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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 Today at the round table, 
we have the founder of Doctors 

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of Running, doctor Matthew Klein
and myself, I am Nathan Brown 

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and we are going to be having a 
really fun episode where we 

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start to talk about various 
conditions. 

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And although we cannot give 
specific recommendations and 

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there is no evidence to 
definitively say what is going 

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to help each regarding footwear,
regarding prevention, regarding 

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recovery. 
We are going to talk about 

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common things that we see both 
in the literature and also 

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within our own clinical 
experiences and just some pearls

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that we may have for you. 
So before we do that, I'm pretty

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sure Matt is basically doing 
this episode from a hot box in 

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his garage. 
So if you see him sweating, you 

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can you can understand why and. 
Apologies for the constant like 

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me getting sips of water so I 
don't pass out 'cause it is 95° 

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outside and I don't know what 
temperature it is in this 

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garage. 
But Oh my gosh, brutal. 

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Meanwhile, the things I do to 
make sure I have a good 

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background. 
Well for me I am in a chilled 

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unfinished basement so yay. 
In Wisconsin which very 

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different weather patterns. 
So what we want to do before we 

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go into that episode is talk 
about the shoes that are in for 

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testings. 
This is our in for testing 

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segment which is powered and 
fueled by Scratch Labs. 

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If you want to try out Scratch 
Labs which has great different 

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hydration and nutrition options 
for endurance athletes, you can 

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use the code Doctors of Running 
that gets you 20% off your first

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order. 
But let's talk about what we are

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testing right now. 
Do you have anything that you've

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been getting miles on? 
I've got 4 things right now that

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I'm getting miles on. 
So the first one is the Hoka, a 

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Rocky 8, which was a pretty big 
surprise to me because they 

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completely redid the shoe. 
It does not feel anything like 

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prior version. 
So J frames gone. 

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It's now the what's called the H
frame, although there's a pretty

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significant amount on the medial
side. 

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The other thing is there's 
actually some room in the upper,

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so there's no longer the Super 
snug narrow fit. 

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So people that like that, sorry,
more room in the upper. 

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It's still a Hoka fit. 
So it's not the widest thing in 

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the world, but there's more 
width and volume. 

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The mid soles also and for those
trying new Hokos, you got to let

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them break in. 
They this shoe came off as 

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really stiff and firm initially 
gave it one run soften a little 

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bit. 
So it's definitely softer than 

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the prior version. 
Just needs some time to break 

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in. 
It's not as biased as the prior 

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version, but it's still got a 
lateral push there. 

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So people that want that and 
want the kind of medial 

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stability it's there. 
There's just also some lateral 

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stuff and they did not get rid 
of it going into the the four 

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foot, which is absolutely 
really, really nice. 

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So doing good so far. 
Not the fastest shoe. 

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It's actually I think heavier 
than the previous version based 

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on my own measurement, but it's 
still it's better cushion and a 

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little different stability. 
The next one I've got is the 

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Nike Structure 26, which I was 
really excited for. 

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Also similar situation where 
version 25 was really firm. 

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This version is now a little bit
softer. 

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Feels pretty blocky in the heel,
but the heel there's at least a 

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lateral bevel in the rear foot 
that makes it smoother. 

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It breaks in not light. 
It's a heavier shoe, but it's 

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got a good like it's just a good
trainer. 

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So definitely a little bit more 
prominent medial stability than 

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the last version and they they 
kind of fixed that a little bit 

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and mid foot filled in. 
So definitely more stable, not 

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as quick, so not as bouncy. 
It like I feel like the last 

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version was like snappy firm, 
even though it was heavy, so you

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could pick the pace up just a 
teeny bit. 

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This one's for easy miles only. 
So I really want to know what's 

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happening with the structure 
plus and premium. 

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I I really Nike, I don't know if
you listen to this, I'm sure 

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everything's already done, but 
anybody working at Nike it I 

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please tell me the structure 
plus is like a stability 

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lightweight trainer that would 
make my day. 

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The Romero plus was not. 
I also have that shoe. 

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It's not quite stable enough for
me, but I do appreciate it. 

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I just thought it was going to 
be a lot lighter, but it's fine.

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That's fair. 
It's OK. 

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I I don't you know, but 
structure 26 and then the last 

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two is the Brooks Hyperion elite
5 and the polka rocket X3. 

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And so I was very excited to try
it. 

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The Hyperion Elite 5. 
It is very light. 

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It's got like a classically 
bouncy PEBA foam. 

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It's unfortunately not stable 
and I am struggling with this a 

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little bit for shorter 
distances. 

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It's fine and it's been good. 
I the heels the best part 4 foot

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really stiff, really rockered, 
but getting on the heel and 

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rolling through this, it's a 
really it's it's a massive 

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improvement. 
We didn't try the Hyperion Elite

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4 PB, but over previous version 
is much better. 

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It's just really different. 
It's not the classic like I 

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would have expected wider 
fitting, more stable. 

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It's exactly the opposite where 
it's actually way more snug and 

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narrow and really aggressive and
not very stable. 

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It's fine when you're like up to
speed in it, but just not a shoe

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I would use for longer 
distances. 

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But the rocket X2 or three 
sorry, sorry, the rocket X3 is 

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doing super well. 
I'm really liking this. 

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This is supposed to be the more 
stable now the two shoes and 

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they've done a great job. 
My my 2 workouts in this have 

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been awesome. 
The foam is snappier, a little 

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bit firmer. 
The fits been fixed. 

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The weird like offset where I 
felt like it was going over a 

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speed bump because it has been 
fixed. 

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I was wondering if that's gonna 
be my question, yeah. 

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Slightly higher drop which takes
a little bit of stress off the 

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calves. 
Really nice posterior bubble. 

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This actually might be my racing
strew of the year. 

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My only concern is I'm really 
scared I'm going to RIP this 

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off. 
It's the perfect pod for you to 

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RIP off man. 
Yeah, I'm like going to cry when

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that happens, and I know it 
probably will. 

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But yeah, so far, like stable, 
neutral, really, really good, 

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really maintains that well, if 
not better than the last version

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because I feel like they just 
improved the transition. 

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It's less of like the negative 
drop feel on this one compared 

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to the last one. 
Does not have that. 

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Still feels lower. 
Drop doesn't quite feel 7, but 

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that's probably just compressed 
to the midsole. 

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But. 
And then when you say, when you 

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say that it's firmer, are you 
saying firmer than other super 

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shoes or firmer than the 
previous version? 

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I think it it as it breaks in 
that's going to be so firmer is 

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not the right word it I would 
say it's snappier and more. 

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Responsive. 
There we go that. 

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Firmer was the wrong word, but 
yeah, it it the fit is also, 

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even though it the length is 
better, it is more snug. 

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So yeah, B word. 
But yeah, I'm loving this thus 

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far, and I'm going to cry when 
the heel piece comes off, Yeah. 

