1 00:00:03,600 --> 00:00:05,760 This weeks episode of The Doctors of Running Podcasts is 2 00:00:05,760 --> 00:00:07,960 sponsored by Running Warehouse Runners. 3 00:00:08,000 --> 00:00:10,680 This is not a drill. The ASICS Nova Blast Three is 4 00:00:10,680 --> 00:00:12,000 now on sale at Running Warehouse. 5 00:00:12,000 --> 00:00:14,800 We repeat, the Nova Blast Three is now on sale at Running 6 00:00:14,800 --> 00:00:17,640 Warehouse, a favorite over a team over the past year. 7 00:00:17,640 --> 00:00:20,000 It's a great shoe for those who own a soft, durable, daily 8 00:00:20,000 --> 00:00:22,080 training shoe for easy and longer miles. 9 00:00:22,600 --> 00:00:25,320 Our Chief Editor and founder Matt Klein calls the FF Blast 10 00:00:25,320 --> 00:00:28,480 Plus Mitzel highly cushioned and soft, which when combined with a 11 00:00:28,480 --> 00:00:31,360 high stack height provides A protective yet surprisingly 12 00:00:31,360 --> 00:00:34,240 light ride under foot. Head over to Running Warehouse 13 00:00:34,240 --> 00:00:37,000 to get your hands on a pair of discounted Nova Blast 3 today. 14 00:00:37,480 --> 00:00:39,840 Find a link to the sale in our description and a full written 15 00:00:39,840 --> 00:00:42,200 review of the shoe on our website for more details. 16 00:00:51,480 --> 00:00:54,560 Hey everyone, welcome to the Doctors Running Podcast where we 17 00:00:54,560 --> 00:00:55,760 a. Group of doctors, physical 18 00:00:55,760 --> 00:00:57,680 therapy. Talk about the art and the 19 00:00:57,680 --> 00:00:59,800 science of the things that we're putting on our feet and 20 00:00:59,800 --> 00:01:01,800 sometimes the art and science of the things that are happening to 21 00:01:01,800 --> 00:01:04,560 our feet and other parts of our lower extremity and our body. 22 00:01:04,840 --> 00:01:08,120 And that is where I'm coming in. So I'm at for those who you 23 00:01:08,120 --> 00:01:10,600 probably know who I am if you've been following this podcast. 24 00:01:12,080 --> 00:01:16,360 So what I'm hoping to do today is do a solo episode sharing 25 00:01:16,560 --> 00:01:19,440 quite a bit about what I have learned about Achilles. 26 00:01:19,440 --> 00:01:22,080 Tendons, Rhino, Mechanics and things that have really been 27 00:01:22,080 --> 00:01:24,120 blowing my mind and for those who don't know. 28 00:01:24,120 --> 00:01:27,000 So I'm finishing up my PhD and hopefully by the time this 29 00:01:27,000 --> 00:01:29,560 releases I will have all my data collection done because I've 30 00:01:29,560 --> 00:01:33,440 done 27 people so far. I have two subjects scheduled 31 00:01:33,440 --> 00:01:36,400 and then one last one that I'm trying to schedule in here to go 32 00:01:36,400 --> 00:01:39,440 test. So I can finally finish this PhD 33 00:01:39,440 --> 00:01:42,600 after 4 1/2 years and get some stuff more stuff published and 34 00:01:42,600 --> 00:01:45,440 share with all all of you what's happening to our bodies as we 35 00:01:45,440 --> 00:01:48,240 age and what we can do about it. So those who don't know. 36 00:01:48,240 --> 00:01:52,880 Again, I'm doing a dissertation in on Masters Runners and trying 37 00:01:52,880 --> 00:01:55,960 to understand why is there a higher occurrence of Achilles to 38 00:01:55,960 --> 00:01:59,080 monopoly as we age. For those who don't know, in 39 00:01:59,080 --> 00:02:03,160 younger runners the most common injury type tends to be more 40 00:02:03,160 --> 00:02:05,080 knee related. Patellar, tendinopathy, 41 00:02:06,200 --> 00:02:10,880 iliotibial stuff. When you get older, that really 42 00:02:10,880 --> 00:02:14,320 shifts to being much more of Achilles tendinopathy being the 43 00:02:14,320 --> 00:02:18,120 number one, calf being #2, and then hamstring and hamstring 44 00:02:18,280 --> 00:02:20,880 tendon issues being #3. So there's a really big 45 00:02:20,880 --> 00:02:23,920 difference between younger and older runners in terms of injury 46 00:02:23,920 --> 00:02:28,560 risk or injury types. The injury risk also goes up as 47 00:02:28,560 --> 00:02:32,400 we get older and there's some. Theories as to why, but nobody's 48 00:02:32,400 --> 00:02:34,840 really tested this and this is where I am coming in trying to 49 00:02:34,840 --> 00:02:36,080 go. Hey so I'm doing. 50 00:02:36,200 --> 00:02:40,120 Observational research comparing masters runners who do and do 51 00:02:40,120 --> 00:02:41,960 not have Achilles tendon issues and trying to see what's 52 00:02:41,960 --> 00:02:44,560 different and what risk factors might be playing in to make 53 00:02:44,560 --> 00:02:47,120 people more at risk for this. I have published A systematic 54 00:02:47,120 --> 00:02:50,080 review on the difference between younger and older runners where 55 00:02:50,080 --> 00:02:52,640 I took all the evidence from the last 20 plus years trying to go 56 00:02:52,640 --> 00:02:53,960 hey, what? What's going on? 57 00:02:54,280 --> 00:02:56,880 If you are curious about this, there is a pay wall. 58 00:02:56,880 --> 00:03:00,360 It's it's published in the Journal of Sports Bio Mechanics. 59 00:03:01,120 --> 00:03:02,960 That's my second check for my dissertation. 60 00:03:03,280 --> 00:03:06,280 If you would like to see read that, please e-mail us and I 61 00:03:06,280 --> 00:03:07,800 will happily send that to you for free. 62 00:03:08,200 --> 00:03:10,360 Just I I think information should be shared. 63 00:03:10,920 --> 00:03:13,200 So. And what I found was that 64 00:03:13,200 --> 00:03:15,720 actually between younger and older runners, the knee doesn't 65 00:03:15,720 --> 00:03:18,600 change that much. What really changes is the hip 66 00:03:18,600 --> 00:03:21,160 and the ankle. So despite having a shorter 67 00:03:21,160 --> 00:03:23,440 stride, which cadence doesn't change? 68 00:03:23,440 --> 00:03:25,720 By the way, that's a whole nother podcast on that. 69 00:03:25,920 --> 00:03:30,640 Cadence doesn't change stride, Length shortens, hip extension 70 00:03:30,920 --> 00:03:33,800 lengthens. Still doesn't make sense to me, 71 00:03:34,920 --> 00:03:38,400 but your ankle joint really changes, especially all the 72 00:03:38,400 --> 00:03:41,880 things related to propulsion. So ground reaction forces like 73 00:03:41,880 --> 00:03:45,800 when you land the reactive force that like the the the when you 74 00:03:45,800 --> 00:03:47,880 you know when you put force to something there's an equal and 75 00:03:47,880 --> 00:03:50,760 opposite reaction. So the propulsive forces 76 00:03:51,120 --> 00:03:54,400 decrease at the ankle, joint powers decrease the ankle. 77 00:03:54,440 --> 00:03:57,960 Everything related to propulsion and moving forwards really 78 00:03:57,960 --> 00:04:01,440 decreases the ankle range of motion, like peak joint angles. 79 00:04:01,840 --> 00:04:06,040 Really don't change supposedly. But what does change is a lot of 80 00:04:06,040 --> 00:04:08,960 the forces associated with that. So we'll talk about that in just 81 00:04:08,960 --> 00:04:10,600 a second. So that was kind of the 82 00:04:10,600 --> 00:04:13,240 background for this. And as I have dived into this, 83 00:04:13,240 --> 00:04:16,040 although I have not completed my data analysis because I don't 84 00:04:16,040 --> 00:04:18,880 have all my subjects, some of the things that I've seen have 85 00:04:18,880 --> 00:04:22,280 really made me. Think and then some other things 86 00:04:22,280 --> 00:04:24,240 that I've learned along this journey like oh, I should have 87 00:04:24,240 --> 00:04:26,920 tested that are things that I want to share with you. 88 00:04:27,040 --> 00:04:28,840 And one of the biggest things I want to share with you is 89 00:04:28,840 --> 00:04:31,840 helping you understand what are tendons and. 90 00:04:31,840 --> 00:04:33,960 Especially with the Achilles tendon, although the stuff we're 91 00:04:33,960 --> 00:04:37,000 going to talk about also applies to the hamstring tendon and the 92 00:04:37,000 --> 00:04:39,640 patellar or the quad tendon. What is really going on with 93 00:04:39,640 --> 00:04:40,720 them? What's their function? 94 00:04:40,920 --> 00:04:43,160 Can we talk about injury stuff a little bit and then what can we 95 00:04:43,160 --> 00:04:46,760 do about this in regards to what how aging and and pathology. 