in 
perspective and for my patients 

657
00:32:21,640 --> 00:32:24,200
is it's like, you know, have you
seen a, you know, have you seen 

658
00:32:24,200 --> 00:32:26,680
a weight lifter or a bodybuilder
or whatever? 

659
00:32:26,760 --> 00:32:29,160
And like, yeah, have you seen a 
marathon runner? 

660
00:32:29,280 --> 00:32:31,600
It's like, yeah, they look very 
different, right? 

661
00:32:31,800 --> 00:32:35,920
So they train very different. 
They both train the same amount,

662
00:32:36,160 --> 00:32:39,000
but how they train matter for 
the response, right? 

663
00:32:39,000 --> 00:32:40,760
And I think it's the same for 
the tendon. 

664
00:32:40,760 --> 00:32:44,320
If you want the tendon to be 
stronger and bigger and tolerate

665
00:32:44,320 --> 00:32:48,240
more, you need to do the kind of
strength training to let it do 

666
00:32:48,240 --> 00:32:51,000
that. 
And then if in order for it to 

667
00:32:51,000 --> 00:32:53,960
tolerate like the quicker load 
and things too, then you do the 

668
00:32:53,960 --> 00:32:56,520
running or you do the 
plyometrics and those kind of 

669
00:32:56,520 --> 00:32:57,960
things too. 
So I think that's how we're 

670
00:32:57,960 --> 00:33:00,560
looking from the tendon. 
And then I also learned that 

671
00:33:00,560 --> 00:33:03,600
there's a muscle too, right? 
Then the muscle needs more of 

672
00:33:03,600 --> 00:33:06,680
that heavier load to kind of 
build as well, right? 

673
00:33:06,680 --> 00:33:11,160
The muscle needs to be loaded 
enough for it to respond to get 

674
00:33:11,160 --> 00:33:12,720
stronger. 
And we know that the weakness 

675
00:33:12,720 --> 00:33:16,080
might be the problem. 
And I think when I, with the 

676
00:33:16,080 --> 00:33:19,440
runners that I've worked with, 
sometimes given the idea that 

677
00:33:19,440 --> 00:33:22,480
heavier strengthening is going 
to be a really beneficial part 

678
00:33:22,480 --> 00:33:25,240
of the rehab is hard to swallow 
or process because they are 

679
00:33:25,240 --> 00:33:29,200
like, I don't need heavy 
strengthening to be able to do 

680
00:33:29,200 --> 00:33:31,640
the activity that I want to do. 
And so I think it's helpful to 

681
00:33:31,640 --> 00:33:34,440
think about the why behind it. 
So that's why I wanted you to go

682
00:33:34,440 --> 00:33:39,440
into, OK, it's, it's a timestamp
to stimulate regeneration or 

683
00:33:39,440 --> 00:33:43,040
stimulate cells in a way that 
help them with your recovery 

684
00:33:43,040 --> 00:33:45,120
process. 
And it's also not going to bulk 

685
00:33:45,120 --> 00:33:46,840
you up. 
That's, you know, because that's

686
00:33:46,840 --> 00:33:49,040
sometimes the fear is like, oh, 
I'm going to bulk up from this. 

687
00:33:49,040 --> 00:33:51,200
And and I think decreased 
running economy. 

688
00:33:51,440 --> 00:33:53,200
Yeah. 
And I, and I think that's, you 

689
00:33:53,200 --> 00:33:55,760
know, really, really important 
to think about because 

690
00:33:55,760 --> 00:33:58,400
especially as you say, you go by
Matthew or Matt. 

691
00:33:59,800 --> 00:34:02,800
It is you both OK Matt for 
easier I'm. 

692
00:34:03,040 --> 00:34:05,360
Going to go by Matt, if you're 
talking about Matt master 

693
00:34:05,360 --> 00:34:08,639
runners or others too, right? 
If you're talking about you're 

694
00:34:08,639 --> 00:34:10,719
testing them and then don't not 
weak. 

695
00:34:10,800 --> 00:34:13,400
And then you're telling to do 
heel rises and they're like, 

696
00:34:13,400 --> 00:34:16,440
well, why do I need to do that? 
So I think it's really important

697
00:34:16,440 --> 00:34:19,600
to no, no, no, no. 
The heel rises for you is 

698
00:34:19,600 --> 00:34:23,239
medication to your tendon and 
you don't do that just a little 

699
00:34:23,239 --> 00:34:26,239
bit like if I'm giving you blood
pressure medication, you take 

700
00:34:26,239 --> 00:34:28,800
that every day, you don't stop 
and your blood pressure goes 

701
00:34:28,800 --> 00:34:30,679
down, right? 
It's something that you 

702
00:34:30,679 --> 00:34:33,920
continue. 
So the exercise is to kind of 

703
00:34:33,920 --> 00:34:37,360
address the tendon and then we 
can design it to help the muscle

704
00:34:37,360 --> 00:34:40,040
and things too, right? 
But that's really what it's for 

705
00:34:40,040 --> 00:34:43,440
and that's for me, it's really 
critical to kind of give the 

706
00:34:43,440 --> 00:34:46,400
tendon that medication on a 
consistent basis and we can talk

707
00:34:46,400 --> 00:34:47,920
about what's the best way to do 
it. 

708
00:34:47,920 --> 00:34:51,600
It's probably a ton of different
ways, but the tendon needs the 

709
00:34:51,679 --> 00:34:55,960
loading to get the medication. 
And my especially for runners 

710
00:34:55,960 --> 00:34:58,600
and others too, is like, you 
need to give that medication at 

711
00:34:58,600 --> 00:35:01,320
least for a year after the 
symptoms were gone. 

712
00:35:01,320 --> 00:35:04,680
Like you're not recovered until 
you've had no pain for a year. 

713
00:35:04,680 --> 00:35:06,520
You just got to keep on doing 
that. 

714
00:35:06,520 --> 00:35:08,880
And people don't do calf raises,
right? 

715
00:35:08,880 --> 00:35:10,560
It's like that's what you need 
it for running. 

716
00:35:10,560 --> 00:35:13,160
What are you going to do? 
Quads and little biceps? 

717
00:35:13,160 --> 00:35:16,520
And so it looks good. 
I, I mean, it's like, I, I do 

718
00:35:16,520 --> 00:35:20,520
this for NFL, talk to NFL and 
NBA and you know, he's talking 

719
00:35:20,520 --> 00:35:22,720
to strength and conditioning 
coaches and how are we going to 

720
00:35:22,720 --> 00:35:25,080
prevent Achilles and rupture? 
I'm like, well, how many of you 

721
00:35:25,080 --> 00:35:28,440
do heel rises when you go into 
the gym and you get like 10% say

722
00:35:28,440 --> 00:35:30,880
yes, right. 
So I think that is that. 

723
00:35:30,880 --> 00:35:33,280
That to me is, well, that's my 
pet peeve, clearly. 

724
00:35:35,920 --> 00:35:38,120
I think, I think to add it, you 
got me on this because normal 

725
00:35:38,120 --> 00:35:39,880
I'll tell patients, especially 
the masters that I'm working 

726
00:35:39,880 --> 00:35:43,000
with is like, I will. 
The one of the reasons I'm doing

727
00:35:43,000 --> 00:35:46,360
heavier dosaging is a based on 
the literature of knowing, like 

728
00:35:46,360 --> 00:35:49,040
you talked about that that tends
to make more tissue changes. 

729
00:35:49,040 --> 00:35:52,120
We're trying to change tendons. 
They respond, the cells respond 

730
00:35:52,120 --> 00:35:55,400
much better to those slower kind
of higher strain rates. 

731
00:35:55,680 --> 00:35:57,760
But the other thing I'll tell 
people is I want you lifting 

732
00:35:57,760 --> 00:36:00,560
heavy enough that you can only 
do like four or five of these 

733
00:36:00,560 --> 00:36:02,160
and they're like, Oh well, how 
much should I be lifting? 

734
00:36:02,160 --> 00:36:04,800
Like you only need to do a 
couple sets of this and you're 

735
00:36:04,800 --> 00:36:06,080
done. 
It should take you like less 

736
00:36:06,080 --> 00:36:08,360
than 5 minutes. 
And runners who only want to run

737
00:36:08,360 --> 00:36:10,360
like, wait, I don't have to do 
this for a couple minutes. 

738
00:36:10,360 --> 00:36:12,920
I'm like, that's it. 
But then I think you got me. 

739
00:36:12,920 --> 00:36:15,360
Whereas I've normally told 
people based on some literature 

740
00:36:15,360 --> 00:36:17,080
that I read, I think I'd missed 
this. 

741
00:36:17,080 --> 00:36:21,400
That usual tip of you need to do
is at a minimum of nine months 

742
00:36:21,680 --> 00:36:24,600
from when it started. 
Even though we know, and I'm 

743
00:36:24,600 --> 00:36:27,520
sure you'll correct me on this, 
that usually a tendinopathy has 

744
00:36:27,520 --> 00:36:28,920
been going on way longer than 
that. 

745
00:36:28,920 --> 00:36:31,680
You can have a tendinopathy and 
actually not have any symptoms 

746
00:36:32,040 --> 00:36:33,760
and like what is it? 
I think they have is like 50% of

747
00:36:33,760 --> 00:36:36,600
runners have tendinopathy in at 
least one Achilles tendon even 

748
00:36:36,600 --> 00:36:40,480
if they don't have symptoms. 
But what I heard you say was you

749
00:36:40,480 --> 00:36:44,320
need to do it from a year when 
it you actually your symptoms 

750
00:36:44,320 --> 00:36:47,800
resolve that I did not know. 
Could you elaborate that? 

751
00:36:47,800 --> 00:36:50,000
Sorry, Nate to interrupt, but 
could I could you elaborate that

752
00:36:50,000 --> 00:36:52,480
in a little bit because I did 
not know that and I like that. 