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Well, that's great. 
Well, I've got 1 shoe that I 

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want to talk about and you're 
going to have to FAC Fact Check 

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me on this. 
And it's a shoe from ultra that 

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I have just started testing. 
I do not have a lot in it yet, 

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but it's one of those like we 
test enough shoes that we kind 

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of know if we're going to like 
something or not early on. 

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And sometimes shoes surprise us 
and they change. 

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But the experience flow to from 
Ultra is awesome. 

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It's one of their 4mm drop 
shoes. 

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This would be like their neutral
kind of daily trainer. 

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It is unrecognizable from the 
previous version. 

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And this is where I need to be 
fact checked because when we 

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first tested the old version of 
the Flow, it was called the 

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Ultra Forward Experience. 
I think so. 

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00:08:05,280 --> 00:08:06,480
I. 
Think you're right. 

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They rebranded it. 
They rebranded it to the Flow. 

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When we first got it, it was the
forward experience, but the 

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midsole in the new version is 
incredibly softer, like very 

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notably softer. 
It's probably the first ultra 

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that I would actually call soft.
Where I feel like most of the 

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softer, more plus shoes that 
they offer just have more stack 

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but not really a lot of 
compliance. 

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This one actually has 
compliance, so that's one major 

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difference between the older 
version and this one. 

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The other difference that comes 
along with that is the stiffness

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of the midsole longitudinally 
from front to back. 

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So in the older version, because
of how firm the foam was, there 

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was not a lot of flexibility in 
the forefoot. 

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You can kind of see that there, 
but with the new version it 

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bends like crazy so you get a 
very natural running feel. 

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And I am just, I am just loving 
it. 

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The fit is really good. 
A lot of ultras lately have been

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00:09:05,440 --> 00:09:09,120
and there's one of them that got
sent that still is this way that

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are just too snug at that 
transition between the midfoot 

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and forefoot. 
It's just locked down too much 

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right over the ball of my foot. 
I wish they would just open that

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up, but this one is not too snug
there. 

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So fit is good. 
I love the feel of the midsole. 

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It's softer, so it's 4mm, but if
you like lower, it even feels 

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that way because the dynamic 
drop as you load it. 

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And then I just really like the 
forefoot flexibility. 

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00:09:30,120 --> 00:09:35,560
So very excited about getting 
more miles on this shoe and it's

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00:09:35,760 --> 00:09:38,160
it's a good time. 
A really good thing not to Fact 

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Check you. 
There was an experience flow one

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it looks like and I had totally 
forgot about that, but I didn't 

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00:09:45,000 --> 00:09:49,360
realize that they were basically
transitioning this into the the 

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forward and that was 
transitioning into the flow to, 

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00:09:52,840 --> 00:09:54,880
if I'm hearing you correctly. 
Interesting. 

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00:09:55,080 --> 00:09:57,600
Yeah. 
Yeah, from from what I know, 

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they've originally called the 
experience flow one the 

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00:10:00,880 --> 00:10:02,720
experience forward and then 
they. 

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00:10:02,760 --> 00:10:06,360
Changed the name. 
I and again like I'm if somebody

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00:10:06,360 --> 00:10:09,360
is on YouTube and. 
Yeah, tell me I'm wrong. 

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00:10:09,360 --> 00:10:12,720
Please do and maybe if there's 
someone from Ultra watching you 

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00:10:12,720 --> 00:10:14,440
can you can check Fact Check 
that, but I'm. 

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00:10:14,440 --> 00:10:17,680
Pretty sure say and this is a 
hot take, sorry ultra. 

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00:10:17,680 --> 00:10:20,800
I thought the original like 
experience in flow shoes, the 

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00:10:20,800 --> 00:10:27,040
mid soles were not very good 
like they were way too firm and 

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so and some people are going to 
love that right the forward 

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00:10:29,680 --> 00:10:32,240
experience actually like I kind 
of liked it for picking because 

205
00:10:32,240 --> 00:10:34,160
it was like 8 oz. 
You could pick up the pace and I

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00:10:34,520 --> 00:10:36,720
surprisedly did unintentional 
workouts in it. 

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00:10:36,960 --> 00:10:40,800
When I put the Flow 2 on, it was
like, oh, this is better, OK, 

208
00:10:40,800 --> 00:10:42,280
this is going to be more 
comfortable. 

209
00:10:42,560 --> 00:10:45,320
Not as snappy and fast, but it 
was going to be like, OK, this 

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00:10:45,320 --> 00:10:48,320
is going to be more. 
What's the word I'm looking for?

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00:10:50,080 --> 00:10:52,160
It's more crucial. 
It's going to be more this is 

212
00:10:52,160 --> 00:10:54,560
not the right word, but 
accessible to people. 

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00:10:55,120 --> 00:10:56,600
Like there's certain people that
do well. 

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00:10:56,600 --> 00:11:00,200
Yeah, it, it can do more. 
I think this can do more than 

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00:11:00,200 --> 00:11:01,920
the previous one. 
I think the previous one just 

216
00:11:01,920 --> 00:11:05,120
felt too stiff and firm to, 
like, enjoy at a variety of 

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00:11:05,120 --> 00:11:09,120
paces. 
This one now is, you know, 

218
00:11:10,440 --> 00:11:13,160
cushioned enough to enjoy a 
chill run and has that 

219
00:11:13,160 --> 00:11:15,480
flexibility, but it's light 
enough to do more. 

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00:11:15,480 --> 00:11:18,080
So I think it has a little bit 
more versatility, but that's 

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00:11:18,240 --> 00:11:19,920
that's coming up with early test
miles. 

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00:11:20,680 --> 00:11:23,040
So I shouldn't say its praises 
too much yet because I have I 

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00:11:23,040 --> 00:11:28,200
have more to more to put on it. 
Yeah, so that's what we're have 

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00:11:28,200 --> 00:11:31,800
in for testing right now. 
Again, if you want to check out 

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00:11:31,800 --> 00:11:36,080
Scratch Labs, you can use the 
code docs of running for 20% off

226
00:11:36,080 --> 00:11:38,960
your first order. 
Before we get to our main 

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00:11:38,960 --> 00:11:40,800
segment, Matt, I'm going to ask 
you a question that you didn't 

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00:11:40,800 --> 00:11:43,120
know I was going to ask you. 
It's about me. 

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00:11:43,480 --> 00:11:46,600
So I'm going to have you kind of
diagnose me on on air. 

230
00:11:48,040 --> 00:11:54,160
So I have been pretty consistent
in my increasing of my running 

231
00:11:54,160 --> 00:11:58,800
mileage overall. 
Last I did a longer like 2 hour 

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00:11:58,800 --> 00:12:03,800
trail run two weekends or last 
weekend now a whole week ago and

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00:12:03,800 --> 00:12:06,360
then I kind of took a down week 
this week and I haven't ran in a

234
00:12:06,360 --> 00:12:08,520
couple days. 
I've been having some dorsal 

235
00:12:08,520 --> 00:12:14,400
sided foot pain and I think my 
brain starts to get scared when 

236
00:12:14,400 --> 00:12:17,280
I get dorsal sided foot pain. 
So I'm like, is this a 

237
00:12:17,280 --> 00:12:20,520
metatarsal stress fracture? 
Is this like a chronic Lis Frank

238
00:12:20,520 --> 00:12:22,920
type injury? 
And we can talk about what those

239
00:12:22,920 --> 00:12:26,000
are, but I'm also like, should I
just keep running? 