96 00:04:46,760 --> 00:04:49,520 So we're going to do a little tendon talk today, which Nathan 97 00:04:49,520 --> 00:04:50,800 and I talked to teeny bit about this a. 98 00:04:50,800 --> 00:04:53,240 Couple weeks ago. But I want to give you a little 99 00:04:53,240 --> 00:04:55,520 bit more because I feel like tenants are very, very 100 00:04:55,520 --> 00:04:58,240 misunderstood. And I say this is somebody who I 101 00:04:58,240 --> 00:05:01,080 have a doctorate degree in physical therapy and have been 102 00:05:01,080 --> 00:05:04,760 working on a PhD for years in this, and I'm still learning new 103 00:05:04,760 --> 00:05:07,400 stuff all the time. So hopefully I can share some of 104 00:05:07,400 --> 00:05:09,000 that with you. So let's. 105 00:05:10,200 --> 00:05:12,680 Let's let's share a little bit of on on masters runners. 106 00:05:12,680 --> 00:05:16,040 So masters runners again for my definition I define as over 50 107 00:05:16,040 --> 00:05:17,800 because a lot of the evidence suggests that there are three 108 00:05:17,800 --> 00:05:20,000 time points where our bodies really change in terms of the 109 00:05:20,000 --> 00:05:23,560 muscular skill system. 30 is where it starts, 50 is where it 110 00:05:23,560 --> 00:05:26,200 accelerates and then 75 were really accelerate. 111 00:05:26,200 --> 00:05:29,560 So I think US ATF, if you're listening, I think having 35 to 112 00:05:29,560 --> 00:05:32,880 40 being when masters age group starts totally wrong. 113 00:05:33,240 --> 00:05:36,240 Different podcasts. But just a heads up, so as you 114 00:05:36,240 --> 00:05:39,200 get older, there are a lot of things that change. 115 00:05:39,200 --> 00:05:41,440 I already mentioned that there's a higher risk of Achilles tendon 116 00:05:41,440 --> 00:05:44,840 issues, injury, wrist changes, but there's also some changes to 117 00:05:44,840 --> 00:05:48,200 your musculoskeletal system that may or may not make put you more 118 00:05:48,200 --> 00:05:51,120 at risk. Before we go there, I need you 119 00:05:51,120 --> 00:05:56,720 to understand what a tendon is. So tendons really are basically 120 00:05:56,720 --> 00:05:58,680 like your rubber bands for your muscles. 121 00:05:59,000 --> 00:06:01,800 They are defined as kind of the connective tissue, elastic 122 00:06:01,800 --> 00:06:03,960 tissue that connects a muscle to a bone. 123 00:06:04,440 --> 00:06:07,440 And they are not contractile, so to speak. 124 00:06:08,400 --> 00:06:10,400 It's not an actively contracting tissue. 125 00:06:10,400 --> 00:06:11,880 It's a tissue that acts like a rubber band. 126 00:06:12,120 --> 00:06:15,240 If you load it and stretch it, there is going to be some out 127 00:06:15,240 --> 00:06:18,320 where it kind of snaps back. At least it should if it's 128 00:06:18,320 --> 00:06:21,160 working correctly, OK. It doesn't have as good blood 129 00:06:21,160 --> 00:06:23,680 flow as muscles. It can get stronger and it can 130 00:06:23,680 --> 00:06:25,600 change. If you don't load it enough, it 131 00:06:25,600 --> 00:06:27,200 can definitely get weaker in terms. 132 00:06:27,200 --> 00:06:29,160 Of have a lot less stiffness and elasticity. 133 00:06:29,400 --> 00:06:34,120 If you load it enough, it can actually get stronger and it can 134 00:06:34,120 --> 00:06:35,760 get more. Stiff, so this tissue does 135 00:06:35,760 --> 00:06:37,600 adapt, even though it doesn't. Have great blood flow. 136 00:06:38,000 --> 00:06:40,760 It is very much alive. It's got very good nerves. 137 00:06:41,360 --> 00:06:42,720 Innervation. There's a lot of very 138 00:06:42,720 --> 00:06:46,480 interesting things about it, but it functions as elastic energy 139 00:06:46,480 --> 00:06:49,320 storage. So specifically the calf. 140 00:06:49,960 --> 00:06:53,200 I'm sorry, the gap, the gastrocnemius and the Achilles 141 00:06:53,200 --> 00:06:54,480 tendon. The way things work is, as 142 00:06:54,480 --> 00:06:56,920 you're running the first half of, when your foot's on the 143 00:06:56,920 --> 00:06:59,880 ground, called stance. When you land, you're loading 144 00:06:59,880 --> 00:07:01,280 that tendon. You're lengthening it. 145 00:07:01,280 --> 00:07:02,600 You're stretching out the rubber band. 146 00:07:02,840 --> 00:07:05,480 As you get to the second-half, when you start pushing off, it's 147 00:07:05,480 --> 00:07:08,480 not just the calf contracting, it is also the Achilles tendon 148 00:07:08,480 --> 00:07:11,120 starting to release that energy, snap back and help you push your 149 00:07:11,120 --> 00:07:14,160 foot off. You can imagine the more stiff 150 00:07:14,160 --> 00:07:17,760 this thing is, the more energy you're going to be able to 151 00:07:17,760 --> 00:07:19,280 return. Maybe that's not the best 152 00:07:19,280 --> 00:07:21,320 phrase, but the more elastic, more stiff, the more you're 153 00:07:21,320 --> 00:07:24,040 going to pop off the ground, which has been associated with 154 00:07:24,040 --> 00:07:26,240 better running economies. So those runners that are 155 00:07:26,240 --> 00:07:29,280 stiffer within reason tender have, are more efficient, they 156 00:07:29,280 --> 00:07:32,440 use less energy and I want to say they're faster. 157 00:07:32,440 --> 00:07:34,680 But speed is kind of its own thing because it's also how much 158 00:07:34,680 --> 00:07:38,440 force you can produce as well. But a lot of elasticity does 159 00:07:38,440 --> 00:07:41,440 play a role in those elite runners that you see, right? 160 00:07:41,480 --> 00:07:43,560 Very economic, chemical. They can go for a long time 161 00:07:43,880 --> 00:07:45,360 again in the distance running world. 162 00:07:45,360 --> 00:07:48,040 Sprinting. Not as much my expertise, but 163 00:07:48,040 --> 00:07:51,880 distance running definitely. So again, it acts like energy 164 00:07:51,880 --> 00:07:54,320 storage, OK. It is stores your energy and 165 00:07:54,320 --> 00:07:57,200 then the the forces and then it pops you back off. 166 00:07:57,200 --> 00:08:01,640 Force is not the right term. So what happens when you 167 00:08:01,680 --> 00:08:03,800 irritate this thing? So let's talk about what the 168 00:08:03,800 --> 00:08:06,760 difference between tendonitis and tendinopathy is. 169 00:08:07,040 --> 00:08:10,760 So a tendonitis is a acute, meaning it just happened 170 00:08:10,760 --> 00:08:14,840 literally like a couple seconds ago, a day ago, an acute 171 00:08:14,840 --> 00:08:17,720 irritation of a tendon. OK, there is usually an 172 00:08:17,720 --> 00:08:20,320 inflammatory response. Often it can usually be at the 173 00:08:20,320 --> 00:08:22,240 insertion point or one of the midpoints. 174 00:08:22,480 --> 00:08:24,120 Very. Rarely was like in the middle. 175 00:08:24,320 --> 00:08:26,840 That's different from something like a tear where you actually 176 00:08:26,840 --> 00:08:28,720 rupture or rip through the thing. 177 00:08:28,880 --> 00:08:31,320 That's a rupture or tear. That is very different than a 178 00:08:31,320 --> 00:08:33,480 tendonitis or tendonopathy, Although you can often have a 179 00:08:33,480 --> 00:08:37,200 tendonitis with a rupture or tear they can go together, but a 180 00:08:37,200 --> 00:08:40,000 pure tendonitis is acute. It just happened. 181 00:08:40,000 --> 00:08:42,960 There's inflammatory stuff. They generally respond well to 182 00:08:42,960 --> 00:08:44,640 anti inflammatories, which makes sense. 183 00:08:44,840 --> 00:08:46,920 That may not be the best thing cuz there's some evidence to 184 00:08:46,920 --> 00:08:48,240 just that. Might slow down healing. 185 00:08:48,880 --> 00:08:51,440 Different conversation. But it just happened and there's 186 00:08:51,440 --> 00:08:53,680 inflammation. Okay, things are pissed off. 187 00:08:53,680 --> 00:08:55,000 Your body's trying to calm stuff down. 188 00:08:55,360 --> 00:08:58,120 That's a tendonitis. Those aren't actually very 189 00:08:58,120 --> 00:09:00,440 common because what the evidence suggests, a lot of times we 190 00:09:00,440 --> 00:09:02,400 don't even notice the first time these things get injured. 