753
00:36:52,480 --> 00:36:55,800
And I, and I would say, you 
know, I would be calling the 

754
00:36:55,800 --> 00:36:58,480
tendinosis if this tendon is 
changing, if they don't have the

755
00:36:58,480 --> 00:37:01,080
pain, right, like, you know, go 
back and forth and people go 

756
00:37:01,080 --> 00:37:02,560
back and forth that pain for 10 
years. 

757
00:37:02,560 --> 00:37:04,440
But it's not like they're 
completely painful. 

758
00:37:04,440 --> 00:37:08,720
They, they kind of fluctuate in 
that kind of metabolic range 

759
00:37:08,720 --> 00:37:10,840
too. 
But I, I, and, and, and I've 

760
00:37:10,840 --> 00:37:13,920
been very adamant about this. 
And, and, and you know, what is 

761
00:37:13,920 --> 00:37:16,560
my evidence? 
I don't know, I think it sounds 

762
00:37:16,560 --> 00:37:19,760
good, but part of it is also 
when working with with the 

763
00:37:19,760 --> 00:37:23,960
runners and elite athletes, it's
like you, I see every single 

764
00:37:23,960 --> 00:37:29,120
time they start feeling better, 
they stop with the exercises and

765
00:37:29,120 --> 00:37:31,880
they're doing fine and they're 
increasing the running and then 

766
00:37:31,880 --> 00:37:34,480
it's coming back again. 
I'm like, you need to continue. 

767
00:37:34,480 --> 00:37:36,760
You need to have this 
consistency. 

768
00:37:37,120 --> 00:37:39,840
And I think it's part, I think, 
I think I do really think it's 

769
00:37:39,840 --> 00:37:41,440
like a medication for the 
tendon. 

770
00:37:41,800 --> 00:37:45,040
And I also think it is, you 
know, making sure that the 

771
00:37:45,040 --> 00:37:48,800
muscles are strong, keeping that
path moving forward. 

772
00:37:49,080 --> 00:37:51,920
And it could also be 
psychological or just a reminder

773
00:37:51,920 --> 00:37:54,240
of thinking about that this is 
important to do. 

774
00:37:54,240 --> 00:37:57,280
But I do think that we are 
missing the laugh a lot. 

775
00:37:57,280 --> 00:38:00,560
And I think that's to me has 
always been like you, you need 

776
00:38:00,560 --> 00:38:01,960
to make sure that you're doing 
it. 

777
00:38:01,960 --> 00:38:06,520
And I and the, the the greatest,
one of the greatest risk factors

778
00:38:06,520 --> 00:38:09,920
to having Achilles tendonopathy 
is having had it before, right? 

779
00:38:10,160 --> 00:38:12,520
And to me it's like, no, that 
you weren't injured, you didn't 

780
00:38:12,520 --> 00:38:15,480
re injure, you just reoccurred 
because you didn't, you didn't 

781
00:38:15,480 --> 00:38:18,120
follow through the whole way. 
Right. 

782
00:38:19,640 --> 00:38:22,120
You didn't finish with the 
actual and and how much tissue 

783
00:38:22,120 --> 00:38:22,880
change? 
I don't know. 

784
00:38:22,880 --> 00:38:24,920
You may be able to tell me, but 
like you didn't finish with the 

785
00:38:24,920 --> 00:38:27,800
actual point of actually getting
some real tissue change rather 

786
00:38:27,800 --> 00:38:28,960
than just symptom. 
Exactly. 

787
00:38:29,040 --> 00:38:31,040
Those are two completely 
separate things. 

788
00:38:31,040 --> 00:38:33,800
Yes. 
I think people would love to 

789
00:38:33,800 --> 00:38:36,680
hear a little bit more about the
study that you just kind of 

790
00:38:36,680 --> 00:38:40,240
finished up and what was some of
the protocol that you can talk 

791
00:38:40,240 --> 00:38:42,280
about that the people went 
through in the study. 

792
00:38:42,280 --> 00:38:47,280
And then we can even talk about 
some of the other modality ways 

793
00:38:47,320 --> 00:38:49,240
that you treated as well and 
kind of what that looked like 

794
00:38:49,240 --> 00:38:51,880
for results. 
Well, I think so taking a step 

795
00:38:51,880 --> 00:38:55,040
back, like if this kind of 
started with with my PhD and we 

796
00:38:55,040 --> 00:38:57,840
kind of developed and we haven't
gotten that fancy and it still 

797
00:38:57,840 --> 00:39:01,800
works, right. 
So basically what we're doing, 

798
00:39:01,800 --> 00:39:04,360
and this is my joke a lot of 
times too, because I'm from 

799
00:39:04,360 --> 00:39:06,880
Sweden, but you know, Hokan 
Alfreson within the eccentric 

800
00:39:06,880 --> 00:39:10,200
protocol, he's from northern 
Sweden, I'm from Malmore, 

801
00:39:10,240 --> 00:39:12,360
southern Sweden. 
And then you have the Danes 

802
00:39:12,360 --> 00:39:14,680
starting with a heavy slow 
resistance training. 

803
00:39:15,360 --> 00:39:18,480
So I, I think when you live in 
northern Sweden, you exercise 

804
00:39:18,480 --> 00:39:20,840
twice a day because you have 
nothing else to do when you live

805
00:39:20,840 --> 00:39:25,480
up there in, in my program, we 
exercise daily. 

806
00:39:25,480 --> 00:39:28,720
So we just do the heel rises 
daily kind of program. 

807
00:39:28,720 --> 00:39:31,840
And then the Danes do it three 
times a week with heavier load 

808
00:39:31,840 --> 00:39:36,560
is because the Danes are lazy. 
So that's kind of no, but I. 

809
00:39:37,360 --> 00:39:39,360
I love it. 
But I think the interesting 

810
00:39:39,360 --> 00:39:42,960
thing is that we are not that 
difference in the outcomes, 

811
00:39:43,280 --> 00:39:44,800
right. 
So I don't also think you need 

812
00:39:44,800 --> 00:39:47,600
to think about this like so you 
need to do the heel rises. 

813
00:39:47,600 --> 00:39:51,560
So we do when we start, we do 
daily heel rises. 

814
00:39:51,560 --> 00:39:55,280
So we do bilateral single, we 
can do some eccentric to kind of

815
00:39:55,280 --> 00:39:59,040
get that daily load. 
And then when we kind of 

816
00:39:59,040 --> 00:40:02,280
progress through the faces, 
people can do more heavy maybe 

817
00:40:02,280 --> 00:40:04,760
three times a week. 
Some people do that heavier more

818
00:40:04,760 --> 00:40:07,840
three times a week. 
Some people do daily at home or 

819
00:40:07,840 --> 00:40:11,720
with a backpack at home. 
So, but it doesn't seem to be 

820
00:40:11,720 --> 00:40:16,320
now in the studies and maybe the
extreme heavy load versus the 

821
00:40:16,320 --> 00:40:19,480
moderate low might not be that 
big of a difference when you get

822
00:40:19,480 --> 00:40:21,760
started like so. 
So the key is to do the 

823
00:40:21,760 --> 00:40:23,920
exercises and get some 
consistency. 

824
00:40:24,840 --> 00:40:27,560
And the other thing as you note 
too from our program too, is 

825
00:40:27,560 --> 00:40:31,040
using the pain monitoring model,
which has been influential I 

826
00:40:31,040 --> 00:40:33,880
think from, from abroad from a 
lot of injuries too. 

827
00:40:33,880 --> 00:40:37,200
And it came from my, my PhD 
advisor that started with 

828
00:40:37,280 --> 00:40:40,840
patellofemoral. 
And I think the key is tendons 

829
00:40:40,840 --> 00:40:44,560
don't like rest, right? 
If you don't have any input, 

830
00:40:44,560 --> 00:40:47,440
they're not going to recover. 
And that's actually detrimental 

831
00:40:47,440 --> 00:40:51,080
for tendons to have complete 
rest, especially for tendon that

832
00:40:51,080 --> 00:40:54,680
is pathological and too much is 
kind of negative, right? 

833
00:40:54,680 --> 00:40:58,240
So the problem when I started 
and we talked about my history 

834
00:40:58,240 --> 00:41:00,640
with tendonitis was like, oh, 
you can't have pain. 

835
00:41:00,640 --> 00:41:03,480
We're not doing anything and 
nothing is happening, right? 

836
00:41:03,480 --> 00:41:06,280
So we want to make sure that you
have this load. 

837
00:41:06,280 --> 00:41:07,880
So we have the pain monitoring 
model. 

838
00:41:07,880 --> 00:41:10,880
When we're talking about serious
no pain, 10 is the worst pain 

839
00:41:11,240 --> 00:41:13,400
and zero to 2 is the greenstone,
right? 

840
00:41:13,400 --> 00:41:16,960
And then up to 5 is acceptable. 
When your exercise is in above a

841
00:41:16,960 --> 00:41:20,160
5, then you've done too much. 
And we use that to grade the 

842
00:41:20,160 --> 00:41:23,680
number of running. 
Not necessarily during running, 

843
00:41:23,680 --> 00:41:25,440
because once you start running 
you feel good. 

844
00:41:25,440 --> 00:41:27,600
It's more like what you feel 
like the next day. 

845
00:41:28,200 --> 00:41:30,160
Yeah, exactly. 
The day after it's going to be 

846
00:41:30,160 --> 00:41:33,080
really critical. 
And this has been really working

847
00:41:33,080 --> 00:41:37,080
well into designing both 
exercise program and the sports 

848
00:41:37,080 --> 00:41:39,080
activity. 
And we've seen that if being 

849
00:41:39,080 --> 00:41:41,760
active, following the pain 
monitoring model, you can 

850
00:41:41,760 --> 00:41:45,560
actually continue running while 
you are doing the rehab. 

851
00:41:45,560 --> 00:41:48,560
You just need to really modify 
and give recovery days. 

852
00:41:49,080 --> 00:41:51,960
And I think that that was one of
the studies in my PhD. 

853
00:41:51,960 --> 00:41:54,640
And I think that one of the most
influential things that I've 

854
00:41:54,640 --> 00:41:57,520
done because runners, people 
come like you tell me it's going

855
00:41:57,520 --> 00:41:59,880
to take nine months to a year. 
Like, were you crazy? 