240
00:12:26,040 --> 00:12:27,400
What would you do if you were 
me? 

241
00:12:27,400 --> 00:12:29,040
Or what questions would you ask?
Yeah. 

242
00:12:29,040 --> 00:12:31,280
I think the first question is, 
is that 2 hour show around 

243
00:12:31,280 --> 00:12:33,600
something unnormal for you? 
Is that very AB? 

244
00:12:33,600 --> 00:12:35,720
Did you work up to that or is 
this an abnormal out of the 

245
00:12:35,720 --> 00:12:37,480
blue? 
Like I just suddenly jumped to 

246
00:12:37,480 --> 00:12:40,880
two hours? 
No, the timeline is similar. 

247
00:12:40,880 --> 00:12:44,760
I've I've done like an hour 40 
hour, like a couple hour 40 

248
00:12:44,760 --> 00:12:49,720
fives an hour 52. 
So I have a a lot longer runs in

249
00:12:49,720 --> 00:12:51,640
there. 
It's definitely my first vert 

250
00:12:51,640 --> 00:12:54,200
day. 
So Stevens Point is flat, super 

251
00:12:54,200 --> 00:13:00,440
duper flat and the trail like. 
So when I say flat, I if when I 

252
00:13:00,440 --> 00:13:05,040
was marathon training, I would 
run 20 mile training run and I 

253
00:13:05,040 --> 00:13:12,440
would get 112 feet of vert and I
would look for the hills And in 

254
00:13:12,440 --> 00:13:16,400
the I ran on the Ice Age trail 
and we got like, I think it was 

255
00:13:16,400 --> 00:13:20,800
like 1500 feet of vert or like 
1300 or something like that. 

256
00:13:20,800 --> 00:13:24,480
So, yeah, very different in 
terms of like the amount of, 

257
00:13:24,600 --> 00:13:27,520
yeah, incline decline and 
running on sideways. 

258
00:13:28,120 --> 00:13:31,640
OK, can you describe where 
exactly in the dorsum of your 

259
00:13:31,640 --> 00:13:35,960
foot this is? 
If this is my foot, this would 

260
00:13:35,960 --> 00:13:40,160
be my big toe. 
It sits kind of from the midfoot

261
00:13:40,520 --> 00:13:43,640
towards the forefoot, kind of 
moves between the 2nd and 4th. 

262
00:13:43,760 --> 00:13:45,960
Got it. 
So not like really proximal, not

263
00:13:45,960 --> 00:13:48,640
super distal, kind of in the 
middle is what you describe this

264
00:13:48,640 --> 00:13:50,720
as. 
Yeah, but kind of vague. 

265
00:13:50,720 --> 00:13:54,040
Kind of so not consistent like 
so there's some, it changes 

266
00:13:54,040 --> 00:13:56,760
location. 
OK, that's yeah, that's not a 

267
00:13:56,760 --> 00:13:58,400
bad thing. 
What I'll tell people is don't 

268
00:13:58,400 --> 00:14:00,960
panic If you're like, I feel 
like it moves, that's 

269
00:14:00,960 --> 00:14:02,680
information. 
And then we'll be able to go, 

270
00:14:02,680 --> 00:14:05,920
oh, OK, 'cause different things 
will tend to move or be more 

271
00:14:05,920 --> 00:14:07,680
consistent. 
So that's not an abnormal thing.

272
00:14:07,680 --> 00:14:11,360
It's great information. 
How did it change from that run?

273
00:14:11,360 --> 00:14:13,320
Do you did it? 
Like did you have any symptoms 

274
00:14:13,320 --> 00:14:17,280
beforehand? 
I had nothing before it and not 

275
00:14:17,280 --> 00:14:20,360
even during it. 
And then I would say I started 

276
00:14:20,360 --> 00:14:25,240
to feel it for it three or four 
days after and and it, you know,

277
00:14:25,240 --> 00:14:27,760
I feel it most when I'm putting 
weight through my forehead. 

278
00:14:28,480 --> 00:14:33,080
So not so much when you are 
like, if you're like initial 

279
00:14:33,080 --> 00:14:37,320
contact heel strike and you feel
it walking, running, both. 

280
00:14:38,760 --> 00:14:43,680
It's not even pain and I don't 
really feel it like pain. 

281
00:14:44,200 --> 00:14:45,920
I I can kind of feel it when I'm
walking. 

282
00:14:45,920 --> 00:14:47,440
If I just stand and put weight 
through it. 

283
00:14:47,440 --> 00:14:49,880
Sometimes I'll feel it, 
sometimes it'll feel like a 

284
00:14:49,880 --> 00:14:53,040
little bit like tighter on my 
shoe, like almost like there's 

285
00:14:53,040 --> 00:14:55,560
some swelling in there. 
OK. 

286
00:14:55,800 --> 00:14:58,760
But I'm not sure but like if you
go for a run right now, are you 

287
00:14:58,760 --> 00:15:02,000
going to feel it? 
I ran on Thursday and I really 

288
00:15:02,000 --> 00:15:03,120
didn't feel it. 
Got it. 

289
00:15:03,360 --> 00:15:07,040
But so it's been more like 
occasional walking standing, 

290
00:15:07,680 --> 00:15:11,320
little less consistent. 
It's sounding like, OK, all 

291
00:15:11,320 --> 00:15:13,680
right, that's actually kind of a
good sign. 

292
00:15:13,680 --> 00:15:16,120
So that that's positive because 
like more consistent, like ow, 

293
00:15:16,240 --> 00:15:18,200
ow, ow. 
Then I get kind of a little more

294
00:15:18,200 --> 00:15:19,640
worried. 
The less consistency is like, 

295
00:15:19,640 --> 00:15:22,280
OK, all right, this is this is 
actually a good thing. 

296
00:15:23,320 --> 00:15:28,680
Where can you describe it? 
So you use the P word, but is 

297
00:15:28,680 --> 00:15:30,640
there any other words that you 
use to describe it? 

298
00:15:30,920 --> 00:15:34,600
Yeah, and I don't even think 
pain is the right one. 

299
00:15:34,840 --> 00:15:39,400
It feels like the pressure got 
pointed pressure. 

300
00:15:39,400 --> 00:15:42,920
I would say the most pressure I 
feel is between the midfoot and 

301
00:15:42,920 --> 00:15:46,080
the long bones, like the 
metatarsals of 1. 

302
00:15:46,080 --> 00:15:48,000
And two, what have you done for 
it so far? 