191 00:09:02,560 --> 00:09:04,320 What's actually more common is something called the 192 00:09:04,320 --> 00:09:07,560 tendonopathy, meaning you've had a chronic irritation of the 193 00:09:07,560 --> 00:09:10,320 tendon. There is no longer than normal 194 00:09:10,320 --> 00:09:12,160 inflammation. These are the things that do not 195 00:09:12,160 --> 00:09:14,720 respond to and to anti inflammation like oh, I took 196 00:09:14,720 --> 00:09:18,080 this doesn't seem to work. It's like yeah, because it's not 197 00:09:18,080 --> 00:09:20,800 inflammatory, it's not acute. This has been going on for a 198 00:09:20,800 --> 00:09:24,040 long time and not to scare you, that also usually means there's 199 00:09:24,040 --> 00:09:26,320 in terms of internal degeneration of the tendon, 200 00:09:26,520 --> 00:09:28,800 you've been irritating this thing enough that it hasn't had 201 00:09:28,800 --> 00:09:31,800 time to fully adapt to recover. So your body's just throwing 202 00:09:31,800 --> 00:09:35,240 scaffolding on those connected tissue fibers aren't aligned as 203 00:09:35,240 --> 00:09:38,480 well anymore, you but it's like. Port like a house that kind of 204 00:09:38,480 --> 00:09:39,520 broke down. You're trying to, like, put 205 00:09:39,520 --> 00:09:41,360 pieces back together really quick and it's kind of like a 206 00:09:41,360 --> 00:09:43,400 mess. We found That's actually what 207 00:09:43,400 --> 00:09:45,720 happens to the tendon. It gets irritated. 208 00:09:45,920 --> 00:09:48,320 You never get a chance for it to actively recover the right 209 00:09:48,320 --> 00:09:49,840 weight. And that doesn't mean rest, by 210 00:09:49,840 --> 00:09:51,000 the way. And we'll talk about that in a 211 00:09:51,040 --> 00:09:52,360 second. It just means things. 212 00:09:52,360 --> 00:09:55,320 Are chronically irritated and chronically changed. 213 00:09:55,720 --> 00:09:58,920 There is evidence, by the way, that suggests that about 50% of 214 00:09:58,920 --> 00:10:01,880 runners have an Achilles tendonopathy and have no idea. 215 00:10:02,440 --> 00:10:04,240 Pain is not not to freak you out. 216 00:10:04,240 --> 00:10:09,200 Pain is not the best indication of your health or of healing. 217 00:10:09,280 --> 00:10:10,760 And we'll again talk about in a second. 218 00:10:10,760 --> 00:10:13,000 So you can have this pathology and not have any pain. 219 00:10:13,000 --> 00:10:17,640 We found 50% of runners have it, and those runners, at least 50% 220 00:10:17,640 --> 00:10:19,520 of them have it on one if not both sides. 221 00:10:19,520 --> 00:10:22,560 Again, they have no idea, so this stuff happens. 222 00:10:22,880 --> 00:10:25,480 Don't freak out, OK? That's what I was just to worry 223 00:10:25,480 --> 00:10:26,840 about going, Oh my gosh, I have this thing. 224 00:10:26,840 --> 00:10:29,160 I have to worry about it. It happens, right? 225 00:10:29,280 --> 00:10:30,600 Probably. You know, there is some 226 00:10:30,600 --> 00:10:32,040 suggestion. Maybe it's a normal part of 227 00:10:32,040 --> 00:10:33,960 aging. Who knows? 228 00:10:33,960 --> 00:10:39,600 I'm still gonna help you try to fix it and treat it so as you 229 00:10:39,600 --> 00:10:42,800 get a tendinopathy, usually what happens is you start losing some 230 00:10:42,800 --> 00:10:44,440 of that stiffness. Remember I talked about that? 231 00:10:44,440 --> 00:10:46,840 There's an optimal level of stiffness that you want if you 232 00:10:46,840 --> 00:10:48,400 had. That good level of stiffness in 233 00:10:48,400 --> 00:10:50,320 your lower extremity and the tendon and muscle. 234 00:10:50,560 --> 00:10:54,640 When you land, you absorb you. You absorb that into the tendon 235 00:10:54,640 --> 00:10:56,960 and then you. Release it really well if it's. 236 00:10:57,080 --> 00:11:00,880 If you're too stiff, you can't get that thing to move at all, 237 00:11:00,880 --> 00:11:02,920 and then you actually have a higher injury risk. 238 00:11:03,240 --> 00:11:06,520 If it's not stiff enough, the opposite happens where you can't 239 00:11:06,520 --> 00:11:09,560 absorb stuff and the muscles end up having to work way harder and 240 00:11:09,560 --> 00:11:10,720 put more more stress for the area. 241 00:11:10,920 --> 00:11:12,640 So you want an optimal level stiffness. 242 00:11:12,920 --> 00:11:16,320 Tendinopathies often cause a loss of that stiffness because 243 00:11:16,320 --> 00:11:20,320 the tendon, that rubber band, isn't absorbing energy and 244 00:11:20,320 --> 00:11:22,360 storing it. Elastically, the way it's 245 00:11:22,360 --> 00:11:26,080 supposed to, right? The the tissues aren't lining 246 00:11:26,080 --> 00:11:27,600 up. They're not these nice fibers 247 00:11:27,600 --> 00:11:28,840 anymore. They're just kind of scaffold. 248 00:11:28,840 --> 00:11:31,320 And those don't, Those don't. Those don't function super well. 249 00:11:31,560 --> 00:11:33,720 They can function well enough for you to continue continue 250 00:11:33,720 --> 00:11:37,200 running, and a lot of this to continue to run through it, but 251 00:11:37,200 --> 00:11:40,120 it's just not going to be the same as it was. 252 00:11:40,440 --> 00:11:42,400 The same thing happens with aging. 253 00:11:42,400 --> 00:11:45,520 There are mechanical changes that can occur with age. 254 00:11:45,520 --> 00:11:47,200 You tend to lose some of that stiffness. 255 00:11:47,200 --> 00:11:50,640 And again, I'm talking about like the ability when I define 256 00:11:50,640 --> 00:11:54,600 stiffness as the ability of a tissue to absorb shock and and 257 00:11:54,600 --> 00:11:58,160 lastly like pop back, right. So how much, I guess I don't 258 00:11:58,160 --> 00:12:01,120 know how to explain this, like you're like almost like your pop 259 00:12:01,120 --> 00:12:03,560 off, right? Like how much you can land and 260 00:12:03,560 --> 00:12:05,760 snap back, your snap back so to speak, right. 261 00:12:06,160 --> 00:12:08,640 So as you get older, you also tend to lose a lot of that. 262 00:12:08,640 --> 00:12:14,360 And so instead of having a stiff and elastic lower extremity, you 263 00:12:14,360 --> 00:12:17,720 tend to have just a stiff extremity that doesn't adapt as 264 00:12:17,720 --> 00:12:19,440 much range of motion, even though I've told you that 265 00:12:19,440 --> 00:12:22,160 doesn't really change. And you tend to adapt in certain 266 00:12:22,160 --> 00:12:24,800 ways. So you have stiff joints and 267 00:12:24,800 --> 00:12:27,480 don't shock absorb as much rather than like elastically 268 00:12:27,480 --> 00:12:29,360 landing. OK, so there is something 269 00:12:29,360 --> 00:12:33,480 related to age, we don't quite have that nailed down, but 270 00:12:33,480 --> 00:12:35,000 that's something that definitely happens. 271 00:12:35,200 --> 00:12:41,240 OK, so with those changes that happen, you can either have 272 00:12:41,240 --> 00:12:43,200 those loss, that loss of statistics and loss of those 273 00:12:43,200 --> 00:12:44,880 mechanical properties with aging. 274 00:12:44,880 --> 00:12:47,120 You can also have it with Achilles tendinopathy. 275 00:12:47,320 --> 00:12:50,520 And there's some suggestions those might happen together. 276 00:12:51,200 --> 00:12:55,320 So here's the part where we talk about things that blew my mind 277 00:12:55,320 --> 00:12:57,680 not too long ago. So I don't know if you know 278 00:12:57,680 --> 00:13:00,480 this, and I say this after having learned this, going 279 00:13:00,480 --> 00:13:03,000 through running courses, after going through all this, 280 00:13:03,000 --> 00:13:04,840 continuing education after a doctorate degree, and now 281 00:13:04,840 --> 00:13:08,280 working on a second one when you are running. 282 00:13:08,920 --> 00:13:10,480 I don't know if you know this, but. 283 00:13:10,640 --> 00:13:12,480 Your muscles. Your calf is right. 284 00:13:12,480 --> 00:13:15,840 So a tendon is the connection between a muscle to the bone. 285 00:13:17,080 --> 00:13:21,040 Your calf muscles when you are trying to do things their their 286 00:13:21,040 --> 00:13:25,320 extension, so to speak. Is the Achilles tendon OK when 287 00:13:25,320 --> 00:13:28,840 you're running? This Current work by Adrian Ley 288 00:13:29,200 --> 00:13:36,040 found that as you run, your calf muscles optimally don't change 289 00:13:36,040 --> 00:13:38,880 range of motion very much. They had they do what's called 290 00:13:38,880 --> 00:13:41,800 an isometric contraction, meaning the muscle length 291 00:13:41,800 --> 00:13:44,440 doesn't change. That's like if I, you know, grab 292 00:13:44,440 --> 00:13:47,160 a book over here. If I hold this up in one place, 293 00:13:47,160 --> 00:13:49,920 my biceps right now, for those who can see me on YouTube, is 294 00:13:49,920 --> 00:13:51,720 Holt is an. It's an isometric contraction. 295 00:13:51,720 --> 00:13:55,280 It's not changing length. Which, think about that for a 296 00:13:55,280 --> 00:13:58,280 second. So supposedly when you run your 297 00:13:58,280 --> 00:14:01,440 calf muscles really don't change length that much. 298 00:14:03,000 --> 00:14:05,360 You go through a massive range of motion of the ankle. 