856
00:41:59,880 --> 00:42:01,680
I'm not going to run for that 
long. 

857
00:42:02,320 --> 00:42:04,520
Those runners and golfers are 
the ones that's going to 

858
00:42:04,520 --> 00:42:06,760
threaten you, right, If they 
can't do what they're doing. 

859
00:42:07,000 --> 00:42:09,400
Yeah. 
And maybe Crossfitter like me 

860
00:42:09,400 --> 00:42:11,080
too. 
Like it's, it's like, you know, 

861
00:42:11,080 --> 00:42:15,120
I I got to do this, right? 
So, so I think that the the 

862
00:42:15,200 --> 00:42:18,080
influential is like, no, you can
continue running as long as you 

863
00:42:18,080 --> 00:42:19,880
have the pain below. 
We can start. 

864
00:42:19,880 --> 00:42:22,200
And for some of them is just 
starting half a mile, right. 

865
00:42:22,200 --> 00:42:25,320
But I think it's kind of 
understanding, especially in 

866
00:42:25,320 --> 00:42:27,960
that, Matt, if you work with 
master athletes, right, if they 

867
00:42:27,960 --> 00:42:31,520
stop running, maybe it's good 
for the tendon, but now the 

868
00:42:31,520 --> 00:42:35,240
cartilage like the, the recovery
is going to be extreme if you 

869
00:42:35,240 --> 00:42:39,720
stop everything like you really 
need to have a, a level, the 

870
00:42:39,720 --> 00:42:42,480
body is doing really well. 
So we kind of with the pain 

871
00:42:42,480 --> 00:42:46,000
monitor when you can continue 
doing that with modification 

872
00:42:46,200 --> 00:42:47,760
while you're doing the 
strengthening. 

873
00:42:47,760 --> 00:42:49,800
So the heel rises is going to be
critical. 

874
00:42:50,200 --> 00:42:52,560
And then we can talk about 
little bit about how you're 

875
00:42:52,560 --> 00:42:54,240
doing it. 
Can I, can I take another 

876
00:42:54,240 --> 00:42:56,360
tangent? 
Can I go off on that? 

877
00:42:56,520 --> 00:42:59,360
Yes. 
So, so the thing that we're 

878
00:42:59,360 --> 00:43:01,200
working on, we're working on the
sub tendons too. 

879
00:43:01,200 --> 00:43:03,360
But the other thing that we're 
working on is what I think is 

880
00:43:03,360 --> 00:43:06,800
really interesting is so there's
been them like the heavy slow 

881
00:43:06,800 --> 00:43:09,880
resistance training and the 
moderate resistance training 

882
00:43:09,880 --> 00:43:12,640
from the patellar tendinopathy. 
And I know the Danish group I 

883
00:43:12,640 --> 00:43:16,160
think now is doing and also for 
Achilles like heavy slow versus 

884
00:43:16,160 --> 00:43:18,280
moderate. 
And then people have compared 

885
00:43:18,280 --> 00:43:21,600
our exercise program with, you 
know, this and that all. 

886
00:43:21,800 --> 00:43:25,600
And it's the, the outcomes are 
fairly similar as long as people

887
00:43:25,600 --> 00:43:27,960
are very consistent. 
There's variability between the 

888
00:43:27,960 --> 00:43:30,120
two. 
So I'm really interested. 

889
00:43:30,120 --> 00:43:32,600
It is like when we're training, 
we're talking about we have 

890
00:43:32,600 --> 00:43:36,160
flexor houses longest, which is 
really big after ruptures that 

891
00:43:36,160 --> 00:43:40,120
can compensate and things too. 
So we are now using what's 

892
00:43:40,120 --> 00:43:44,440
called a 10 geometry thanks to 
Stephanie Cone and and Daryl 

893
00:43:44,440 --> 00:43:46,800
Thielen has developed. 
So you can tap the tendon and 

894
00:43:46,800 --> 00:43:49,760
depending on how much tension, 
you can kind of see this wave 

895
00:43:49,760 --> 00:43:51,520
speeds. 
So you can kind of get an idea 

896
00:43:51,520 --> 00:43:54,600
directly what the tension is in 
the tendon instead of using 

897
00:43:54,600 --> 00:43:57,080
inverse dynamics to calculate 
the load, right. 

898
00:43:58,000 --> 00:44:01,640
And what we've done now with one
of my collaborators in Brazil, 

899
00:44:01,640 --> 00:44:05,480
Shroud Durigan is and I have a 
one of his PhDs to now looking 

900
00:44:05,480 --> 00:44:07,720
tendinopathy. 
But what we saw in Healthies 

901
00:44:07,720 --> 00:44:11,080
when you do in the HUMAC, like 
lying down, plantar flexion, 

902
00:44:11,320 --> 00:44:15,080
knee straight, pushing as hard 
as you can, MBIC, right, OK, 

903
00:44:15,240 --> 00:44:20,920
MBIC has much. 
You get high torque and then you

904
00:44:20,920 --> 00:44:23,640
can measure the wave speed of 
the tendon there. 

905
00:44:23,640 --> 00:44:28,280
And then we put NMES on the calf
and we turn up the NMES as high 

906
00:44:28,280 --> 00:44:33,640
as we can and we get a torque, 
we get a torque about 60% lower.

907
00:44:34,400 --> 00:44:36,600
But when you're looking at the 
wave speed that measure the 

908
00:44:36,600 --> 00:44:42,760
tension, it's only 20% lower. 
So and I don't and I can't say 

909
00:44:42,760 --> 00:44:45,800
that it's 40% of it is not 
coming from the calf, but I 

910
00:44:45,800 --> 00:44:49,320
think there is when you're 
really doing the Max especially 

911
00:44:49,320 --> 00:44:53,000
then if you have pain, you are 
just starting to compensate, 

912
00:44:53,280 --> 00:44:55,160
right. 
So there is some balance of and 

913
00:44:55,160 --> 00:44:57,800
you can't, you know that like 
you, you can do a lunch and then

914
00:44:57,800 --> 00:45:00,240
you're adding these weights. 
All of a sudden you're not using

915
00:45:00,240 --> 00:45:01,800
what you thought you were using,
right. 

916
00:45:01,800 --> 00:45:06,360
So we are really trying to look 
at using enemy as to try to 

917
00:45:06,360 --> 00:45:10,200
pinpoint the loading now versus 
the other parts because when we 

918
00:45:10,200 --> 00:45:16,360
did 20% of MBIC with active 
pushing or enemy as only. 

919
00:45:16,360 --> 00:45:19,200
So there's no activity like 
enemy as then we get the same 

920
00:45:19,200 --> 00:45:23,920
wave speed in, right? 
So yeah. 

921
00:45:24,120 --> 00:45:26,080
Does that make sense something 
yes. 

922
00:45:26,120 --> 00:45:29,400
And just one, one quick thing 
for people who might not know 

923
00:45:29,400 --> 00:45:33,080
what like NMES is basically 
you're taking electrode pads and

924
00:45:33,080 --> 00:45:36,320
putting it over a muscle that's 
causing the muscle to contract 

925
00:45:36,320 --> 00:45:38,600
without you having to 
volitionally do it with your 

926
00:45:38,600 --> 00:45:41,200
brain. 
And because of the position of 

927
00:45:41,200 --> 00:45:44,120
all of these muscles, the pads 
are going in the spot that's 

928
00:45:44,120 --> 00:45:47,880
going to selectively activate 
more of those super, the ones 

929
00:45:47,880 --> 00:45:50,160
that are closer to the pads 
which are your gastroxoleus 

930
00:45:50,160 --> 00:45:53,720
which flow into to the Achilles 
tendon versus these deeper ones 

931
00:45:53,720 --> 00:45:55,480
that could be part of that 
compensation. 

932
00:45:55,720 --> 00:45:59,240
So just to bring people up to 
speed there a little bit, Matt, 

933
00:45:59,240 --> 00:46:00,560
did you have anything else on 
that one? 

934
00:46:00,560 --> 00:46:01,280
So. 
This is what happened. 

935
00:46:04,640 --> 00:46:07,640
I just have a joke. 
Let's see, yeah. 

936
00:46:08,120 --> 00:46:11,760
I was going to say, so when you 
added an MES to this, were you 

937
00:46:11,760 --> 00:46:14,040
shocked by the results or were 
you expecting that? 

938
00:46:14,240 --> 00:46:16,240
That's brilliant. 
I'm going to use that. 

939
00:46:17,280 --> 00:46:19,480
You're welcome to take that. 
Yeah, I totally take. 

940
00:46:19,480 --> 00:46:22,920
That shocked by the results. 
Yes, please. 

941
00:46:24,320 --> 00:46:28,120
My life, my lifelong goal is to 
do a joke like that in a paper 

942
00:46:28,120 --> 00:46:30,360
and actually get in a journal, 
get it published and see if I 

943
00:46:30,360 --> 00:46:31,720
can get it through the 
reviewers. 

944
00:46:31,720 --> 00:46:33,480
But I don't. 
I haven't done it so far, sorry.

945
00:46:33,720 --> 00:46:36,280
My my head. 
I laughed so my headphones fell 

946
00:46:36,280 --> 00:46:40,000
out. 
That's brilliant, but I but I 

947
00:46:40,000 --> 00:46:43,320
think it you know and and and 
Nate you were you you deal with 

948
00:46:43,320 --> 00:46:46,080
Lynn Snyder Mackler when the 
enemies for the quads and things

949
00:46:46,080 --> 00:46:47,560
too. 
And I think that I'm getting 

950
00:46:47,560 --> 00:46:50,240
really getting back to basics 
pain on palpation right. 