303
00:15:48,880 --> 00:15:52,880
I have not really done much. 
I've done a little bit of 

304
00:15:52,880 --> 00:15:57,160
needling of like my calf like 
lateral complex and then 

305
00:15:57,160 --> 00:15:59,840
anterior compartments like 
tibialis, anterior and fibularis

306
00:15:59,840 --> 00:16:01,680
muscles. 
Is there anything you can do 

307
00:16:01,680 --> 00:16:04,880
consistently to reproduce it? 
It's like oh every time I do 

308
00:16:04,880 --> 00:16:06,760
this for sure. 
Loading it OK. 

309
00:16:07,080 --> 00:16:08,840
Loading. 
Like just putting weight through

310
00:16:08,840 --> 00:16:11,440
the ball of my foot. 
OK, probably the most. 

311
00:16:11,440 --> 00:16:13,520
OK. 
Is there anything you can do to 

312
00:16:13,520 --> 00:16:18,920
change that to lessen symptoms? 
Sometimes when I activate like 

313
00:16:18,920 --> 00:16:23,040
my intrinsic muscles it I can 
feel it less on the top. 

314
00:16:23,040 --> 00:16:26,720
OK, I got it. 
So if you activate intrinsics, 

315
00:16:26,720 --> 00:16:28,920
it reduces that, correct? 
Yeah. 

316
00:16:28,960 --> 00:16:32,800
Is there anything else? 
That's pretty much it. 

317
00:16:32,800 --> 00:16:35,000
Got it. 
You notice any like time 

318
00:16:35,000 --> 00:16:37,800
relationship to this like 
throughout the day any change it

319
00:16:37,800 --> 00:16:41,560
like morning is more prevalent 
or evening or no, it's more 

320
00:16:41,560 --> 00:16:46,600
sounds like activity specific 
like if you load it got it 

321
00:16:46,800 --> 00:16:49,920
nothing at night right, No 
symptoms, nothing like that. 

322
00:16:50,840 --> 00:16:53,640
OK, great, that's good. 
The reason for the listeners 

323
00:16:53,640 --> 00:16:57,040
that I, I frequently ask about 
night symptoms is often times in

324
00:16:57,040 --> 00:16:59,000
PT school, by the way, they 
scare the heck out of us and go,

325
00:16:59,000 --> 00:17:01,680
any night pain is cancer and 
you're like, and then you get to

326
00:17:01,680 --> 00:17:03,880
clinical practice and you're 
like, well, often times night 

327
00:17:03,880 --> 00:17:06,040
pain is actually more consistent
with something being really 

328
00:17:06,040 --> 00:17:08,720
flared up and like like an 
inflammatory kind of thing. 

329
00:17:09,000 --> 00:17:11,839
So if it's not, that's great. 
That's really, really good. 

330
00:17:12,200 --> 00:17:15,079
And so it sounded like loading 
can bring on the symptoms. 

331
00:17:15,079 --> 00:17:17,319
Obviously not. 
Do you get any symptoms when 

332
00:17:17,319 --> 00:17:18,760
you're not loading it or just 
sitting there? 

333
00:17:18,839 --> 00:17:19,960
Nope. 
Great, great. 

334
00:17:20,240 --> 00:17:22,599
So if you're not loading it, no 
symptoms. 

335
00:17:22,599 --> 00:17:25,680
If you can like activate 
musculature around it, it 

336
00:17:25,680 --> 00:17:27,760
reduces symptoms a little bit. 
So I'm a little bit less 

337
00:17:27,760 --> 00:17:31,400
concerned about it being one of 
the major muscles or something 

338
00:17:31,400 --> 00:17:33,840
like that, Although I haven't 
done like, so it's my brain's 

339
00:17:33,840 --> 00:17:37,760
going, what's the tissue source 
Just based on this stuff of 

340
00:17:37,760 --> 00:17:39,720
going, is it bone? 
Is it ligament? 

341
00:17:39,720 --> 00:17:43,240
Is it muscle? 
Is it tendon? 

342
00:17:43,400 --> 00:17:45,800
And a lot of the stuff, 
especially the delay in symptoms

343
00:17:45,800 --> 00:17:48,320
is making me go, I'm a little 
less concerned about this. 

344
00:17:48,320 --> 00:17:50,840
This is good. 
Hearing the fact that it sounds 

345
00:17:50,840 --> 00:17:54,400
like irritability is fairly low,
correct, right. 

346
00:17:54,400 --> 00:17:59,360
Severity is fairly low nature 
kind of starting to not 100% 

347
00:17:59,360 --> 00:18:01,080
yet. 
Would definitely need a little 

348
00:18:01,080 --> 00:18:03,800
bit more like testing to figure 
this out. 

349
00:18:03,800 --> 00:18:06,360
You said you needed your calf, 
but haven't really done like 

350
00:18:07,080 --> 00:18:09,520
anything there. 
That's the hard part. 

351
00:18:09,600 --> 00:18:11,600
Like I could have asked you 
like, did you put a tuning fork 

352
00:18:11,600 --> 00:18:12,800
on this? 
And that's not even the most 

353
00:18:12,800 --> 00:18:14,480
accurate thing either. 
Which? 

354
00:18:14,520 --> 00:18:20,280
Is I did, I did do some soft 
tissue to kind of extensor 

355
00:18:20,280 --> 00:18:23,120
digitorum brevis and I don't 
know if it really made a 

356
00:18:23,120 --> 00:18:25,320
difference. 
That's for for the listeners. 

357
00:18:25,320 --> 00:18:28,040
That's a small muscle that 
starts and finishes within your 

358
00:18:28,040 --> 00:18:29,600
foot, on the top part of your 
foot. 

359
00:18:29,600 --> 00:18:33,600
Yeah, so. 
The pattern is a little bit less

360
00:18:33,720 --> 00:18:35,800
consistent, which isn't a bad 
thing. 

361
00:18:36,000 --> 00:18:40,520
What shoe were you wearing? 
I did the Tecnix 3 OK for the 

362
00:18:40,520 --> 00:18:41,480
trail run. 
Yeah. 

363
00:18:42,400 --> 00:18:43,960
And you have experience in that 
shoe previously? 

364
00:18:44,200 --> 00:18:45,200
Yeah, you do. 
Yeah. 

365
00:18:45,280 --> 00:18:46,480
Yeah, got it. 
Did you? 

366
00:18:46,480 --> 00:18:48,720
And you said no discomfort 
during the run at all? 

367
00:18:49,760 --> 00:18:51,720
No. 
How's the progression been since

368
00:18:51,720 --> 00:18:53,600
that time? 
Staying the same, getting 

369
00:18:53,600 --> 00:18:56,080
better, getting worse. 
It's just kind of been there I 

370
00:18:56,080 --> 00:18:58,680
would say since I I did. 
I think the other thing I did 

371
00:18:58,680 --> 00:19:01,480
for it is take time off. 
So I haven't ran since Thursday.

372
00:19:01,480 --> 00:19:04,640
It's Sunday right now. 
So I've taken a couple days off 

373
00:19:04,760 --> 00:19:09,240
and I did go on a five mile walk
yesterday with Jana. 