299 00:14:05,560 --> 00:14:08,200 You need at least 50 degrees of ankle plantar flexion, which is 300 00:14:08,200 --> 00:14:10,080 when you point your toes down, your ankle down. 301 00:14:10,280 --> 00:14:13,200 You need at least 20-30 degrees of dorsiflexion, which is when 302 00:14:13,200 --> 00:14:16,920 your toes come up. How can you tell me that you 303 00:14:17,000 --> 00:14:20,280 your range of motion doesn't change at the calf at the 304 00:14:20,280 --> 00:14:23,640 muscle. So what happens is the majority 305 00:14:23,640 --> 00:14:26,160 of that range of motion is actually supposed to be coming 306 00:14:26,160 --> 00:14:29,760 from your Achilles tendon, which is amazing to me. 307 00:14:29,760 --> 00:14:32,600 It is one of the largest, if not the largest tendon in the body. 308 00:14:32,840 --> 00:14:35,280 But when you're running, supposedly the range of motion 309 00:14:35,280 --> 00:14:38,240 that your calf actually changes is very little compared to how 310 00:14:38,240 --> 00:14:40,360 much gets loaded and how much the length changes to the 311 00:14:40,360 --> 00:14:42,160 Achilles tendon. So that blew my mind and going, 312 00:14:42,360 --> 00:14:44,400 wow, this is a really important structure for running. 313 00:14:44,920 --> 00:14:47,440 Similar evidence has found the same thing for the hamstring 314 00:14:47,440 --> 00:14:50,920 tendon and the quad tendon, which totally changed my 315 00:14:50,920 --> 00:14:53,600 understanding of going wait, how are we actually training these? 316 00:14:53,800 --> 00:14:57,040 We typically do these like deep squats or these great these big 317 00:14:57,040 --> 00:15:00,560 heel raises and wait, what if this is just an these muscles 318 00:15:00,560 --> 00:15:02,760 are an isometric contracting. Are we training this the right 319 00:15:02,760 --> 00:15:04,560 way? We don't know by the way. 320 00:15:04,560 --> 00:15:07,600 We just know that these don't the the muscles don't change as 321 00:15:07,600 --> 00:15:10,720 much range of motion to this as we thought being efficient 322 00:15:10,720 --> 00:15:12,800 during running. A lot more of that supposed to 323 00:15:12,800 --> 00:15:16,840 come from the tendon. Now when you have a 324 00:15:16,840 --> 00:15:20,040 tendinopathy, or again tendinopathy plus age, which I 325 00:15:20,040 --> 00:15:23,480 don't know which one came first, chicken or the egg or that one, 326 00:15:23,840 --> 00:15:26,040 you start losing some of that elasticity. 327 00:15:26,280 --> 00:15:29,680 OK, so more if you don't have as much tendon elasticity that 328 00:15:29,680 --> 00:15:32,360 doesn't move as much, you're going to have to use a lot more 329 00:15:32,360 --> 00:15:35,120 muscle force to try to get through that, which is not as 330 00:15:35,120 --> 00:15:37,560 efficient, right? Instead of storing energy, 331 00:15:37,560 --> 00:15:40,160 you're having to create it, shock, absorb, and move 332 00:15:40,160 --> 00:15:43,680 forwards. That is a lot more energy and 333 00:15:43,680 --> 00:15:46,360 work OK, which might also explain some of the things that 334 00:15:46,360 --> 00:15:50,920 older runners losing speed, losing elasticity as they age, 335 00:15:51,040 --> 00:15:56,080 may or may not explain that. But we also know tendinopathy is 336 00:15:56,080 --> 00:15:58,680 like the pathology that tendon increases as we get older. 337 00:15:58,920 --> 00:16:05,040 So why, like what's happening? So let's go back a second and 338 00:16:05,040 --> 00:16:09,800 talk about tendinopathy from what we know in and average and 339 00:16:09,800 --> 00:16:12,520 and younger individuals like, quote, UN quote under 50. 340 00:16:13,000 --> 00:16:17,200 So the current evidence on this stuff is once you have these 341 00:16:17,200 --> 00:16:19,640 things, which is a lot of risk factors by the way. 342 00:16:19,840 --> 00:16:22,880 So the crazy ones for those who don't know certain types of 343 00:16:22,880 --> 00:16:25,600 antibiotics are actually a risk factor for Achilles tendon 344 00:16:25,600 --> 00:16:26,840 issues. Excessive. 345 00:16:26,920 --> 00:16:29,160 Alcohol consumption. I'm sorry to tell you this is 346 00:16:29,160 --> 00:16:31,840 also risk factor, but other things for the Achilles tendon, 347 00:16:32,160 --> 00:16:34,280 poor calf strength. Is a risk factor. 348 00:16:35,240 --> 00:16:38,440 Poor hip strength is actually risk factor, excessive pronation 349 00:16:38,440 --> 00:16:40,160 or supination. So a lot of frontal plane 350 00:16:40,160 --> 00:16:43,080 changes, which by the way as you age that frontal plane stuff 351 00:16:43,080 --> 00:16:45,280 didn't change as much so I wasn't as worried about that. 352 00:16:45,840 --> 00:16:48,800 Hip strength changes can change loss of range of motion at the 353 00:16:48,800 --> 00:16:52,440 hip or the ankle, so either too much or too little can be a risk 354 00:16:52,440 --> 00:16:54,960 factor, but number strength seemed to be the bigger one. 355 00:16:56,080 --> 00:17:01,760 What's also interesting about that is that as you get older, 356 00:17:03,640 --> 00:17:06,200 you tend to lose calf strength more than any other area in the 357 00:17:06,200 --> 00:17:07,760 body. We still aren't really sure 358 00:17:07,760 --> 00:17:10,920 about this, but for any if you ask any physical therapist that 359 00:17:10,920 --> 00:17:13,000 works with older individuals, I'm a geriatric clinical 360 00:17:13,000 --> 00:17:15,560 specialist. Calf strength is not good, and 361 00:17:15,560 --> 00:17:17,920 that's a problem because it's so important for so many things. 362 00:17:18,319 --> 00:17:20,839 It is your primary propulsive muscle during running. 363 00:17:21,119 --> 00:17:23,839 Your hip gets more involved, by the way, when you run faster, 364 00:17:23,839 --> 00:17:26,480 but at most speeds your calf is the main thing pushing you 365 00:17:26,480 --> 00:17:28,720 forward. For those not running, it is 366 00:17:28,720 --> 00:17:31,360 also a primary propulsive muscle during walking. 367 00:17:31,680 --> 00:17:35,360 It's also a very important muscle for balance and for a 368 00:17:35,360 --> 00:17:37,840 posture because it helps hold you up and can hold that 369 00:17:37,840 --> 00:17:40,080 contraction. So if you start losing that 370 00:17:40,080 --> 00:17:41,600 function, that's really problematic. 371 00:17:41,760 --> 00:17:44,680 Calf strength is really important for balance, for fall 372 00:17:44,680 --> 00:17:48,840 risk reduction, and also for generals gate speed, so if 373 00:17:48,840 --> 00:17:50,480 you're losing that, that's a problem. 374 00:17:51,600 --> 00:17:53,640 Now, nobody's really looked at this in masters runners, but we 375 00:17:53,640 --> 00:17:57,120 know that masters runners don't maintain their strength if they 376 00:17:57,120 --> 00:17:59,920 don't, strength train running itself doesn't maintain 377 00:17:59,920 --> 00:18:02,360 strength. Sorry, that's why we all tell 378 00:18:02,360 --> 00:18:04,080 all the runners you need to strength train a little bit. 379 00:18:04,080 --> 00:18:05,680 You don't have to do it be a weightlifter, but you need to 380 00:18:05,680 --> 00:18:08,200 strength train. Running doesn't maintain your 381 00:18:08,200 --> 00:18:11,320 strength. OK, weightlifting, the the 382 00:18:11,320 --> 00:18:14,840 masters, power lifters and bodybuilders, they maintain 383 00:18:14,840 --> 00:18:16,400 strength really, really well, right? 384 00:18:16,400 --> 00:18:21,040 They have comparable strength to young people, OK, but masters 385 00:18:21,040 --> 00:18:22,240 runners, they don't maintain strength. 386 00:18:22,240 --> 00:18:24,000 You maintain your aerobic capabilities. 387 00:18:24,560 --> 00:18:26,920 You also don't get great bone adaptation. 388 00:18:26,920 --> 00:18:29,560 To this, please go listen to the episode with Doctor Rich Willie 389 00:18:29,560 --> 00:18:31,280 where we talked about this and he's going to mention some of 390 00:18:31,280 --> 00:18:35,680 the stuff in that episode that running only has a osteogenic 391 00:18:35,680 --> 00:18:39,120 effect, like a positive effect for like the first minute or so. 392 00:18:39,120 --> 00:18:42,880 And then that's it. You go for a 60 minute run, you 393 00:18:42,880 --> 00:18:44,880 only got benefit from the first one or two minutes. 394 00:18:45,280 --> 00:18:48,560 So strength is something we lose as we get older. 