951
00:46:50,240 --> 00:46:53,520
You know, we use the pain 
monitoring model, do heel rises 

952
00:46:53,520 --> 00:46:56,960
and now enemies, but enemies is 
brilliant and really pinpointing

953
00:46:56,960 --> 00:47:01,400
some of the muscles and I think 
we have gotten in physical 

954
00:47:01,400 --> 00:47:04,160
therapy. 
I think maybe I'm just dating 

955
00:47:04,160 --> 00:47:08,080
myself, but I think we've gotten
so like you're more Instagrammy,

956
00:47:08,400 --> 00:47:11,120
flashy. 
It is the more of a complicated 

957
00:47:11,360 --> 00:47:15,280
cool thing it is And and that's 
kind of fun to see those 

958
00:47:15,280 --> 00:47:18,840
exercises, but we're not 
pinpointing and the body's so 

959
00:47:18,840 --> 00:47:22,440
good at compensating, right? 
So if you are putting too much 

960
00:47:22,440 --> 00:47:25,600
load in or trying to do much, 
we're going to use something 

961
00:47:25,600 --> 00:47:28,680
else, right, Which in Achilles 
and rupture is a good 

962
00:47:28,680 --> 00:47:31,040
compensation. 
You have probably like the the 

963
00:47:31,040 --> 00:47:33,600
group in Finland at the time of 
fitness show that you probably 

964
00:47:33,600 --> 00:47:37,600
have like a 5 or 6% increase in 
flexor houses longest because 

965
00:47:37,600 --> 00:47:39,040
you lose some and that's 
perfect. 

966
00:47:39,520 --> 00:47:41,840
But if you're going to exercise 
and try to load something 

967
00:47:41,840 --> 00:47:44,840
specific and you're just 
compensating, I think that is 

968
00:47:44,840 --> 00:47:46,760
one of the problems that we're 
having too. 

969
00:47:46,760 --> 00:47:48,840
So that's kind of me with with 
that. 

970
00:47:48,840 --> 00:47:51,000
I don't know, did that make 
sense with the exercises? 

971
00:47:51,560 --> 00:47:53,800
Yeah. 
And are you, are you dosing the 

972
00:47:53,800 --> 00:47:58,360
NMES similarly to what what 
we've done for a while with the 

973
00:47:58,360 --> 00:48:00,400
quad or is it dosed a little bit
differently? 

974
00:48:00,840 --> 00:48:04,000
So yeah, we have, we have the 
quad where you're kind of dosing

975
00:48:04,000 --> 00:48:05,440
it. 
So it's a whole, we brought 

976
00:48:05,440 --> 00:48:07,000
papers on. 
It's a whole discussion that 

977
00:48:07,000 --> 00:48:09,640
should be active muscle 
contraction or not active muscle

978
00:48:09,640 --> 00:48:11,000
contraction. 
If you're going to build 

979
00:48:11,000 --> 00:48:13,920
strength in the quad. 
No active muscle contraction up 

980
00:48:13,920 --> 00:48:18,640
to 50% of the MBIC to really 
build up the quad for the calf. 

981
00:48:18,640 --> 00:48:21,120
We're doing it a little bit 
differently now too. 

982
00:48:21,120 --> 00:48:25,680
We're trying to partly just kind
of increasing that when standing

983
00:48:25,680 --> 00:48:29,640
to kind of activate that too. 
But we also do it more like FES 

984
00:48:29,640 --> 00:48:31,120
too. 
Like we can do it with the 

985
00:48:31,120 --> 00:48:33,600
contractions. 
So you can do heel rises with it

986
00:48:33,600 --> 00:48:35,520
and things too. 
I don't know what the best is. 

987
00:48:35,520 --> 00:48:38,640
We haven't really designed 
what's best, but I know a lot of

988
00:48:38,640 --> 00:48:41,320
my, my friends in Sweden have 
done it for a long time too. 

989
00:48:41,320 --> 00:48:43,400
We're supposed to have the 
rupture and those really to try 

990
00:48:43,400 --> 00:48:45,360
to activate it. 
Right. 

991
00:48:45,960 --> 00:48:49,560
It's fantastic. 
There's so many other things 

992
00:48:49,840 --> 00:48:55,520
that I want to ask you about, 
but I, I think it would one more

993
00:48:55,520 --> 00:48:57,600
question on some of the rehab 
stuff and then I want to talk 

994
00:48:57,600 --> 00:48:59,040
about shoes with you for a 
little while. 

995
00:48:59,040 --> 00:49:02,320
Because if we don't talk about 
shoes, people get upset because 

996
00:49:02,320 --> 00:49:04,680
this is. 
I want to, I want to hear you 

997
00:49:04,720 --> 00:49:08,560
talk about shoes. 
But when it comes to the rehab 

998
00:49:08,560 --> 00:49:12,640
stuff, I think you talked about 
Instagram like kind of taking 

999
00:49:12,640 --> 00:49:15,200
over and saying, hey, it has to 
be a little bit more sexy, a 

1000
00:49:15,200 --> 00:49:17,640
little bit more complicated. 
It makes it pretty, pretty cool 

1001
00:49:17,640 --> 00:49:20,160
looking. 
One of those things that does 

1002
00:49:20,320 --> 00:49:24,440
get more airtime are some of the
newer modalities that are used, 

1003
00:49:24,760 --> 00:49:26,480
including like shockwave 
therapy. 

1004
00:49:26,760 --> 00:49:29,040
And that was part of the study 
that I think you said it was 

1005
00:49:29,040 --> 00:49:30,360
part of the study that you just 
did. 

1006
00:49:30,600 --> 00:49:34,040
What's your current take on the 
use of shockwave therapy for 

1007
00:49:34,040 --> 00:49:37,080
Achilles tendinopathy and what 
it's looking like in terms of 

1008
00:49:37,080 --> 00:49:39,280
its efficacy? 
Yeah, I mean there is a lot of 

1009
00:49:39,280 --> 00:49:43,120
things I am not a proponent of 
putting, you know, inside of the

1010
00:49:43,120 --> 00:49:46,880
needles like all the 10X and 
scraping that I'd like the 

1011
00:49:46,880 --> 00:49:48,920
tendon to kind of recover with 
the exercise. 

1012
00:49:48,920 --> 00:49:52,680
But I also always said, and this
is what Adams quote me all the 

1013
00:49:52,680 --> 00:49:55,800
time, like sometimes I'm like 
the tendon, just like we 

1014
00:49:55,800 --> 00:49:58,960
exercising it, but it's just 
kind of it's stuck right? 

1015
00:49:58,960 --> 00:50:01,040
I, I need to get it. 
I need a hammer. 

1016
00:50:01,040 --> 00:50:04,640
I just want to whack it. 
So you get an inflammation and 

1017
00:50:04,640 --> 00:50:06,760
kind of, you know what I mean? 
You kind of want to get it 

1018
00:50:06,760 --> 00:50:09,360
started. 
Something needs to restart it. 

1019
00:50:09,360 --> 00:50:11,400
You kind of want the 
inflammation or whatever. 

1020
00:50:11,720 --> 00:50:13,320
And that's to me is my 
shockwave. 

1021
00:50:13,320 --> 00:50:16,480
We actually, we did radio 
pressure waves versus the focus 

1022
00:50:16,480 --> 00:50:18,600
right too. 
But that to me is where the 

1023
00:50:18,600 --> 00:50:23,080
shockwave, I'm like, it fits in 
my well in my life view I guess 

1024
00:50:23,080 --> 00:50:24,160
too. 
I just want to whack it but I'm 

1025
00:50:24,160 --> 00:50:25,640
not allowed to do it with a 
hammer. 

1026
00:50:27,760 --> 00:50:29,360
Apparently it's just frowned 
upon. 

1027
00:50:30,120 --> 00:50:32,400
It wouldn't be acceptable. 
Yeah. 

1028
00:50:32,400 --> 00:50:33,960
Well, they do that actually in 
India. 

1029
00:50:33,960 --> 00:50:36,400
I have a video when they do a 
Schissel and Hammer. 

1030
00:50:36,480 --> 00:50:40,640
Yeah, so they actually do that. 
But but I think that so to me 

1031
00:50:40,640 --> 00:50:43,400
the shockwave is really you can 
really get it localized and you 

1032
00:50:43,400 --> 00:50:47,400
can really stimulate the area. 
Is it, you know what, what are 

1033
00:50:47,520 --> 00:50:50,520
the mechanisms and things too, 
but we know the cells and things

1034
00:50:50,520 --> 00:50:53,600
needs to be activated and I 
think part of maybe are there 

1035
00:50:53,600 --> 00:50:57,040
areas that not activated or are 
we costing inflammation or not? 

1036
00:50:57,040 --> 00:51:00,880
It's really hard to say. 
So with Adam then is who's, you 

1037
00:51:00,880 --> 00:51:03,600
know, seeing a lot of runners in
in Boston, I was really 

1038
00:51:03,600 --> 00:51:05,720
interested. 
We took the program that I've 

1039
00:51:05,720 --> 00:51:08,120
done forever, our exercise 
program. 

1040
00:51:08,400 --> 00:51:12,720
We added shockwave to one group.
So it was exercise, exercise 

1041
00:51:12,720 --> 00:51:15,440
shockwave, exercise shockwave 
and laser. 

1042
00:51:16,280 --> 00:51:19,520
Those three groups later on it 
was a crossover and those kind 

1043
00:51:19,520 --> 00:51:21,680
of things as well. 
But they got the exercise 

1044
00:51:21,680 --> 00:51:24,920
program, they got help with the 
PT, but a lot of it was on their

1045
00:51:24,920 --> 00:51:28,160
own. 
And what we could see is like in

1046
00:51:28,160 --> 00:51:32,320
the early stages, it seems to be
a little bit of increased 

1047
00:51:32,320 --> 00:51:35,640
recovery, a little bit faster in
the shockwave exercise. 

1048
00:51:36,000 --> 00:51:38,680
We didn't see and we didn't see 
much difference with the with 

1049
00:51:38,680 --> 00:51:41,120
the laser, right. 
But there can be a lot of 

1050
00:51:41,120 --> 00:51:42,480
different reasons for doing 
this. 

1051
00:51:42,480 --> 00:51:46,200
But these are in runners when 
you're starting to see kind of 

1052
00:51:46,200 --> 00:51:49,800
over time that that difference 
might get more closer. 