374
00:19:09,280 --> 00:19:12,000
We went out to a State Park and 
we were walking around and it 

375
00:19:12,000 --> 00:19:15,160
would it was nothing and then it
would come for a little bit, 

376
00:19:15,160 --> 00:19:17,240
then it would go away and then 
it would come and then it would 

377
00:19:17,240 --> 00:19:19,320
go away. 
Did that twice during the walk. 

378
00:19:19,320 --> 00:19:21,120
Got it. 
But not consistently like, oh, 

379
00:19:21,120 --> 00:19:23,040
it's like now it's every single 
time. 

380
00:19:23,040 --> 00:19:25,000
OK, correct. 
So still not a progressive 

381
00:19:25,000 --> 00:19:25,720
worsening. 
Yeah. 

382
00:19:25,720 --> 00:19:28,160
Did it force you to change your 
gait or no? 

383
00:19:29,320 --> 00:19:34,520
It didn't force me to. 
I have sometimes to try to put 

384
00:19:34,520 --> 00:19:39,400
less pressure through the ball 
of my foot, but I didn't have 

385
00:19:39,400 --> 00:19:40,760
to. 
It didn't hurt so much that I 

386
00:19:40,760 --> 00:19:42,000
need to switch. 
Got it. 

387
00:19:42,320 --> 00:19:46,360
So irritability and severity 
still pretty low stick like 

388
00:19:46,440 --> 00:19:47,560
nature. 
I'm doing what's called the 

389
00:19:47,560 --> 00:19:49,920
sins, by the way, and I'm doing 
this because I'm literally 

390
00:19:49,920 --> 00:19:52,280
making an orthopedic course from
scratch right now going how do I

391
00:19:52,280 --> 00:19:55,360
teach this stuff? 
Nature is still a little bit up 

392
00:19:55,360 --> 00:19:59,760
in the air, but I'm less the 
consistency stuff makes me less 

393
00:19:59,760 --> 00:20:02,440
concerned for more serious 
stuff. 

394
00:20:02,440 --> 00:20:06,920
And I'm kind of almost like kind
of leaning toward like sheath. 

395
00:20:07,840 --> 00:20:10,160
Kind of stuff like extensor 
sheath and things like that, but

396
00:20:10,160 --> 00:20:13,960
I might that's an unknown state.
Stability sounds it's pretty 

397
00:20:13,960 --> 00:20:16,560
stable, like it's like you can 
reproduce it. 

398
00:20:16,560 --> 00:20:18,800
It's not too bad. 
So I'd say that's really good. 

399
00:20:18,800 --> 00:20:21,240
There is some level of 
consistency even though it's not

400
00:20:21,240 --> 00:20:25,400
100%. 
And then stage still sounds 

401
00:20:25,840 --> 00:20:28,720
early like or at least not maybe
not early, but like not 

402
00:20:28,720 --> 00:20:32,680
inflammatory, not you know, 
it's, you know, not chronic that

403
00:20:32,680 --> 00:20:34,400
hasn't been going on for a while
because you haven't had this 

404
00:20:34,400 --> 00:20:36,040
before, right? 
No history of this. 

405
00:20:36,840 --> 00:20:41,040
Well, I think this is another 
factor for me is this is my foot

406
00:20:41,040 --> 00:20:43,240
that I've had issues. 
So this is where I had my 

407
00:20:43,240 --> 00:20:46,000
planter plate tear. 
This is where I had like my 5th 

408
00:20:46,000 --> 00:20:50,040
metatarsal issue. 
It's doesn't feel anything like 

409
00:20:50,040 --> 00:20:52,400
either of those two, very 
different location, different 

410
00:20:52,400 --> 00:20:55,800
sensation. 
But I think because I have this 

411
00:20:55,800 --> 00:20:57,880
foot having a history, I get 
scared that. 

412
00:20:58,000 --> 00:20:59,160
Makes sense. 
That's a normal. 

413
00:20:59,160 --> 00:21:01,200
That stuff happens. 
Yeah, that's a normal like, 

414
00:21:01,200 --> 00:21:02,720
yeah, that, that totally makes 
sense. 

415
00:21:02,720 --> 00:21:05,840
That would be a a normal 
concern. 

416
00:21:06,280 --> 00:21:08,960
However, hearing this, I would 
go, hey, there's still some 

417
00:21:08,960 --> 00:21:11,080
testing I would want to do. 
And the fact you can actually 

418
00:21:11,080 --> 00:21:13,880
reduce symptoms with intrinsic 
stuff is like, that's great. 

419
00:21:14,400 --> 00:21:18,080
I would say unless there's 
anything, unless it starts to 

420
00:21:18,080 --> 00:21:21,440
get worse and you, you, your 
original question is what should

421
00:21:21,440 --> 00:21:23,720
I do with this, right? 
Yeah, should I keep running? 

422
00:21:23,720 --> 00:21:25,720
Yeah, if I was. 
You a couple weeks of biking. 

423
00:21:26,680 --> 00:21:29,560
I feel like the symptoms and you
can tell me if I'm wrong aren't 

424
00:21:29,880 --> 00:21:33,200
bad enough to not run. 
I would still see if you're 

425
00:21:33,200 --> 00:21:36,480
like, hey, can we modify some 
like find a shoe maybe that that

426
00:21:36,480 --> 00:21:39,080
tends to reduce symptoms. 
Maybe something that's a little 

427
00:21:39,080 --> 00:21:43,960
rockard just to reduce some 
symptoms there just in case the 

428
00:21:43,960 --> 00:21:46,560
meantime. 
But I don't think I would say 

429
00:21:46,560 --> 00:21:49,000
time off just cause the 
irritability and severity are so

430
00:21:49,000 --> 00:21:53,280
low and it doesn't smell or 
sound like bone stress. 

431
00:21:53,280 --> 00:21:55,400
Although I could could be wrong 
and you're going to know that 

432
00:21:55,400 --> 00:21:57,920
better than me because you've 
actually had one before so it 

433
00:21:57,920 --> 00:21:59,800
feels similar or different. 
Different. 

434
00:21:59,800 --> 00:22:01,440
Different. 
Yeah, Mike. 

435
00:22:02,000 --> 00:22:03,840
And you can tell me. 
You can tell me if I'm wrong. 

436
00:22:03,840 --> 00:22:06,000
Reality is, I get less 
objective. 

437
00:22:06,160 --> 00:22:09,120
That's me. 
Yeah, the this is not evidence 

438
00:22:09,120 --> 00:22:11,600
based at all, but I've had 
several people that have asked 

439
00:22:11,600 --> 00:22:13,600
this and I should do a 
qualitative study even though I 

440
00:22:13,600 --> 00:22:14,560
don't know how to do 
qualitative. 

441
00:22:15,680 --> 00:22:19,480
Is most patients who have had a 
bone stress injury before, I 

442
00:22:19,480 --> 00:22:21,800
would say almost 100% of the 
time when they're like, I'm 

443
00:22:21,800 --> 00:22:23,680
like, hey, does this feel 
similar, different. 

444
00:22:23,680 --> 00:22:27,200
Like their answer is almost 
100%, right? 