395 00:18:48,680 --> 00:18:51,720 It's also a significant risk factor for Achilles tendon 396 00:18:51,720 --> 00:18:55,760 issues because you need that isometric muscle contraction, or 397 00:18:55,760 --> 00:18:59,160 at least the small movement to help protect the tendon and form 398 00:18:59,160 --> 00:19:02,960 a stable base for it. So you might be asking, Oh my 399 00:19:02,960 --> 00:19:04,800 gosh, is this being running is bad for my tendon? 400 00:19:04,800 --> 00:19:06,640 No, actually, quite the opposite. 401 00:19:06,960 --> 00:19:11,040 That movement is good for your tendon rest is one of the worst 402 00:19:11,040 --> 00:19:13,640 things you can do, actually. Unless, of course, you've 403 00:19:13,640 --> 00:19:15,600 ruptured it and you've and you've had a repair. 404 00:19:15,600 --> 00:19:17,200 And that's a different story. We're not talking about 405 00:19:17,200 --> 00:19:18,880 ruptures, We're talking about tendinopathies. 406 00:19:19,400 --> 00:19:22,640 So tendinopath tendons respond very well to movement. 407 00:19:22,640 --> 00:19:25,720 If you don't load them, they tend to lose the elasticity. 408 00:19:25,720 --> 00:19:30,080 They can get weaker. OK, for those that have a true 409 00:19:30,080 --> 00:19:33,560 tendinopathy, you need to load this thing. 410 00:19:33,560 --> 00:19:38,200 Appropriately for guess how long it takes 9 to 12 months for a 411 00:19:38,200 --> 00:19:41,840 true tendinopathy with appropriate rehab to actually 412 00:19:41,920 --> 00:19:44,520 heal. OK And that doesn't necessarily 413 00:19:44,520 --> 00:19:46,680 mean to actually change the structure 'cause I mentioned 414 00:19:46,720 --> 00:19:49,520 there's some degeneration for you to get your function truly 415 00:19:49,520 --> 00:19:51,320 back and not have a high recurrence, right? 416 00:19:51,320 --> 00:19:54,600 It takes 9 to 12 months of loading this thing to actually 417 00:19:54,600 --> 00:19:56,200 make a difference. And we've. 418 00:19:56,200 --> 00:20:01,360 Seen which is super interesting is that the the the tendon like 419 00:20:01,360 --> 00:20:03,680 if you do a diagnostic ultrasound or you look at this 420 00:20:03,680 --> 00:20:07,720 thing under imaging this the some of the generation doesn't 421 00:20:07,720 --> 00:20:10,320 always change but the function definitely will. 422 00:20:10,880 --> 00:20:13,000 Now somebody may actually Oh well, when's the pain go away? 423 00:20:13,240 --> 00:20:17,200 The pain goes away long before you start seeing some permanent 424 00:20:17,200 --> 00:20:19,080 changes in the tendon. So this is what's hard for 425 00:20:19,080 --> 00:20:21,880 people with tendinopathies, and probably why the recurrence rate 426 00:20:21,880 --> 00:20:23,360 is so high. So do you know what? 427 00:20:23,360 --> 00:20:26,760 The biggest risk factor for a tendinopathy is having it in the 428 00:20:26,760 --> 00:20:28,200 past. If you've had it before, you 429 00:20:28,200 --> 00:20:31,560 have a high risk factor for it in the future because most 430 00:20:31,560 --> 00:20:35,800 people, when they learn what to do with this, they go until that 431 00:20:35,800 --> 00:20:37,640 stops hurting and then they go right back to what they were 432 00:20:37,640 --> 00:20:41,280 doing, which isn't enough time. Pain is not a good. 433 00:20:41,280 --> 00:20:43,520 Indicator of your rehab or your function. 434 00:20:43,720 --> 00:20:45,960 That's not to make you more paranoid cause pain's also a 435 00:20:45,960 --> 00:20:48,840 threat response and like and can be modulated by fear. 436 00:20:49,320 --> 00:20:53,360 But you need to keep doing some of this stuff that I'm going to 437 00:20:53,360 --> 00:20:56,440 suggest to you to improve the function for longer than just 438 00:20:56,440 --> 00:20:58,560 pain. It needs to be a minimum of 9 to 439 00:20:58,560 --> 00:21:01,280 12 months. OK, so. 440 00:21:01,440 --> 00:21:05,000 How do you heal a tendinopathy? You've lost some calf strength. 441 00:21:05,000 --> 00:21:06,720 Things are irritated. You're having a little 442 00:21:06,720 --> 00:21:09,560 difficulty running. Some days you can run, some days 443 00:21:09,560 --> 00:21:11,400 you can't. Tendons aren't always consistent 444 00:21:11,400 --> 00:21:12,520 and you're getting frustrated going. 445 00:21:12,520 --> 00:21:14,880 I really want to deal with this, so here's what I've learned. 446 00:21:15,320 --> 00:21:19,320 So tendons do need load. They need appropriate load. 447 00:21:19,560 --> 00:21:21,960 You can't overload them because they they get pissed off. 448 00:21:22,320 --> 00:21:25,720 The things that tend to really irritate them is a lot of fast 449 00:21:25,720 --> 00:21:27,800 running and high load when they're not ready for it. 450 00:21:27,800 --> 00:21:30,520 So a lot of people go, yeah, I can run slow, but as soon as I 451 00:21:30,520 --> 00:21:33,760 start to run fast it gets. Really irritated, Yeah, cuz fast 452 00:21:33,760 --> 00:21:36,040 high loads is the most stress you can put through a tendon. 453 00:21:36,480 --> 00:21:39,200 You have to start somewhere and slowly work your way up. 454 00:21:39,640 --> 00:21:43,240 So if the people that are tolerable to it, if you tend to 455 00:21:43,240 --> 00:21:45,680 can handle it. Which by the way, classic 456 00:21:45,680 --> 00:21:48,040 tendinopathy. It'll ache and hurt when you 457 00:21:48,040 --> 00:21:51,160 first run, then when it warms up it feels better, and then as 458 00:21:51,160 --> 00:21:53,880 soon as you stop, it tends to hurt a lot more after the run. 459 00:21:53,960 --> 00:21:57,440 That's a classic tendon. Like if somebody's telling me 460 00:21:57,440 --> 00:21:59,760 that during my subjective, my interview with them as I'm doing 461 00:21:59,760 --> 00:22:02,080 the examination, that's a classic tendon type thing. 462 00:22:02,440 --> 00:22:05,840 So you can do that if you can keep your symptoms within a 463 00:22:05,840 --> 00:22:08,640 tolerable level, which again for runners is a whole different 464 00:22:08,640 --> 00:22:12,360 story. So a little running is okay if 465 00:22:12,360 --> 00:22:15,280 it's used in so tolerable, but it's got to be something you got 466 00:22:15,280 --> 00:22:20,280 to be slow, easy pace and ease your way into again, faster 467 00:22:20,280 --> 00:22:23,200 running is harder on the tenant. You really want to gently load 468 00:22:23,200 --> 00:22:26,520 this stuff at 1st and not overdo it, and progressively load this 469 00:22:26,520 --> 00:22:30,120 stuff over time once you've calmed the thing down. 470 00:22:30,120 --> 00:22:31,920 Because if it's. Pissed off, there's no point in 471 00:22:31,920 --> 00:22:34,000 really loading this thing really hard because it's not ready for 472 00:22:34,000 --> 00:22:36,440 it's got to heal a little bit, but you need to get it moving. 473 00:22:36,800 --> 00:22:41,080 Once you have gotten it calmed down a little bit, then you need 474 00:22:41,080 --> 00:22:44,560 to load it the right way. So the current evidence on 475 00:22:44,560 --> 00:22:47,680 tendinopathies in the low extremity is there's two things 476 00:22:47,680 --> 00:22:49,920 that really seem to be beneficial over a long period. 477 00:22:50,400 --> 00:22:52,680 Either the class thing people have heard is eccentrics. 478 00:22:52,680 --> 00:22:55,720 However, just eccentrics by themselves aren't as effective 479 00:22:55,720 --> 00:22:59,960 as heavy eccentrics and what's called the heaviest low 480 00:22:59,960 --> 00:23:02,320 resistance training. So we have found that high 481 00:23:02,320 --> 00:23:06,760 weight tendons tend to respond to really well, but not fast. 482 00:23:06,760 --> 00:23:09,120 They tend to respond really well to eccentrics, which is where 483 00:23:09,240 --> 00:23:13,240 you have a muscular tendonous unit and you slowly lengthen the 484 00:23:13,240 --> 00:23:15,480 under tension. That's like if you go up on your 485 00:23:15,480 --> 00:23:16,800 toes. If you're going to load this, 486 00:23:16,960 --> 00:23:20,720 it's when you slowly come down, so you go up at a decent speed, 487 00:23:20,920 --> 00:23:23,640 slowly come down. Concentric is when you shorten 488 00:23:23,640 --> 00:23:25,920 the muscle, like when you point your toe we point your foot. 489 00:23:26,320 --> 00:23:28,440 Eccentric would be you're loading this thing. 490 00:23:28,520 --> 00:23:30,600 And then lengthening the calves under tension. 491 00:23:31,560 --> 00:23:35,480 OK, so heavy, slow resistance training on the other hand is 492 00:23:35,480 --> 00:23:39,880 just picking up a heavyweight and doing very slow, controlled 493 00:23:39,880 --> 00:23:42,880 movements through your full range of motion. 