1053
00:51:49,800 --> 00:51:52,200
It might not be that big of a 
difference in a year. 

1054
00:51:52,360 --> 00:51:56,000
But if you're a runner too, if 
we can maybe jump started, Yeah,

1055
00:51:56,080 --> 00:51:59,400
if a short term jumping jump 
started a little bit, it might 

1056
00:51:59,400 --> 00:52:01,080
be a benefit along with the 
exercise. 

1057
00:52:01,080 --> 00:52:03,520
But you do have to have the 
exercise with all of these 

1058
00:52:03,520 --> 00:52:06,040
things to kind of jump start. 
So I think that is really 

1059
00:52:06,040 --> 00:52:07,960
exciting. 
So maybe that is something we 

1060
00:52:07,960 --> 00:52:10,760
need to do too. 
But I think what Adam has taught

1061
00:52:10,760 --> 00:52:14,320
me too is like he only does like
3 treatments with Shockwave. 

1062
00:52:14,320 --> 00:52:17,360
It's not like it's not like 
you're doing every day and 

1063
00:52:17,360 --> 00:52:19,920
before you go out on the NBA 
players on the court like it's 

1064
00:52:20,160 --> 00:52:23,040
it's something you do to try to 
get it started and then moving 

1065
00:52:23,040 --> 00:52:25,640
forward. 
So I'm excited about that study.

1066
00:52:25,640 --> 00:52:28,280
I think we need more studies, 
but the evidence is starting to 

1067
00:52:28,280 --> 00:52:31,880
climb up that shockwave might be
the one thing that actually much

1068
00:52:31,880 --> 00:52:34,320
better than PRP. 
It doesn't have shown as much 

1069
00:52:34,320 --> 00:52:37,600
evidence and things too. 
And what I want to say, what I 

1070
00:52:37,600 --> 00:52:41,960
got excited about from my 
results, biased as I am, but the

1071
00:52:42,080 --> 00:52:45,840
the exercise program with the 
exercise group only, the 

1072
00:52:45,840 --> 00:52:48,760
recovery on the visa score, 
which is the questionnaire we 

1073
00:52:48,760 --> 00:52:53,360
use is pretty much identical to 
my randomized controlled trial 

1074
00:52:53,360 --> 00:52:55,480
from 2007. 
So. 

1075
00:52:55,560 --> 00:52:58,840
That's cool, right. 
So it looks very similar like in

1076
00:52:58,840 --> 00:53:02,640
the recovery over time in the 
group that we can see, you know,

1077
00:53:02,640 --> 00:53:06,720
so and, and where they are at 12
weeks and I think 6 months or 

1078
00:53:06,720 --> 00:53:09,520
whatever too. 
So to, to me that is important 

1079
00:53:09,520 --> 00:53:12,920
too, because I always say that 
you can, you can show anything 

1080
00:53:12,920 --> 00:53:16,560
is equally good to exercise or a
better, better than exercise if 

1081
00:53:16,560 --> 00:53:20,120
you do shitty exercise, right. 
So you need to make sure anytime

1082
00:53:20,120 --> 00:53:22,640
you look at these things like, 
oh, Oh yeah, this was better 

1083
00:53:22,640 --> 00:53:24,760
than exercise. 
Exercise didn't do anything. 

1084
00:53:24,760 --> 00:53:27,040
But the evidence is that XX 
doing something. 

1085
00:53:27,040 --> 00:53:30,360
So it has to be both of them has
to be good to kind of move 

1086
00:53:30,360 --> 00:53:32,400
forward. 
So I think shockwave is really, 

1087
00:53:32,400 --> 00:53:35,680
really interesting. 
And you know, I'm sure there are

1088
00:53:35,680 --> 00:53:38,760
other things too, but again, I 
really want to emphasize none of

1089
00:53:38,760 --> 00:53:42,800
that works without exercise. 
Yeah, that's really great. 

1090
00:53:42,840 --> 00:53:45,720
And like you said, that is kind 
of the most exciting part is 

1091
00:53:45,720 --> 00:53:50,680
when you have something that was
done, wow, Now what is it, 18 

1092
00:53:51,000 --> 00:53:54,920
some sort of years ago, one or 
two or something, 2007, one or 

1093
00:53:54,920 --> 00:53:58,920
two years ago, but that you're 
getting similar results now. 

1094
00:53:58,960 --> 00:54:01,600
It validates the process, which 
is that is that is pretty 

1095
00:54:01,600 --> 00:54:04,080
exciting. 
Let's try and talk about shoes. 

1096
00:54:04,120 --> 00:54:05,120
Oh, go ahead. 
Sorry. 

1097
00:54:05,520 --> 00:54:08,080
No, and I, you know, I designed 
the program, but it was done up 

1098
00:54:08,080 --> 00:54:09,760
in Boston. 
I wasn't there like because 

1099
00:54:09,760 --> 00:54:13,080
otherwise if I people are going 
to get better if I treat them 

1100
00:54:13,080 --> 00:54:15,960
sometimes because you know, I 
googled you and this and like 

1101
00:54:15,960 --> 00:54:19,240
you have those kind of extra, 
but this works similarly to what

1102
00:54:19,240 --> 00:54:21,200
we had done in Sweden. 
To me that was that. 

1103
00:54:21,320 --> 00:54:23,800
It was validating OK shoes more 
important. 

1104
00:54:24,520 --> 00:54:27,280
Yeah, of course. 
Well, we, we always are very 

1105
00:54:27,280 --> 00:54:30,040
clear that, you know, if you 
have the pie of your health as a

1106
00:54:30,040 --> 00:54:32,840
runner, right, you have all of 
these different facets of what 

1107
00:54:32,840 --> 00:54:34,360
make up your health. 
You talked about some of them, 

1108
00:54:34,360 --> 00:54:37,480
your sleep, your nutrition, your
training program, what sort of 

1109
00:54:37,720 --> 00:54:40,200
exercises you're doing. 
And then you have shoes, which 

1110
00:54:40,240 --> 00:54:42,760
we sometimes make 98% of our 
pie. 

1111
00:54:42,760 --> 00:54:45,200
And it's like, oh, if I just get
this shoe, I'm going to be all 

1112
00:54:45,200 --> 00:54:47,520
the way better. 
It's going to prevent me from 

1113
00:54:47,520 --> 00:54:49,600
getting injured. 
And we can kind of create that 

1114
00:54:49,600 --> 00:54:51,400
complex in our mind. 
But we were like, this is 

1115
00:54:51,400 --> 00:54:54,880
probably like the 1%. 
But it is exciting to think 

1116
00:54:54,880 --> 00:54:57,120
about what we can do with shoes 
and what we can learn about the 

1117
00:54:57,120 --> 00:55:00,760
current landscape of shoes. 
So Matt, you had brought up 

1118
00:55:01,000 --> 00:55:05,200
super shoes before and how some 
of those types of shoes can 

1119
00:55:05,200 --> 00:55:09,280
alter loading profiles. 
What's your current thought on 

1120
00:55:09,480 --> 00:55:13,440
the landscape of super shoes, 
higher utilization of them for 

1121
00:55:13,520 --> 00:55:17,720
training and for racing, and 
potentially their impact on the 

1122
00:55:17,720 --> 00:55:22,280
Achilles tendon? 
Yeah, I mean, sure, maybe no 

1123
00:55:22,280 --> 00:55:23,920
more luck. 
You guys know more than me. 

1124
00:55:23,920 --> 00:55:26,600
But I mean, I think it's from my
perspective too. 

1125
00:55:26,600 --> 00:55:30,040
I mean, I'm really interested in
the shoes in the general too, 

1126
00:55:30,040 --> 00:55:31,080
right? 
And I don't know everything 

1127
00:55:31,080 --> 00:55:33,360
about shoes, but I'm also 
interested in shoes because 

1128
00:55:34,560 --> 00:55:37,240
certain shoes seems to be 
working well, but I also think 

1129
00:55:37,240 --> 00:55:39,520
there's shoes that might make 
you worse. 

1130
00:55:39,520 --> 00:55:42,200
Like, you know what I mean? 
I find it hard to make shoes to 

1131
00:55:42,200 --> 00:55:45,440
make you better, but it's shoes 
that make you worse. 

1132
00:55:45,440 --> 00:55:47,480
Does that make sense? 
Like, you know, you need to find

1133
00:55:47,480 --> 00:55:49,080
your right thing. 
I don't know if it's going to 

1134
00:55:49,080 --> 00:55:50,880
make you a better runner and 
those kind of things too. 

1135
00:55:50,880 --> 00:55:53,560
Now, when we're talking about 
the Super shoes, right, it's, 

1136
00:55:54,360 --> 00:55:57,280
it's really, and I'm going to 
bring in my brother who's, you 

1137
00:55:57,280 --> 00:56:01,800
know, 69 and he bought shoes and
he's a very thoughtful person 

1138
00:56:01,800 --> 00:56:04,920
too, But he's, he put the shoes 
on and it scared the crap out of

1139
00:56:04,920 --> 00:56:07,640
him because he could run so much
faster than things. 

1140
00:56:07,640 --> 00:56:09,480
He's like, this cannot be good 
for me, right? 

1141
00:56:09,480 --> 00:56:12,440
I'm, I'm only going to use. 
So he's like, you know, calling 

1142
00:56:12,440 --> 00:56:15,280
me and like how, how should I 
train and building up? 

1143
00:56:15,280 --> 00:56:18,720
But he was so focused on, which 
is kind of amazing like that. 

1144
00:56:18,720 --> 00:56:22,600
This is not, this is clearly 
affecting me because I can run 

1145
00:56:22,600 --> 00:56:24,440
so much better. 
And if it's affecting me, 

1146
00:56:24,560 --> 00:56:27,720
there's got to be some change in
my Physiology that I need to do,

1147
00:56:27,720 --> 00:56:30,560
right? 
So I think that to me is what 

1148
00:56:30,560 --> 00:56:31,920
what's really, really 
interesting. 