445
00:22:27,320 --> 00:22:29,840
Like if it's been a bone stress 
injury, like this feels the 

446
00:22:29,840 --> 00:22:31,560
same. 
If it hasn't, it's been like, 

447
00:22:31,600 --> 00:22:34,800
no, it feels like something 
totally different, but it gets 

448
00:22:34,800 --> 00:22:37,160
hard when you start panicking, 
panicking a little bit. 

449
00:22:37,160 --> 00:22:39,800
So I would say I think you're 
fine to keep running. 

450
00:22:39,800 --> 00:22:41,160
You have to do a little more 
objective tests. 

451
00:22:41,160 --> 00:22:43,560
You kind of figure out like what
this is in terms of like 

452
00:22:43,840 --> 00:22:47,000
continue with palpation, a 
couple like, you know, squeeze 

453
00:22:47,000 --> 00:22:50,840
tests and stuff like that. 
But given this, so yeah, so 

454
00:22:50,840 --> 00:22:52,600
given the severity and your 
ability to be low, I think 

455
00:22:52,600 --> 00:22:56,040
you're clear to keep running. 
I would just make sure to have a

456
00:22:56,040 --> 00:22:59,120
rocker of some kind to reduce 
some of the load at the moment. 

457
00:22:59,320 --> 00:23:02,000
But then don't be afraid to 
slowly start reintroducing that 

458
00:23:02,000 --> 00:23:04,880
load because you don't want to 
totally unload something. 

459
00:23:05,120 --> 00:23:08,960
But I also would say don't jump 
1000% back into running. 

460
00:23:08,960 --> 00:23:11,360
I think you still like with the 
week off takes some time to 

461
00:23:11,360 --> 00:23:14,240
build back up I think would be 
important. 

462
00:23:15,040 --> 00:23:16,080
Perfect. 
How's stress? 

463
00:23:16,200 --> 00:23:18,840
How's stress and like sleep and 
nutrition and stuff like that. 

464
00:23:19,560 --> 00:23:21,600
Pretty normal, sweet, no 
changes. 

465
00:23:21,600 --> 00:23:25,080
Nothing weird there. 
Fantastic. 

466
00:23:25,080 --> 00:23:26,920
Well, thanks for going on that 
journey with me, Matt. 

467
00:23:27,040 --> 00:23:28,320
How long did that take? 
What 5? 

468
00:23:29,120 --> 00:23:31,360
I don't even know. 
Yeah, yeah, something like that 

469
00:23:31,360 --> 00:23:31,600
all. 
Right. 

470
00:23:31,600 --> 00:23:33,800
For all my students who think 
they can't do a subjective in 

471
00:23:33,800 --> 00:23:39,680
less than 15 minutes, I'm in 
like, I'm in like the creation 

472
00:23:39,680 --> 00:23:42,160
of the testing right now. 
I'm like, how long do I give 

473
00:23:42,160 --> 00:23:43,960
them for this on the practical 
exam? 

474
00:23:44,760 --> 00:23:46,720
Yeah. 
And went back and forth with my 

475
00:23:46,720 --> 00:23:48,400
director and he's like, you're 
being way too aggressive. 

476
00:23:48,400 --> 00:23:51,440
I'm like, they'll be fine. 
He's like, I'm pulling you back 

477
00:23:51,440 --> 00:23:52,640
on this. 
You got to give him more time. 

478
00:23:52,640 --> 00:23:54,480
Oh. 
That's good. 

479
00:23:54,480 --> 00:23:55,840
I. 
Wonder if any of them listened 

480
00:23:55,840 --> 00:23:58,480
to this. 
They can panic because this will

481
00:23:58,480 --> 00:23:59,840
be out long before the course 
starts. 

482
00:24:00,680 --> 00:24:04,000
It's funny, some of the students
that I that I get to work with, 

483
00:24:04,000 --> 00:24:07,880
they, they make fun of me 
because they'll like in our lab 

484
00:24:07,880 --> 00:24:11,440
environment, which is really 
like flowy and open and really 

485
00:24:11,440 --> 00:24:14,760
interactive. 
They'll just like we play music 

486
00:24:14,840 --> 00:24:17,240
most of the time. 
Wow music playing students are 

487
00:24:17,240 --> 00:24:21,600
learning. 
It's really fun and sometimes 

488
00:24:21,600 --> 00:24:23,960
one will go up and they'll turn 
on the Dior podcast with me 

489
00:24:23,960 --> 00:24:28,000
talking just just to make funny,
like, oh, I heard this really 

490
00:24:28,000 --> 00:24:30,320
good new podcast and they're 
just making fun of me. 

491
00:24:30,760 --> 00:24:34,040
It's a good time. 
All right, So we're going to 

492
00:24:34,040 --> 00:24:37,800
dive into the main segment of 
this podcast, which is talking 

493
00:24:37,800 --> 00:24:43,200
about various regions of pain, 
why those regions sometimes 

494
00:24:43,200 --> 00:24:46,840
develop pain and then kind of 
this conglomerate of what can we

495
00:24:46,840 --> 00:24:48,560
do about it? 
What sort of shoe wear 

496
00:24:48,560 --> 00:24:51,880
recommendations can we have and 
how could we maybe prevent it in

497
00:24:51,880 --> 00:24:54,920
the first place. 
And so as I have said when we 

498
00:24:54,920 --> 00:24:58,320
introduced the episode, these 
are not medical advice. 

499
00:24:58,320 --> 00:25:01,560
This is not specifics as to 
everyone can do this and you're 

500
00:25:01,560 --> 00:25:04,600
not going to have pain or it's 
going to perfectly rehabilitate 

501
00:25:04,600 --> 00:25:07,560
you. 
This is going to be overarching 

502
00:25:07,560 --> 00:25:10,080
things that we've learned 
through the literature as well 

503
00:25:10,080 --> 00:25:13,400
as our clinical experiences. 
So what we're going to start 

504
00:25:13,400 --> 00:25:17,880
with are two different causes of
and regions of foot pain. 

505
00:25:18,080 --> 00:25:21,840
One of these is plantar surface,
so like the bottom of the foot 

506
00:25:22,080 --> 00:25:25,240
in what we call the forefoot and
then we're going to move and 

507
00:25:25,240 --> 00:25:28,400
talk about the heel. 
So when you work with runners, 

508
00:25:28,400 --> 00:25:32,400
what are the most common causes 
of pain in the plantar surface 

509
00:25:32,400 --> 00:25:36,200
of the forefoot? 
So most common thing that people

510
00:25:36,200 --> 00:25:40,760
get diagnosed with is going to 
be plantar fasciitis or plantar 

511
00:25:40,760 --> 00:25:45,640
fasciopathy is a better term. 
How often that actually is the 

512
00:25:45,640 --> 00:25:48,240
source is not as common what 
people think. 

513
00:25:48,240 --> 00:25:50,600
So you can totally get. 
So there's a lot of musculature 

514
00:25:50,600 --> 00:25:54,360
in that area very, very common 
to have some strains of some of 

515
00:25:54,360 --> 00:25:56,920
the small intrinsic muscles and 
that that happens all the time, 

516
00:25:56,920 --> 00:26:00,280
especially medial arch to like 
planter surface, media arch. 