494 00:23:43,000 --> 00:23:46,240 OK Eccentrics is just focusing on the downward motion with 495 00:23:46,240 --> 00:23:49,000 heavy heavyweight, heavyweight heavy slow resistance training 496 00:23:49,000 --> 00:23:52,560 is going both up and down. There's these things have been 497 00:23:52,560 --> 00:23:54,120 compared. They found that they're actually 498 00:23:54,120 --> 00:23:57,320 pretty similar. There's some better patient 499 00:23:58,600 --> 00:24:01,800 focused out like improvement. So people tend to feel better 500 00:24:01,800 --> 00:24:04,200 with some of the heavy slow resistance training early on. 501 00:24:04,400 --> 00:24:07,480 But long term, if you look at this stuff over a year, the 502 00:24:07,520 --> 00:24:09,520 outcomes are fairly similar, so you have options. 503 00:24:10,040 --> 00:24:12,480 I tend to like heavy, slow resistance training because more 504 00:24:12,480 --> 00:24:13,720 simple. You don't have to set yourself 505 00:24:13,720 --> 00:24:16,320 up weird, Just pick a heavyweight and you go up down, 506 00:24:16,720 --> 00:24:20,920 load it. OK, so slower activity with 507 00:24:20,920 --> 00:24:23,320 higher weights, tendons tend to love. 508 00:24:23,680 --> 00:24:25,240 Right. So if you do this, so if you 509 00:24:25,240 --> 00:24:27,280 take a break, if you're driving, don't do this. 510 00:24:27,520 --> 00:24:29,840 But if you're listening to this and not running and not doing 511 00:24:29,840 --> 00:24:33,560 anything else, go grab something heavy and go do some calf 512 00:24:33,560 --> 00:24:36,440 raises. But go like go on one leg and go 513 00:24:36,440 --> 00:24:40,600 super slow up and super slow down. 514 00:24:40,800 --> 00:24:43,000 You will find that if you're really controlling this with 515 00:24:43,000 --> 00:24:45,960 some weight, it's gonna, you're gonna get tired pretty quick, 516 00:24:45,960 --> 00:24:47,040 right? Things are gonna kind of start 517 00:24:47,040 --> 00:24:50,400 to tense up and we found that there is actually some increase 518 00:24:50,400 --> 00:24:54,120 improvements in tendon stiffness as you do this stuff. 519 00:24:54,120 --> 00:24:57,960 So in adult, additionally there's enough stress with this, 520 00:24:57,960 --> 00:24:59,560 the tendon. You can't do this every day. 521 00:24:59,760 --> 00:25:02,760 This has to be it every other day or sometimes every like 3 522 00:25:02,760 --> 00:25:06,200 day kind of thing. You can give enough stimulus 523 00:25:06,200 --> 00:25:10,480 with this type of exercise to get the tendons to change and to 524 00:25:10,480 --> 00:25:13,640 build up, strengthen your calf and build up more stiffness in 525 00:25:13,640 --> 00:25:16,760 the tendon and get that back. We found if you do this for long 526 00:25:16,760 --> 00:25:20,520 enough in some people. A lot of people will do super 527 00:25:20,520 --> 00:25:21,680 well. The outcomes with this are 528 00:25:21,680 --> 00:25:24,080 really, really good, so you'll see decreases in pain, 529 00:25:24,080 --> 00:25:26,000 improvements in function improves, improvements of 530 00:25:26,000 --> 00:25:28,840 jumping ability, improves of elasticity, improves of running. 531 00:25:29,200 --> 00:25:32,320 All this stuff, you sometimes will see changes in the actual 532 00:25:32,320 --> 00:25:34,520 structure of the tenant, sometimes you won't, but 533 00:25:34,520 --> 00:25:37,360 everybody tends to see improvements in performance and 534 00:25:37,360 --> 00:25:39,480 all this stuff, OK. So it's kind of the best thing 535 00:25:39,480 --> 00:25:42,360 we have for rehab in terms of conservative stuff. 536 00:25:43,440 --> 00:25:45,960 And even if you go do surgery for this, you need to do this 537 00:25:45,960 --> 00:25:47,880 stuff, 'cause you still gotta build it back, OK. 538 00:25:48,160 --> 00:25:51,080 But the problem is this takes 9 to 12 months and how do you do 539 00:25:51,080 --> 00:25:55,560 this? OK, so it's not an everyday 540 00:25:55,560 --> 00:25:57,600 thing. You need to do this with enough 541 00:25:57,600 --> 00:26:00,400 weight that you can only handle a couple reps, So my students 542 00:26:00,400 --> 00:26:02,240 know this really well. But a lot of you have probably 543 00:26:02,240 --> 00:26:03,800 heard three sets of 10 before. Right. 544 00:26:04,360 --> 00:26:08,560 So how you dose exercise is extremely important. 545 00:26:08,960 --> 00:26:12,240 You will see very different changes if you take do like 3:00 546 00:26:12,240 --> 00:26:14,520 to 5:00 repetitions of extremely heavyweight. 547 00:26:14,880 --> 00:26:17,200 You'll see very different changes in your body compared to 548 00:26:17,200 --> 00:26:19,840 if you do like three sets of 10 with a lightweight. 549 00:26:19,840 --> 00:26:21,680 The three sets of 10 is like not going to do anything. 550 00:26:21,680 --> 00:26:23,680 It's like just doing range of motion if. 551 00:26:23,680 --> 00:26:26,000 You want to load stuff and you want to build strength and 552 00:26:26,000 --> 00:26:28,200 change tissues. Lower weight. 553 00:26:28,320 --> 00:26:31,080 Higher Rep So the thing that I have told people and I picked 554 00:26:31,080 --> 00:26:33,920 this up from Cal State Fullerton, one of the pH DS down 555 00:26:33,920 --> 00:26:38,280 there is the rule of three to five, three to five sets of 556 00:26:38,280 --> 00:26:41,240 three to five reps And that means when you're doing these 557 00:26:41,240 --> 00:26:44,200 heel raises, right? So the the heavy slow resistance 558 00:26:44,200 --> 00:26:46,000 training or the eccentric heel drops. 559 00:26:46,000 --> 00:26:49,040 Meaning the eccentric version is you're going up on 2 feet 560 00:26:49,040 --> 00:26:51,680 usually and then slowly come on down on one. 561 00:26:51,960 --> 00:26:54,400 Or the heavy slow resistance training is you're on one leg 562 00:26:54,400 --> 00:26:57,160 and you're slowly going up and slowly going down. 563 00:26:57,560 --> 00:27:00,360 You should have enough weight that by the time you get to like 564 00:27:00,360 --> 00:27:04,160 4 to 5 repetitions, you need a break and you can't do any more, 565 00:27:04,440 --> 00:27:07,200 which most runners aren't used to producing that much force. 566 00:27:07,200 --> 00:27:08,840 And it's kind. It's a very foreign thing for 567 00:27:08,840 --> 00:27:10,720 them. If you just do three to five 568 00:27:10,720 --> 00:27:13,280 reps with no weight, you are not going to get any change. 569 00:27:13,280 --> 00:27:16,600 You need that higher. Rep Rep with the lower weight or 570 00:27:16,640 --> 00:27:19,840 sorry, higher weight? Let me say it again. 571 00:27:19,880 --> 00:27:23,720 Higher weight with lower Rep kind of the multiple sets to 572 00:27:23,800 --> 00:27:25,360 actually make those tissue changes. 573 00:27:25,360 --> 00:27:28,480 This is why we say strength training shouldn't take that 574 00:27:28,480 --> 00:27:30,080 long and ritually mentioned this. 575 00:27:30,520 --> 00:27:32,800 Wait, If you do good strength training for low extremity, it 576 00:27:32,800 --> 00:27:35,280 should take you 5020 minutes and you can be done if you're really 577 00:27:35,280 --> 00:27:36,600 gonna do this as a runner. OK. 578 00:27:36,800 --> 00:27:39,120 And why I say this is you need to do this more than two, three 579 00:27:39,120 --> 00:27:41,160 days a week because if you do it right, you are not gonna be able 580 00:27:41,160 --> 00:27:42,360 to do this the next day. OK? 581 00:27:42,360 --> 00:27:44,400 So be careful with your running with this, OK? 582 00:27:44,400 --> 00:27:47,840 Make sure you've got this strategic, but if you want to 583 00:27:47,840 --> 00:27:49,840 make chase your changes you got to load it heavy and like I 584 00:27:49,840 --> 00:27:51,320 said, runners aren't used to doing that. 585 00:27:51,320 --> 00:27:55,400 I've joked about this on the podcast but I really have £255 586 00:27:55,400 --> 00:27:59,040 kettle bells, 275 pound kettle bells and 200 pound kettle bells 587 00:27:59,040 --> 00:28:01,880 that I've been messing with to deal with my own tetanopathy and 588 00:28:01,880 --> 00:28:05,400 it really works. So I'm up to doing 75 single leg 589 00:28:05,400 --> 00:28:08,400 heel raises right now that I'm hoping to work up to the 100, 590 00:28:08,400 --> 00:28:11,000 but my grip strength is limiting me with the kettlebell which I'm 591 00:28:11,000 --> 00:28:13,480 working on. But you need to do those and 592 00:28:13,480 --> 00:28:15,360 work up to those and it needs to be progressive. 593 00:28:15,360 --> 00:28:18,000 As it gets easier you got to add more weight. 