1149
00:56:31,920 --> 00:56:35,120
And as you said Matt too, like 
you're shifting the loads like 

1150
00:56:35,120 --> 00:56:38,960
the load is not going away, the 
load is going to end up 

1151
00:56:38,960 --> 00:56:41,800
somewhere, right. 
So I think that is every time 

1152
00:56:41,800 --> 00:56:44,200
when you're looking at like it 
would used to be barefoot or 

1153
00:56:44,200 --> 00:56:47,400
forefoot or rear foot runner and
those kind of things, the load 

1154
00:56:47,400 --> 00:56:50,400
is there somewhere and maybe you
get a little bit of support 

1155
00:56:50,400 --> 00:56:52,320
moving forward. 
But I think that is the problem.

1156
00:56:52,320 --> 00:56:54,760
So that's kind of what I and I'm
really interested to hear what 

1157
00:56:54,760 --> 00:56:56,800
you guys have to say about and 
what you see. 

1158
00:56:59,120 --> 00:57:01,160
Matt, you want to go? 
Sure. 

1159
00:57:01,440 --> 00:57:05,480
So I'll, I'll jump in a little 
bit where so the evidence 

1160
00:57:05,480 --> 00:57:08,320
suggests thus far and there's a 
lot more that we don't know 

1161
00:57:08,320 --> 00:57:09,880
about this. 
And so some of this is going to 

1162
00:57:09,880 --> 00:57:13,720
be a little bit like clinical 
testimonial level 5 evidence 

1163
00:57:13,720 --> 00:57:16,640
that I'm going to talk about. 
But that yeah, some of these, 

1164
00:57:16,760 --> 00:57:19,360
the designs and we don't know 
what component if we don't know 

1165
00:57:19,360 --> 00:57:21,480
if it's the combination, what 
specifically. 

1166
00:57:21,680 --> 00:57:24,120
But we know some of these 
factors like the rocker 

1167
00:57:24,120 --> 00:57:28,040
geometry, some of these softer 
foams certainly do redirect 

1168
00:57:28,040 --> 00:57:30,840
forces away from the foot and 
ankle especially like the ankle 

1169
00:57:30,840 --> 00:57:33,160
joint end up maybe to the knee 
and the hip. 

1170
00:57:33,200 --> 00:57:35,360
And so we know that that's where
that's left lot of times going. 

1171
00:57:35,560 --> 00:57:38,600
What that might explain some of 
the increase in like hamstring 

1172
00:57:38,600 --> 00:57:42,080
tendon in shoes that we've seen 
recently, no idea. 

1173
00:57:42,240 --> 00:57:45,000
The problem is when, as your 
brother, I have the same thought

1174
00:57:45,000 --> 00:57:49,200
of going, this improves running 
economy and you're like so much.

1175
00:57:49,400 --> 00:57:51,640
What is the trade off? 
There's there's there's no such 

1176
00:57:51,640 --> 00:57:53,960
thing as a free lunch, right? 
Like there's something you're 

1177
00:57:53,960 --> 00:57:57,400
giving in and I don't know if 
it's is it actually decreasing 

1178
00:57:57,400 --> 00:58:00,000
load And you just mentioned the 
tendons need load. 

1179
00:58:00,280 --> 00:58:04,360
If you take that away from them 
or reduce it, they don't respond

1180
00:58:04,360 --> 00:58:05,960
as well. 
Now that I might be wrong and 

1181
00:58:05,960 --> 00:58:08,520
there might be someone who the 
load of running is too great for

1182
00:58:08,520 --> 00:58:11,640
the tendon and this actually 
modulate to a level that's maybe

1183
00:58:11,640 --> 00:58:12,960
better for them. 
There's going to be other where 

1184
00:58:12,960 --> 00:58:15,520
maybe that's too low and you see
changes. 

1185
00:58:15,520 --> 00:58:18,120
Who knows what happens in those 
that actually have pathology. 

1186
00:58:18,120 --> 00:58:21,520
But what people have to also 
realize is that that is assuming

1187
00:58:21,520 --> 00:58:24,040
the shoe is actually lining up 
with their bio mechanics 

1188
00:58:24,040 --> 00:58:26,200
perfectly. 
It can also go the opposite way 

1189
00:58:26,200 --> 00:58:29,960
where if you have a shoe that is
too stiff, you're actually no 

1190
00:58:29,960 --> 00:58:32,400
matter what's in it, you're 
going to still increase the load

1191
00:58:32,400 --> 00:58:35,120
through the the Achilles tendon 
and and ankle plantar flexors 

1192
00:58:35,120 --> 00:58:37,040
because they're pushing off 
harder. 

1193
00:58:37,040 --> 00:58:39,360
So it just, there's so many 
factors that depends. 

1194
00:58:39,360 --> 00:58:42,760
I guess my question for you is 
if we have a shoe that may 

1195
00:58:42,760 --> 00:58:45,840
theoretically, assuming you get 
the right one that matches your 

1196
00:58:45,840 --> 00:58:49,320
mechanics, matches where you 
know, your metatarsophalangeal 

1197
00:58:49,320 --> 00:58:52,880
joints actually go through and 
it does reduce that, is that 

1198
00:58:52,880 --> 00:58:54,720
necessarily something we want to
use all the time? 

1199
00:58:54,720 --> 00:58:58,640
Because that technology is now 
bleeding in to all shoes? 

1200
00:58:58,640 --> 00:59:00,480
It's getting harder. 
It's not that you can't. 

1201
00:59:00,480 --> 00:59:03,320
We're actually seeing a slight 
like the industry is actually 

1202
00:59:03,320 --> 00:59:05,280
flipping back a little bit where
we're starting to see things 

1203
00:59:05,280 --> 00:59:08,560
that are actually more flexible 
and less stiff and maybe a 

1204
00:59:08,560 --> 00:59:10,440
little bit more moderate in 
terms of the height. 

1205
00:59:10,440 --> 00:59:11,960
So maybe we're going back that 
way. 

1206
00:59:12,320 --> 00:59:15,640
But right now there's not many 
things that don't have super 

1207
00:59:15,640 --> 00:59:17,640
components. 
So I'm curious, how do you think

1208
00:59:17,640 --> 00:59:19,200
that affects us? 
And do you think there are 

1209
00:59:19,200 --> 00:59:22,680
possible risks or is it all, is 
it all positive? 

1210
00:59:22,680 --> 00:59:24,000
Great. 
We should not be questioned. 

1211
00:59:24,000 --> 00:59:28,000
If I can run faster, I'll take a
super shoot, but if I could run,

1212
00:59:28,000 --> 00:59:32,440
no, But I I think what you're 
really getting at too is like we

1213
00:59:32,440 --> 00:59:37,280
have a study going on with Elisa
Archos, professor at UD as well.

1214
00:59:37,280 --> 00:59:39,560
And I have been really 
interested mainly from the 

1215
00:59:39,560 --> 00:59:42,800
Achilles and rupture like she 
does Afos for strokes, right 

1216
00:59:42,800 --> 00:59:45,400
ankle foot orthosis and those 
kind of things too. 

1217
00:59:45,400 --> 00:59:49,560
Can we get a AFO to use during 
the rehabilitation? 

1218
00:59:49,560 --> 00:59:52,680
So they can run 10 miles, but 
now we're loading at the seven 

1219
00:59:52,680 --> 00:59:56,560
mile level, right? 
Can, can we modulate the load so

1220
00:59:56,560 --> 00:59:59,960
we can continue? 
Because I want all the other 

1221
00:59:59,960 --> 01:00:02,760
tissues to have the same load. 
So that's kind of been my goal 

1222
01:00:02,760 --> 01:00:06,200
thinking about those things. 
But one of our PhD students just

1223
01:00:06,200 --> 01:00:08,200
did. 
So we do some pilot data now 

1224
01:00:08,200 --> 01:00:12,440
with, with Healthies and people 
with Achilles tendinopathy doing

1225
01:00:12,440 --> 01:00:16,360
AF OS with different stiffnesses
to see. 

1226
01:00:16,360 --> 01:00:19,000
And then we're using the 10 
geometry to look at the tendon. 

1227
01:00:19,680 --> 01:00:24,280
So you have the the AFO on with 
no stiffness, right? 

1228
01:00:24,280 --> 01:00:29,720
And then you have moderate and 
high loads stiffnesses and it's 

1229
01:00:29,720 --> 01:00:32,200
just pilot data and she's going 
to be working on it this coming 

1230
01:00:32,200 --> 01:00:34,560
year too. 
But it never turns out the way 

1231
01:00:34,560 --> 01:00:37,400
you think, right? 
Because it seems like the no 

1232
01:00:37,400 --> 01:00:38,200
stiffness. 
OK. 

1233
01:00:38,200 --> 01:00:41,880
So you had a low stiffness and 
you had decreased load, but the 

1234
01:00:41,880 --> 01:00:45,840
stiffer it got all of a sudden 
you have higher load in the 

1235
01:00:45,840 --> 01:00:48,280
tendon, right, which is probably
like it's. 

1236
01:00:48,320 --> 01:00:51,840
So I think it is there is 
probably some optimal offloading

1237
01:00:51,840 --> 01:00:56,640
maybe we can get to kind of 
help, but it's probably very. 

1238
01:00:56,640 --> 01:00:59,840
So I think that's the stiffer is
not better, more is not better 

1239
01:00:59,840 --> 01:01:01,280
when you come to these kind of 
things. 

1240
01:01:01,280 --> 01:01:04,280
I would love to see how we can 
figure that out and measure it. 

1241
01:01:05,280 --> 01:01:08,240
But your other question too, 
like do I want to completely 

1242
01:01:08,240 --> 01:01:10,360
offload? 
I don't think I want to. 

1243
01:01:10,400 --> 01:01:12,760
Like there's two things that I'm
a little concerned about. 

1244
01:01:13,440 --> 01:01:16,400
And this is also my clinical 
experience over the years, like 

1245
01:01:16,400 --> 01:01:19,320
some of the with the pain and 
inhibition. 