517
00:26:00,480 --> 00:26:02,200
That's really got you were 
asking about heel or just 

518
00:26:02,200 --> 00:26:05,680
planter surface? 
I was saying the the four foot 

519
00:26:05,680 --> 00:26:08,120
of the planter surface, so like 
by the ball by the balls of the.

520
00:26:08,120 --> 00:26:09,520
Okay, got it. 
I want to beg, did I? 

521
00:26:09,560 --> 00:26:10,600
Am I answering this correct? 
Correct. 

522
00:26:10,600 --> 00:26:12,280
Okay. 
So probably not planter fashion.

523
00:26:12,680 --> 00:26:14,720
So they're not so totally wrong.
Yeah. 

524
00:26:14,760 --> 00:26:17,080
So let me make sure I'm 
listening as this gets hotter in

525
00:26:17,080 --> 00:26:19,880
here and I'm sweating more. 
So 4 foot area. 

526
00:26:20,040 --> 00:26:22,640
So a couple, a couple different 
common things. 

527
00:26:22,640 --> 00:26:26,480
So a just some a little like 
bone bruising or something can 

528
00:26:26,480 --> 00:26:28,880
also happen very frequently. 
And like the lot of metatarsal 

529
00:26:28,880 --> 00:26:32,040
heads, you have two bones call 
on the on under your, your big 

530
00:26:32,040 --> 00:26:34,840
toe called your sesmoid bones, 
which can also get really 

531
00:26:34,840 --> 00:26:36,640
irritated sometimes. 
That's really common because 

532
00:26:36,640 --> 00:26:39,520
they also have a ton of tendons 
that connect in there as well 

533
00:26:40,440 --> 00:26:41,720
and tendons that go through 
them. 

534
00:26:41,960 --> 00:26:45,560
That's a common thing. 
Ligament sprains are also not 

535
00:26:45,560 --> 00:26:47,760
uncommon, especially among trail
runners who they're in a 

536
00:26:47,760 --> 00:26:50,360
flexible shoe and they go a 
certain way and feel something 

537
00:26:50,360 --> 00:26:52,520
in the forefoot. 
That's another one. 

538
00:26:53,600 --> 00:26:57,240
Tendon insertional stuff is 
something I've seen more common.

539
00:26:57,400 --> 00:26:59,920
And then obviously, although 
this is a little distal, you can

540
00:26:59,920 --> 00:27:03,440
get some nervy related things. 
And then the the freaky one, the

541
00:27:03,440 --> 00:27:07,280
scary 1 is like bone stress 
stuff or some of the some, not 

542
00:27:07,280 --> 00:27:10,560
all of the kind of common things
that I'm taking off the top my 

543
00:27:10,560 --> 00:27:12,760
head when we're talking 
forefoot. 

544
00:27:13,760 --> 00:27:16,040
The only one, and you mentioned 
nervy things. 

545
00:27:16,040 --> 00:27:19,640
I think the one that's most 
common in the forefoot by the 

546
00:27:19,640 --> 00:27:22,680
balls of your feet is what's 
called a Morton's neuroma or 

547
00:27:22,680 --> 00:27:25,880
interdigital neuroma. 
And it's kind of a, a thickening

548
00:27:25,880 --> 00:27:29,240
of the nerve as it's passing 
through the end of your kind of 

549
00:27:29,320 --> 00:27:33,480
long metatars, metatarsals and 
that nerve just starts to get 

550
00:27:33,480 --> 00:27:35,360
irritated. 
People usually say like it feels

551
00:27:35,360 --> 00:27:38,160
like you're stepping on a pedal,
you might get some numbness, 

552
00:27:38,160 --> 00:27:40,600
Ting, numbness and tingling up 
into your foot, it hurts to 

553
00:27:40,600 --> 00:27:42,080
squeeze your foot, things like 
that. 

554
00:27:42,080 --> 00:27:44,440
There's actual squeeze test, so 
there's actually a couple of 

555
00:27:44,440 --> 00:27:47,040
different ones now, but yeah. 
Yeah. 

556
00:27:47,520 --> 00:27:52,400
So when we think about, you 
know, what leads to that and 

557
00:27:52,400 --> 00:27:56,040
therefore what can we recommend 
from a shoe perspective like how

558
00:27:56,280 --> 00:28:00,240
when we consider load for those 
areas and how shoes could play a

559
00:28:00,240 --> 00:28:02,160
role, what what would you think 
about? 

560
00:28:02,160 --> 00:28:04,560
So the way that shoes are going 
to play a role in this 

561
00:28:04,560 --> 00:28:08,320
conversation is that you're 
typically in the early rehab 

562
00:28:08,320 --> 00:28:11,800
phases or early like like like 
management phases, you're trying

563
00:28:11,800 --> 00:28:14,400
to reduce load, OK, You're not 
trying to increase it. 

564
00:28:14,600 --> 00:28:16,520
And there's a lot of load that 
goes through your forefoot. 

565
00:28:16,520 --> 00:28:18,800
In fact, that's actually 
probably some of the highest, 

566
00:28:18,800 --> 00:28:20,360
some of the highest loads you 
can get. 

567
00:28:20,360 --> 00:28:22,560
Like you get, you know, if 
you're a four foot striker, 

568
00:28:22,560 --> 00:28:24,080
obviously during initial 
contact. 

569
00:28:24,080 --> 00:28:26,760
But some of the propulsive 
forces like we know now that 

570
00:28:26,760 --> 00:28:29,760
actually some of the greatest 
stresses to bones actually 

571
00:28:29,760 --> 00:28:31,760
happened from muscle 
contraction. 

572
00:28:32,080 --> 00:28:35,800
So like when you're pushing off,
muscles are contracting really 

573
00:28:35,800 --> 00:28:38,960
hard. 
So a way to reduce some of the 

574
00:28:38,960 --> 00:28:41,640
load is you can reduce some of 
the movement there with 

575
00:28:41,640 --> 00:28:43,200
something like a four foot 
rocker. 

576
00:28:43,200 --> 00:28:45,360
And I want to clarify when I 
talk about a four foot rocker, 

577
00:28:45,360 --> 00:28:47,120
there's actually it needs to be 
really specific. 

578
00:28:47,680 --> 00:28:50,360
If the four foot rocker is 
holding you up in a bunch of 

579
00:28:50,360 --> 00:28:53,360
extension, that's may not 
necessarily reduce load. 

580
00:28:53,360 --> 00:28:55,680
We're talking about the 
curvature under the forefoot, 

581
00:28:55,680 --> 00:28:59,360
but it still keeps the toes in a
mostly neutral position that 

582
00:28:59,360 --> 00:29:03,120
allows you to roll off that and 
not have to use your own natural

583
00:29:03,120 --> 00:29:05,560
4 foot rocker, which does 
require some additional load. 