594 00:28:18,000 --> 00:28:20,720 You don't necessarily have to get £100 ghetto bell, but 595 00:28:20,720 --> 00:28:24,800 getting £30.40 pounds, £50 can be really helpful to actually 596 00:28:24,800 --> 00:28:28,720 get enough stress to do this. Now here's the thing, you got to 597 00:28:28,720 --> 00:28:32,080 do this for 9 to 12 months. You got to get a habit out of 598 00:28:32,080 --> 00:28:33,160 this. You can't just be like, oh, I 599 00:28:33,160 --> 00:28:35,400 did this. For four to five weeks, four to 600 00:28:35,400 --> 00:28:36,720 six weeks and now it feels better. 601 00:28:37,440 --> 00:28:39,880 That's to be expected, right? Your pain's less, but remember, 602 00:28:39,880 --> 00:28:43,080 your pain isn't indicative of the tissue quality in the 603 00:28:43,080 --> 00:28:45,160 tendon. It's not indicative of your full 604 00:28:45,160 --> 00:28:47,080 function. It takes longer to make those 605 00:28:47,080 --> 00:28:50,000 permanent changes in the tendon. So you've got to create a 606 00:28:50,240 --> 00:28:53,880 progressive habit of loading this thing heavy, slower 607 00:28:53,880 --> 00:28:57,040 resistance training or heavy eccentric training for at least 608 00:28:57,040 --> 00:28:59,720 nine to 12 months. And I tell people, and a lot of 609 00:28:59,720 --> 00:29:02,320 people that I've worked with, you just need to make a habit. 610 00:29:02,720 --> 00:29:05,400 You don't need 50 freaking exercises, fancy one. 611 00:29:05,400 --> 00:29:07,400 You just need the one thing to really. 612 00:29:07,400 --> 00:29:11,000 Address this SO for the calf single leg heel raised with 613 00:29:11,000 --> 00:29:13,840 higher weight. Great for hamstring Nordic 614 00:29:13,840 --> 00:29:16,960 hamption curls or single leg Romanian deadlifts Loading that 615 00:29:16,960 --> 00:29:19,560 thing. Great for patellar tendinopathy. 616 00:29:20,320 --> 00:29:23,520 Doing single leg squats or single leg decline squats or 617 00:29:23,520 --> 00:29:28,760 just freaking heavy squats in general slowly can is great. 618 00:29:28,760 --> 00:29:30,600 You don't. You just need one thing really. 619 00:29:30,600 --> 00:29:33,040 If there's anything else that's obviously influencing this and 620 00:29:33,040 --> 00:29:35,040 you see it, a healthcare professional says hey, you know, 621 00:29:35,280 --> 00:29:37,040 there are some other risk factors like for Achilles 622 00:29:37,040 --> 00:29:40,200 tendinopathy, pelvic drop, which can come from gluteus medius. 623 00:29:40,240 --> 00:29:42,200 Either coordination or a weakness problem. 624 00:29:42,480 --> 00:29:44,920 Yeah, maybe strengthening your hip muscles might help, but the 625 00:29:45,040 --> 00:29:47,480 most important thing is loading that tendon and getting it to 626 00:29:47,520 --> 00:29:52,120 change too. OK, so 9 to 12 months, just 627 00:29:52,120 --> 00:29:54,600 gotta make it a habit. There are really easy times. 628 00:29:54,600 --> 00:29:57,400 Or my Cosmo is gonna make a guest appearance right now. 629 00:29:57,400 --> 00:30:00,160 For those who can't see. The cat just jumped up, 'cause 630 00:30:00,200 --> 00:30:04,240 he's being really needy, got really great elasticity, so his 631 00:30:04,240 --> 00:30:05,680 tendons are working well for the moment. 632 00:30:07,640 --> 00:30:10,640 So you need to make a habit out of this and keep doing this. 633 00:30:10,640 --> 00:30:13,960 And that's why I say just pick one exercise, don't make things 634 00:30:13,960 --> 00:30:16,320 super complicated. Got one thing to focus on and 635 00:30:16,320 --> 00:30:19,000 then the follow up you might ask is OK, well that's great. 636 00:30:19,000 --> 00:30:21,000 I've got my one exercise and I hate doing strength training, 637 00:30:21,000 --> 00:30:22,040 but. I guess I'll do one thing. 638 00:30:22,240 --> 00:30:25,440 What do I do running wise? Same concept. 639 00:30:25,560 --> 00:30:27,880 So you need to progressively go into this. 640 00:30:27,880 --> 00:30:30,160 It means you can't just start sprinting right away. 641 00:30:30,400 --> 00:30:32,640 You got to slowly build a mileage, see that, get the 642 00:30:32,640 --> 00:30:35,880 tenant to respond to this stuff. If your tenant is too sore, by 643 00:30:35,880 --> 00:30:38,120 the way, the next day it might mean you need to take a break 644 00:30:38,160 --> 00:30:41,520 either from running for a day or so or from the weightlifting 645 00:30:41,640 --> 00:30:45,800 because it needs to recover. The stress that you cause isn't 646 00:30:45,800 --> 00:30:48,560 what makes it better, it's recovering from that stress that 647 00:30:48,560 --> 00:30:49,960 makes it better. So please see one of our 648 00:30:49,960 --> 00:30:51,640 episodes where we talk about this because it's really 649 00:30:51,640 --> 00:30:53,760 important to understand that just doing a ton of this stuff 650 00:30:53,760 --> 00:30:56,200 doesn't help. It's doing it, loading it, 651 00:30:56,360 --> 00:30:58,960 giving it time to adapt, recover, then loading again. 652 00:30:58,960 --> 00:31:01,680 So it's the same thing with 10s, but they just take longer to 653 00:31:01,680 --> 00:31:03,520 adapt. So sometimes, like twice a week 654 00:31:03,520 --> 00:31:06,280 with this stuff is good. Three to four can be a little 655 00:31:06,280 --> 00:31:08,640 bit much certain people can handle that. 656 00:31:08,800 --> 00:31:10,040 So it's the same thing with running. 657 00:31:10,120 --> 00:31:13,080 You got to ease into this stuff, start with slower running and 658 00:31:13,080 --> 00:31:16,240 then as you get into the later stages you start adding some 659 00:31:16,240 --> 00:31:19,840 faster stuff maybe a little astride here than there maybe 660 00:31:19,840 --> 00:31:22,640 just a little bit of up tempo stuff and just slowly loading 661 00:31:22,640 --> 00:31:25,240 this. And then we go back to the other 662 00:31:25,240 --> 00:31:26,440 thing was like the weight training. 663 00:31:26,760 --> 00:31:29,640 At some point you actually need to work on the ability of the 664 00:31:29,640 --> 00:31:32,200 tenant to handle elastic energy storage. 665 00:31:32,480 --> 00:31:34,960 So once you've been doing this for a month or two or if a lot 666 00:31:34,960 --> 00:31:37,520 longer. The one other exercise I might 667 00:31:37,520 --> 00:31:39,400 suggest is a little bit of hopping. 668 00:31:39,800 --> 00:31:41,880 And when I suggest hopping, people are like, oh, that's 669 00:31:41,880 --> 00:31:43,200 easy. And then they actually try to do 670 00:31:43,200 --> 00:31:45,440 it in their 40s, fifties, 60s. And they're like, wait, this is 671 00:31:45,440 --> 00:31:48,240 not as easy as it used to be. Yeah, 'cause your tendons may 672 00:31:48,240 --> 00:31:50,080 not be the same, especially have a tendinopathy. 673 00:31:50,320 --> 00:31:54,080 So the ability to just handle jumping in place, even jump 674 00:31:54,080 --> 00:31:57,520 rope, is a great way to work on energy storage and you actually 675 00:31:57,520 --> 00:31:59,760 have to work on that. And this is just like, you know, 676 00:31:59,760 --> 00:32:02,440 kind of like jump stick the landing jumps. 677 00:32:02,440 --> 00:32:04,640 It's you got to learn how to bounce again. 678 00:32:05,000 --> 00:32:08,560 And it's the same concept by the way, as the strength training. 679 00:32:08,840 --> 00:32:13,560 Lower repetitions and higher intensities tend to make a 680 00:32:13,560 --> 00:32:15,400 bigger effect. So instead of just bouncing 681 00:32:15,400 --> 00:32:18,480 gently on your foot, which you can do early on as it gets 682 00:32:18,480 --> 00:32:21,320 better, you got to go a big bounce and really pop off the 683 00:32:21,320 --> 00:32:24,360 ground and as soon as you hit the ground, pop back off again. 684 00:32:24,520 --> 00:32:26,920 That's a plyometric by the way. Plyometrics people think are 685 00:32:26,920 --> 00:32:29,600 just jumps. It's not a jump, it's a fast 686 00:32:29,600 --> 00:32:33,160 loading or fast eccentric immediately followed by a fast 687 00:32:33,160 --> 00:32:37,600 explosive motion off which that is what helps train your tenant 688 00:32:37,600 --> 00:32:41,000 and some of the interesting parts of the tenant to actually 689 00:32:41,000 --> 00:32:43,720 be able to handle storage. So toward the later part, as you 690 00:32:43,720 --> 00:32:46,680 get into multiple months, you do need a little bit of that. 691 00:32:47,200 --> 00:32:49,720 You can also do that through some faster side sprites or 692 00:32:49,720 --> 00:32:54,240 strengths right sprints by slowly easing that again less is 693 00:32:54,240 --> 00:32:58,000 more start with less slowly build up but and it's better to 694 00:32:58,000 --> 00:33:01,400 be a little bit more intense and do this less frequently than to 695 00:33:01,400 --> 00:33:03,600 be less intense and do it more frequently. 