1246
01:01:19,320 --> 01:01:21,880
If you, if you're injecting, 
this is a study, I didn't do it.

1247
01:01:21,880 --> 01:01:23,640
Somebody injected pain in the 
tendon. 

1248
01:01:24,600 --> 01:01:26,240
I think there was a Danish 
study. 

1249
01:01:26,240 --> 01:01:29,160
And then you see inhibitions of 
the muscles. 

1250
01:01:29,160 --> 01:01:31,920
So you get inhibition of the 
calf and soleus with the pain, 

1251
01:01:32,480 --> 01:01:34,800
but you still walk. 
So now the other muscles are 

1252
01:01:34,800 --> 01:01:38,200
starting to work more. 
What I've seen a lot of times 

1253
01:01:38,200 --> 01:01:41,280
with elite athletes too, like 
the foot intrinsic, sometimes I 

1254
01:01:41,280 --> 01:01:44,720
think it's inhibitions that 
well, so you want to have strong

1255
01:01:44,720 --> 01:01:47,440
foot intrinsic muscles to push 
off of, right? 

1256
01:01:47,440 --> 01:01:50,240
It's, it's not just the Achilles
tendon lifting the heel. 

1257
01:01:50,240 --> 01:01:53,200
You have the whole foot. 
So I'm a little concerned when 

1258
01:01:53,200 --> 01:01:55,560
you're making some of these 
changes like all the other 

1259
01:01:55,560 --> 01:01:58,520
muscles and we talked about 
flexor digitorum, longer 

1260
01:01:58,520 --> 01:02:00,920
flexorhalisis as long as in the 
foot intrinsic. 

1261
01:02:01,160 --> 01:02:04,280
When you're starting to change 
balance, are you going to start 

1262
01:02:04,880 --> 01:02:08,520
causing problems, right. 
And and do we, it's kind of what

1263
01:02:08,520 --> 01:02:11,920
happened way before like we had 
we put more and more cushions 

1264
01:02:11,920 --> 01:02:15,720
and more and more support and 
the muscle works less and less 

1265
01:02:15,720 --> 01:02:18,040
and are we kind of in that 
balance too? 

1266
01:02:18,160 --> 01:02:21,000
So I don't know if you've seen 
that with the runners or no. 

1267
01:02:23,240 --> 01:02:26,720
There hasn't been a way to 
specifically measure like 

1268
01:02:26,720 --> 01:02:30,120
intrinsic muscle activation in 
the types of clinics that I've 

1269
01:02:30,120 --> 01:02:32,880
been in. 
But I work with, we do, we do 

1270
01:02:32,880 --> 01:02:35,480
regular, we do biannual 
screenings with the cross 

1271
01:02:35,480 --> 01:02:37,720
country team that we have in 
town here. 

1272
01:02:38,160 --> 01:02:42,200
And there's definitely a 
difficulty in utilizing the the,

1273
01:02:42,240 --> 01:02:45,480
I would say the utilization of 
super shoes is very, very high 

1274
01:02:45,840 --> 01:02:50,200
even in a more rural, smaller 
Division Three school that I'm 

1275
01:02:50,200 --> 01:02:53,480
at that runners are using them 
in the recreational population 

1276
01:02:53,480 --> 01:02:54,480
too. 
It's just very, very high 

1277
01:02:54,480 --> 01:02:58,040
utilization both for racing, but
also now for training because 

1278
01:02:58,040 --> 01:03:00,240
it, it feels so good. 
So it's just the thing that 

1279
01:03:00,240 --> 01:03:03,520
they're going to do something 
that's definitely true that I 

1280
01:03:03,520 --> 01:03:07,040
don't know if it was true, if 
it's true for everyone or if it 

1281
01:03:07,040 --> 01:03:11,600
was true before we saw them in 
their current training cycles. 

1282
01:03:11,800 --> 01:03:14,240
But their ability to even 
utilize their intrinsic foot 

1283
01:03:14,240 --> 01:03:18,280
muscles is very low Toe splay or
isolating different motions with

1284
01:03:18,280 --> 01:03:20,560
their small or their big toe is 
very, very low. 

1285
01:03:21,920 --> 01:03:24,680
And so we, we usually give every
single runner that's coming 

1286
01:03:24,680 --> 01:03:26,720
through like, hey, let's start 
working on these things just to 

1287
01:03:26,720 --> 01:03:28,960
have them get activated and be 
utilizing them. 

1288
01:03:30,080 --> 01:03:32,440
But it's hard to say if that's 
tied to the Super shoes. 

1289
01:03:32,440 --> 01:03:36,120
But one of the things that I, I 
think about and talk with 

1290
01:03:36,240 --> 01:03:42,120
runners about who are very, 
very, very high users is no, 

1291
01:03:42,480 --> 01:03:43,920
there's a couple things that are
going on. 

1292
01:03:43,920 --> 01:03:47,320
One, if you have a shoe like I'm
thinking about, for me, there's 

1293
01:03:47,320 --> 01:03:49,200
a shoe there. 
They don't have this model 

1294
01:03:49,200 --> 01:03:52,600
anymore, but the Rocket X2 from 
Hoka had a certain drop in the, 

1295
01:03:52,640 --> 01:03:55,600
the, the rocker portfolio is a 
little bit later. 

1296
01:03:55,720 --> 01:03:57,560
And so I couldn't really get up 
on the rocker. 

1297
01:03:57,560 --> 01:04:01,080
So I, my calf was always 
shredded after using that super 

1298
01:04:01,080 --> 01:04:02,240
shoe. 
That's supposed to improve your 

1299
01:04:02,240 --> 01:04:04,080
running economy. 
All the studies that look at 

1300
01:04:04,080 --> 01:04:06,640
running economy, some people 
have worse running economy, some

1301
01:04:06,640 --> 01:04:09,040
people have better. 
The average might be, you know, 

1302
01:04:09,560 --> 01:04:14,320
or you know, Walter, study back 
in 2017, like the 4% was better,

1303
01:04:14,320 --> 01:04:17,320
but there was a range. 
And there's definitely the ones 

1304
01:04:17,320 --> 01:04:19,520
that just aren't going to work 
for people. 

1305
01:04:20,640 --> 01:04:23,640
I think the other piece is that 
when you're utilizing a shoe 

1306
01:04:23,640 --> 01:04:26,680
that does even make it, you're 
running economy may be better. 

1307
01:04:26,680 --> 01:04:29,040
You can run like your brother 
said, like run faster. 

1308
01:04:29,040 --> 01:04:32,480
I just feel great, there should 
be some level of pause on that 

1309
01:04:32,480 --> 01:04:35,240
because if your body's adapting 
to that level of load from that 

1310
01:04:35,240 --> 01:04:38,280
shoe, if it is helping you, if 
you're going back to a typical 

1311
01:04:38,280 --> 01:04:41,760
training shoe now, can you no 
longer handle that typical 

1312
01:04:41,760 --> 01:04:45,520
training shoe because your body 
has started to adapt to this new

1313
01:04:45,520 --> 01:04:47,840
shoe? 
So that's one of the things that

1314
01:04:47,840 --> 01:04:50,880
I have conversations with at the
runners that we work with is 

1315
01:04:50,880 --> 01:04:54,840
just thoughtful progression 
towards and move away movement 

1316
01:04:54,840 --> 01:04:57,720
away from if they're planning to
do those transitions. 

1317
01:04:59,320 --> 01:05:02,280
But I think if you're in the 
zone of using a certain type of 

1318
01:05:02,280 --> 01:05:04,600
shoe and type of load, you're 
not planning on going away from 

1319
01:05:04,600 --> 01:05:06,600
that. 
If you can make sure that you're

1320
01:05:06,600 --> 01:05:08,360
doing all of the other 
management things, I think 

1321
01:05:08,360 --> 01:05:11,560
you're probably in an OK spot. 
But it's this transitioning to 

1322
01:05:11,560 --> 01:05:13,840
and from the type of loading 
that you're getting in some 

1323
01:05:13,840 --> 01:05:18,960
ways. 
But so, oh, go ahead. 

1324
01:05:19,200 --> 01:05:20,640
I was going to add one thing 
too. 

1325
01:05:20,640 --> 01:05:22,680
We haven't talked about, we 
talked a lot about the tendon 

1326
01:05:22,680 --> 01:05:24,960
and things too, but some people 
have insertional Achilles 

1327
01:05:24,960 --> 01:05:28,120
tendinopathy too, right? 
So the big problem with the 

1328
01:05:28,120 --> 01:05:31,960
insertional too is that that's 
when you have compression. 

1329
01:05:31,960 --> 01:05:34,840
So tendons are really good for 
tensile force, They're not very 

1330
01:05:34,840 --> 01:05:37,840
good for compressive force. 
So the insertional Achilles 

1331
01:05:37,840 --> 01:05:40,280
tendinopathy, if you have 
compression between the 

1332
01:05:40,280 --> 01:05:43,840
calcaneus and the Achilles 
tendon because Achilles tendon 

1333
01:05:43,840 --> 01:05:48,000
doesn't attach on top of the 
calcaneus attaches like on the 

1334
01:05:48,000 --> 01:05:50,120
posterior part. 
So when you go into too much 

1335
01:05:50,120 --> 01:05:53,520
dorsiflexion, right and you know
when you're getting into that 

1336
01:05:53,520 --> 01:05:57,280
kind of end range, you have the 
the tendon wraps around the 

1337
01:05:57,720 --> 01:05:59,840
calcaneus and now you have more 
compression. 

1338
01:05:59,840 --> 01:06:03,600
So the insertional ones, I think
it's a bigger other problem. 

1339
01:06:03,600 --> 01:06:05,920
And I think those are the ones 
that we sometimes need to have 

1340
01:06:05,920 --> 01:06:09,040
surgery to kind of remove scar 
tissue in the bone too. 

1341
01:06:09,320 --> 01:06:11,640
But that's when you're thinking 
about shoes in a completely 

1342
01:06:11,640 --> 01:06:13,920
different way. 
Like we, we saw that if you can 

1343
01:06:13,920 --> 01:06:17,280
put two centimetre heel lifts 
in, you can actually get away 

1344
01:06:17,280 --> 01:06:19,920
from that and you can kind of 
relieve the pain, right. 

1345
01:06:19,920 --> 01:06:23,000
So those are the ones we always 
want to have with a higher heel 

1346
01:06:23,000 --> 01:06:25,840
drop and things to kind of 
prevent that compression. 

1347
01:06:26,360 --> 01:06:28,680
But what I think is interesting 
when you're talking about super 

1348
01:06:28,680 --> 01:06:32,360
shoes and other shoes too, that 
I, you know, I don't know how to

1349
01:06:32,360 --> 01:06:35,800
sold this to, but what we've 
just looked at is you're, you're

1350
01:06:35,800 --> 01:06:38,320
assuming that that compression 
is negative, right? 

1351
01:06:38,320 --> 01:06:41,680
So you would assume that people 
are walking to avoid the 

1352
01:06:41,680 --> 01:06:44,960
compression. 
But what's what's happening is 

1353
01:06:44,960 --> 01:06:48,880
they're not using the muscles, 
so they're avoiding contracting,

1354
01:06:49,480 --> 01:06:51,800
but then they get too much into 
doors deflection. 

1355
01:06:51,800 --> 01:06:55,000
So they all the force in the 
tendon is tensile at the end. 

1356
01:06:55,000 --> 01:06:57,480
And we have documentation of 
that too, right? 

1357
01:06:57,480 --> 01:07:00,040
So it's almost like they're I'm 
not going to use my calf. 

1358
01:07:00,040 --> 01:07:01,440
I'm not going to use my calf. 
Oh crap. 

1359
01:07:01,440 --> 01:07:04,360
Now I'm at the end range and you
have a lot of tension and then 

1360
01:07:04,360 --> 01:07:06,040
you press. 
So they're actually have more 

1361
01:07:06,040 --> 01:07:09,280
they're walking with more 
compression than they should, 

1362
01:07:09,280 --> 01:07:11,320
right? 
So I don't know, I think that's 

1363
01:07:11,320 --> 01:07:13,520
something to thinking about too.
When you're thinking about the 

1364
01:07:13,520 --> 01:07:17,520
load from heel strike to push 
off, like where is that load in 

1365
01:07:17,520 --> 01:07:21,240
the Super shoe, right? 
Is it do I spread it out evenly 

1366
01:07:21,240 --> 01:07:24,800
or is a peak in a completely 
different direction so that you 

1367
01:07:24,800 --> 01:07:26,560
don't have it at the 
dorsiflexion? 

1368
01:07:28,160 --> 01:07:30,720
And I would say one of the 
things that's happening with not

1369
01:07:30,720 --> 01:07:33,480
just in super shoes, but across 
the range, we're actually losing

1370
01:07:33,480 --> 01:07:36,360
all of our high drop shoes. 
So a lot of them the drops 

1371
01:07:36,360 --> 01:07:39,200
getting lower and lower and you 
have a combined softer and 

1372
01:07:39,200 --> 01:07:41,680
softer foams that you're 
actually getting. 

1373
01:07:41,720 --> 01:07:44,720
So probably your, your dynamic 
drop is going to be in the 

1374
01:07:44,720 --> 01:07:47,320
negatives just because most 
people are going to be heel 

1375
01:07:47,320 --> 01:07:49,120
strikers. 
That's just that the majority of

1376
01:07:49,120 --> 01:07:51,440
that's just how it is. 
But if you're landing like that,

1377
01:07:51,440 --> 01:07:54,200
so soft foam that's now getting 
lower, lower drop, you're 

1378
01:07:54,200 --> 01:07:57,800
spending more time in those end 
range doors reflection and like 

1379
01:07:57,800 --> 01:08:00,080
you said, there's the more 
compression and that's also the 

1380
01:08:00,080 --> 01:08:01,960
area where your calf actually 
has to generate the other 

1381
01:08:01,960 --> 01:08:03,400
planter flex have to generate 
the most torque. 

1382
01:08:03,400 --> 01:08:06,000
And if you're weak, good luck 
because that's where you 

1383
01:08:06,000 --> 01:08:07,480
absolutely need to be super 
strong. 

1384
01:08:07,480 --> 01:08:09,880
And most people, I don't know if
they have that. 

1385
01:08:10,160 --> 01:08:13,320
So I don't know if people are 
ready to be using, if they have 

1386
01:08:13,320 --> 01:08:16,600
trained adequately or prepare 
their body adequately to 

1387
01:08:16,600 --> 01:08:18,760
actually utilize these shoes. 
I think they're just jumping in.

1388
01:08:18,760 --> 01:08:19,960
They're like, oh, it feels 
great. 

1389
01:08:19,960 --> 01:08:21,800
Rather than going. 
It's kind of like running. 

1390
01:08:21,800 --> 01:08:24,120
People jump into running going, 
oh, I'm just going to use this 

1391
01:08:24,120 --> 01:08:26,720
to get in shape without going. 
You actually need to get in 

1392
01:08:26,720 --> 01:08:28,319
shape to run. 
It's the same thing for 

1393
01:08:28,319 --> 01:08:31,000
CrossFit, same thing for 
anything you need to prepare to 

1394
01:08:31,000 --> 01:08:33,000
get into this. 
If you're not ready for the IT 

1395
01:08:33,000 --> 01:08:36,160
might feel great initially, but 
then if you're not conditioned 

1396
01:08:36,160 --> 01:08:38,640
appropriately, you're probably 
going to have problems. 

1397
01:08:38,640 --> 01:08:42,200
And so overtraining becomes more
prevalent, not because you know 

1398
01:08:42,359 --> 01:08:44,600
the body couldn't handle this. 
You just or about what it was 

1399
01:08:44,600 --> 01:08:47,479
because you didn't do the work 
to prep to be able to tolerate 

1400
01:08:47,479 --> 01:08:49,920
the loads. 
Now you're asking of yourself. 

1401
01:08:49,920 --> 01:08:52,520
So that that helps. 
That helped my brain just light 

1402
01:08:52,520 --> 01:08:54,080
bulb with you talking about that
and. 

1403
01:08:54,120 --> 01:08:57,080
I think that that that what I 
want to leave the runners where 

1404
01:08:57,080 --> 01:08:58,800
they're maybe listening and 
things too. 

1405
01:08:58,800 --> 01:09:00,880
Is that what I've seen a lot 
too. 

1406
01:09:00,880 --> 01:09:04,000
And what you need to thinking 
about is I usually call it like 

1407
01:09:04,000 --> 01:09:08,000
a three, three to four to five 
week kind of range. 

1408
01:09:08,000 --> 01:09:11,080
Like in Sweden, we have 1/2 
marathon where I where I live 

1409
01:09:11,080 --> 01:09:12,560
and you know, the weather is 
crappy. 

1410
01:09:12,560 --> 01:09:14,319
You don't want to run over 
Christmas and then people want 

1411
01:09:14,319 --> 01:09:17,040
to start, right. 
So people start and they get 

1412
01:09:17,120 --> 01:09:19,319
building it up. 
I got this. 

1413
01:09:19,840 --> 01:09:22,720
And you're not going to, you're 
not going to notice the overload

1414
01:09:22,760 --> 01:09:24,359
right away. 
You're not going to notice it 

1415
01:09:24,359 --> 01:09:26,800
until you're like three to six 
weeks in. 

1416
01:09:26,800 --> 01:09:28,279
That's when they're coming to 
me, right? 

1417
01:09:28,279 --> 01:09:30,160
It's like that typical pattern, 
right? 

1418
01:09:30,160 --> 01:09:34,279
So and then by the time you're 
noticing it, you're already on 

1419
01:09:34,279 --> 01:09:38,080
the downhill and now you're 
going to be taking you a while 

1420
01:09:38,080 --> 01:09:39,640
back to get back up again, 
right? 

1421
01:09:39,640 --> 01:09:41,640
So I think this with all of 
those things that you're talking

1422
01:09:41,640 --> 01:09:45,080
about, it's really consistent 
thinking that it's going to feel

1423
01:09:45,080 --> 01:09:48,600
good for a week or two weeks or 
probably 3 weeks, but then 

1424
01:09:48,640 --> 01:09:51,080
you're going to notice it 
because the changes happen, but 

1425
01:09:51,080 --> 01:09:54,040
the the pain and then what 
you're noticing takes a lot 

1426
01:09:54,040 --> 01:09:56,840
longer, right? 
So I think that's my concern 

1427
01:09:56,840 --> 01:09:59,600
with those this like when I talk
to my brother, he feel great in 

1428
01:09:59,600 --> 01:10:02,720
those things, but it's like, 
yeah, I feel great today. 

1429
01:10:02,720 --> 01:10:03,920
I feel great for that couple of 
week. 

1430
01:10:03,920 --> 01:10:05,920
But the body is going to take 
some time, and you're not going 

1431
01:10:05,920 --> 01:10:08,880
to notice it until you're 
already kind of spiraling out of

1432
01:10:08,880 --> 01:10:12,080
control. 
Yeah, absolutely. 

1433
01:10:12,800 --> 01:10:16,120
Well, Karen, thank you for 
giving us all of your time. 

1434
01:10:16,120 --> 01:10:19,640
I know that we could ask you 
questions for probably another 

1435
01:10:19,640 --> 01:10:23,080
couple hours, but we're already 
10 minutes past what I promised.

1436
01:10:23,080 --> 01:10:24,920
I would make sure that I kept 
this too, so that we could all 

1437
01:10:24,920 --> 01:10:26,880
go to bed, especially you being 
on the East Coast. 

1438
01:10:26,880 --> 01:10:30,640
So thank you again for sharing 
your expertise and spending this

1439
01:10:30,640 --> 01:10:32,880
time with us. 
It's been a privilege and we 

1440
01:10:32,880 --> 01:10:34,680
appreciate it. 
Thank you very much. 

1441
01:10:34,680 --> 01:10:35,720
It was my pleasure.