696 00:33:03,960 --> 00:33:06,640 Do it enough, your body adapts to it, and then come back to it. 697 00:33:07,160 --> 00:33:09,960 So what I'm hoping you get from this is not to. 698 00:33:09,960 --> 00:33:13,600 Freak out by the way, but it's that if you have a tendonopathy, 699 00:33:13,600 --> 00:33:15,880 it means that there is a challenge with the ability of 700 00:33:15,880 --> 00:33:20,680 your tendon to tolerate load and to elastically absorb things and 701 00:33:20,680 --> 00:33:23,200 then release them. If you're having a problem with 702 00:33:23,200 --> 00:33:26,560 this, what it seems like the current evidence is, is that you 703 00:33:26,560 --> 00:33:28,600 need to work to restore that stiffness. 704 00:33:28,840 --> 00:33:31,840 Some of the best ways to do that is you got to do heavier 705 00:33:31,840 --> 00:33:33,800 strength training. Doesn't have to be £1000, but 706 00:33:33,800 --> 00:33:37,160 it's got to be something that makes you work OK in a lower Rep 707 00:33:37,160 --> 00:33:41,640 range with slower activities, slower eccentrics or slower 708 00:33:42,600 --> 00:33:44,240 range of motion stuff with that way. 709 00:33:44,240 --> 00:33:50,040 So single leg heel raise like Nordic hamstring curls or you 710 00:33:50,040 --> 00:33:53,920 know Romania deadlifts for hamstring stuff or single leg 711 00:33:53,920 --> 00:33:57,560 squats or slow squats for the quadriceps or patellar tendon. 712 00:33:57,800 --> 00:34:00,280 You have to be able to restore that, that stiffness in the 713 00:34:00,280 --> 00:34:04,280 tendon and the muscle strength, but you will also need to work 714 00:34:04,280 --> 00:34:06,680 on progressively loading that thing up and to be able to 715 00:34:06,680 --> 00:34:10,360 handle energy storage. So that's where this thing seems 716 00:34:10,360 --> 00:34:12,800 to handle. When I go back to the isometric 717 00:34:12,800 --> 00:34:14,480 stuff. By the way, a lot of tendons 718 00:34:14,480 --> 00:34:17,360 when they're irritated. Some people respond super well 719 00:34:17,360 --> 00:34:19,440 to just straight isometric, Which always makes me wonder, 720 00:34:19,440 --> 00:34:22,600 are you just training the the muscles ability to protect the 721 00:34:22,600 --> 00:34:25,280 tendon more so early on? Isometric can be really helpful, 722 00:34:25,440 --> 00:34:27,280 but you. Need to progressively load this 723 00:34:27,280 --> 00:34:30,920 thing over 9 to 12 months with heavier weights and you teach it 724 00:34:30,920 --> 00:34:33,679 to handle energy storage again and learn how to bounce. 725 00:34:33,880 --> 00:34:37,360 Which means at whatever age you are, once you get strong enough, 726 00:34:37,679 --> 00:34:40,000 you might have to work on learning to jump again, and it 727 00:34:40,000 --> 00:34:42,400 sounds super simple. But once you really learn how to 728 00:34:42,400 --> 00:34:44,239 hop again, that's a different story. 729 00:34:44,360 --> 00:34:48,960 So lower repetitions and more quality is way more important 730 00:34:48,960 --> 00:34:50,679 for this, which is hard as runners because we just like 731 00:34:50,679 --> 00:34:54,480 follow you doesn't work as well for rehab attendance. 732 00:34:54,960 --> 00:34:57,600 So can you change these things? Yes. 733 00:34:57,840 --> 00:35:00,920 Does it take a while to do this? Yes, it takes a lot of patience 734 00:35:00,960 --> 00:35:02,400 and this is really hard for runners. 735 00:35:02,400 --> 00:35:05,480 And I am not judging anybody 'cause I do the same thing. 736 00:35:05,760 --> 00:35:08,760 It just takes a long term mindset, just like running. 737 00:35:09,040 --> 00:35:12,200 If you take a long term mindset, you are going to go a lot. 738 00:35:12,200 --> 00:35:14,480 Farther than oh, I'm just going to do these crazy things short 739 00:35:14,480 --> 00:35:18,720 term and then burnout, OK? Create lasting habits. 740 00:35:18,920 --> 00:35:21,320 If you create lasting habits with stuff, you'll stay healthy, 741 00:35:21,320 --> 00:35:22,600 right? You are going to. 742 00:35:22,600 --> 00:35:24,920 I know you hate us saying this, but you do have to strength 743 00:35:24,920 --> 00:35:27,600 train a little bit, right? Doesn't have to be an. 744 00:35:27,600 --> 00:35:31,200 Hour, two hours. It can be 1520 minutes 2-3 times 745 00:35:31,200 --> 00:35:32,840 a week. That is more than enough, but 746 00:35:32,840 --> 00:35:35,240 you got to get yourself warmed up and be lifting a little bit 747 00:35:35,240 --> 00:35:37,440 more if you actually want to get strength changes. 748 00:35:37,760 --> 00:35:39,640 Three sets of sound with the lightweight isn't going to do 749 00:35:39,640 --> 00:35:42,640 anything, remember. Three to five, Three to five 750 00:35:42,640 --> 00:35:46,640 sets of three to five reps with a heavier weight is gonna make 751 00:35:46,640 --> 00:35:48,480 true strength changes. And if you do it the right way 752 00:35:48,480 --> 00:35:50,600 with some of the stuff we talked about, you can also make some 753 00:35:50,600 --> 00:35:53,760 tendon changes. So I hope that's helpful. 754 00:35:53,920 --> 00:35:56,000 And you might be asking what else influences this. 755 00:35:56,000 --> 00:35:57,560 And the answer is, I don't know yet. 756 00:35:57,640 --> 00:36:00,600 I gotta get the last three subjects and finish this up and 757 00:36:00,600 --> 00:36:02,640 then I'll be able to do another episode going, hey, this is what 758 00:36:02,640 --> 00:36:05,240 I found. So hopefully this was helpful. 759 00:36:05,240 --> 00:36:08,440 If you have any questions, let us know because just like you, I 760 00:36:08,440 --> 00:36:10,200 also have questions and I'm also learning. 761 00:36:10,560 --> 00:36:14,120 OK, as again, we'll get this stuff going, I'll get this 762 00:36:14,120 --> 00:36:17,400 research done and share what I'm finding so that you and I can 763 00:36:17,400 --> 00:36:20,080 keep ourselves healthy and running along and we can focus 764 00:36:20,080 --> 00:36:22,240 more on geeking out on shoes and stuff really going what the heck 765 00:36:22,240 --> 00:36:24,800 is going on with my tendon? So as I said again. 766 00:36:25,080 --> 00:36:27,520 I hope this was helpful. I hope it was educational. 767 00:36:27,520 --> 00:36:28,720 I'm learning just as much as you. 768 00:36:29,520 --> 00:36:31,080 Please check out all the different areas. 769 00:36:31,080 --> 00:36:33,680 We are of course on all the different areas of social media, 770 00:36:34,000 --> 00:36:36,400 on Instagram, on LinkedIn, on Facebook. 771 00:36:36,400 --> 00:36:38,720 Bach, as always, is an incredible human being. 772 00:36:38,880 --> 00:36:41,880 We call him the Wizard because he is able to admit these things 773 00:36:41,880 --> 00:36:43,440 and get content out there if you have. 774 00:36:43,440 --> 00:36:45,600 Any questions to message us? We try. 775 00:36:45,600 --> 00:36:47,960 I know some. For those of you, we appreciate 776 00:36:47,960 --> 00:36:49,600 your patience. Please realize we all have full 777 00:36:49,600 --> 00:36:51,480 time jobs. A lot of us are also parents. 778 00:36:51,480 --> 00:36:56,120 I have a as of tomorrow and Saturday, a three month old 779 00:36:56,120 --> 00:36:59,440 right now who my wife and I are learning very well with. 780 00:36:59,440 --> 00:37:02,880 And my wife is a trooper, but we have kids and jobs and all this 781 00:37:02,880 --> 00:37:05,400 stuff, so Please be patient with us, but we do care. 782 00:37:05,400 --> 00:37:07,640 We will try to get back to you. And again, we hope this is 783 00:37:07,640 --> 00:37:08,640 helpful. If there's anything you're 784 00:37:08,640 --> 00:37:11,280 interested in having us talk about or see, we have some great 785 00:37:11,280 --> 00:37:12,760 mailbag episodes that are coming up. 786 00:37:12,760 --> 00:37:15,040 So send us some questions. And as always, we'll continue 787 00:37:15,040 --> 00:37:16,640 to. Geek out on shoes too, Don't 788 00:37:16,640 --> 00:37:18,040 worry. But I hope this episode was 789 00:37:18,040 --> 00:37:19,120 helpful and you learn something because. 790 00:37:19,120 --> 00:37:21,640 Like I said again, I'm learning just as much as you.