584
00:29:05,560 --> 00:29:08,280
It's efficient, but there's some
additional load and range of 

585
00:29:08,280 --> 00:29:10,680
motion and strength requirements
that if you can use a four foot 

586
00:29:10,680 --> 00:29:13,240
rocker, you can reduce some 
stress in that area. 

587
00:29:14,160 --> 00:29:17,400
I think that's super important 
to think about because if we go 

588
00:29:17,400 --> 00:29:21,920
to probably two of the most 
common ones, we'd probably see 

589
00:29:22,760 --> 00:29:26,320
what we call metatarsalgia. 
So like just pain at where you 

590
00:29:26,320 --> 00:29:29,280
can get some irritation and 
bruising to the soft tissues 

591
00:29:29,440 --> 00:29:32,520
that are right under the ball of
the foot or looking at 

592
00:29:32,920 --> 00:29:36,000
sesamoiditis of those two little
floating bones at the base of 

593
00:29:36,000 --> 00:29:37,480
the foot. 
You're going to want to offload 

594
00:29:37,480 --> 00:29:38,840
those. 
And so you need a shoe that's 

595
00:29:38,840 --> 00:29:40,920
going to do that. 
We know that if you have a stiff

596
00:29:40,920 --> 00:29:43,680
Rocard platform, again, not one 
that's holding your toes up, 

597
00:29:43,880 --> 00:29:47,240
that that decreases plantar 
pressure, which means pressure 

598
00:29:47,240 --> 00:29:50,480
underneath that part of the foot
and it's shifting in other 

599
00:29:50,480 --> 00:29:52,720
places. 
But if we want to offload that, 

600
00:29:52,720 --> 00:29:56,000
that rockers can be important 
and it can't just be the shape 

601
00:29:56,000 --> 00:29:58,480
of a rocker. 
Like you can see I'm holding up 

602
00:29:58,520 --> 00:30:01,600
the shoe I talked about today 
for what I'm testing with the 

603
00:30:01,600 --> 00:30:05,640
ultra flow to. 
And you can see if I, if it's 

604
00:30:05,640 --> 00:30:09,200
just sitting here, you can see 
there's a bit of a rocker, but 

605
00:30:09,360 --> 00:30:12,120
it's super flexible. 
And so this isn't going to do 

606
00:30:12,120 --> 00:30:14,280
anything for you from an 
offloading perspective. 

607
00:30:14,280 --> 00:30:17,480
It actually would be doing more 
in their old version, though I 

608
00:30:17,480 --> 00:30:20,120
wouldn't recommend it because of
some of the like how firm the 

609
00:30:20,120 --> 00:30:22,120
foam is. 
But like now this one's not 

610
00:30:22,160 --> 00:30:25,000
bending. 
You need that stiffness on that 

611
00:30:25,000 --> 00:30:26,280
front. 
I think something else that's 

612
00:30:26,280 --> 00:30:29,720
nice is finding one that is 
compliant enough where it's not 

613
00:30:29,720 --> 00:30:32,200
just like directly pushing back 
into your foot. 

614
00:30:32,960 --> 00:30:35,360
And then the last part that I 
was thinking about and it's 

615
00:30:35,360 --> 00:30:38,240
actually nice that I'm have that
I have an ultra shoe here. 

616
00:30:38,320 --> 00:30:42,800
I was going to say yeah. 
Upper a wider space because 

617
00:30:43,400 --> 00:30:46,240
either you're going to have to 
modify what's going on 

618
00:30:46,240 --> 00:30:48,920
underneath your foot with some 
kind of like orthotic, temporary

619
00:30:48,920 --> 00:30:52,120
orthotic stuff, or you just want
enough space, especially if you 

620
00:30:52,120 --> 00:30:54,760
have like a Morton's neuroma. 
If you're having a shoe that's 

621
00:30:54,760 --> 00:30:57,520
pinching your metatarsals 
together, that's pinching on 

622
00:30:57,520 --> 00:30:59,960
that nerve and causing that 
irritation, you want a shoe 

623
00:30:59,960 --> 00:31:02,720
that's allowing your metatarsals
to really splay out. 

624
00:31:03,040 --> 00:31:05,720
And so I'm not saying it's every
ultra because like I said, some 

625
00:31:05,720 --> 00:31:07,960
of them are pinching me where 
it's actually problematic. 

626
00:31:07,960 --> 00:31:11,840
For this. 
You need a wide midfoot to to 

627
00:31:11,840 --> 00:31:15,520
toe box for that toe splay. 
I will say at the the toe box 

628
00:31:15,520 --> 00:31:18,160
part was the other important 
piece that if somebody is going 

629
00:31:18,160 --> 00:31:20,880
to get a shoe for this purpose, 
you know the care. 

630
00:31:20,880 --> 00:31:23,440
We make some recommendations. 
Ultra, I'm glad they have some 

631
00:31:23,440 --> 00:31:28,200
4mm stuff now because my my 
actually go to company for a lot

632
00:31:28,200 --> 00:31:33,360
of the like like medical or like
tissue stuff is actually topo 

633
00:31:33,360 --> 00:31:36,200
because they're not they're not 
usually zero drop. 

634
00:31:36,400 --> 00:31:39,280
They've got that wider, more 
anatomic toe box and not all of 

635
00:31:39,280 --> 00:31:41,040
them, but a lot of those shoes 
tend to have a little stiffer 

636
00:31:41,040 --> 00:31:43,000
rocker so that people can handle
that. 

637
00:31:43,000 --> 00:31:45,040
So that's been a go to suggest 
for people. 

638
00:31:45,280 --> 00:31:48,880
And the toe box with depends on 
the person because everybody has

639
00:31:48,880 --> 00:31:50,760
different width feet. 
Somebody with a really narrow 

640
00:31:50,760 --> 00:31:52,720
foot may not work as well with 
that. 

641
00:31:52,720 --> 00:31:55,400
But for people that need to like
especially so that the poor 

642
00:31:55,400 --> 00:31:59,520
metatarsals that need compressed
because what we suspect with, 

643
00:31:59,520 --> 00:32:00,760
and there's some different 
thoughts on this. 

644
00:32:00,760 --> 00:32:03,720
Some of the like the Morton's 
Deroma is that if you put 

645
00:32:03,720 --> 00:32:06,560
pressure on nerve tissues 
respond to the stress placed 

646
00:32:06,560 --> 00:32:08,840
upon them and they sometimes go 
out in response to that where 

647
00:32:08,840 --> 00:32:10,200
you get that enlargement of the 
nerve. 

648
00:32:10,200 --> 00:32:13,440
So if you have a narrow toe box,
you got toes getting crunched 

649
00:32:13,440 --> 00:32:14,960
together, that puts more 
pressure on the nerve and you 

650
00:32:14,960 --> 00:32:17,880
want to create more space there.
You somebody's a narrow foot. 

651
00:32:18,000 --> 00:32:20,760
You don't simply need a super 
wide shoe to do that. 

652
00:32:20,880 --> 00:32:23,360
Somebody who has a wider foot, 
you might need to have a 

653
00:32:23,360 --> 00:32:25,400
conversation going. 
You may need to start thinking 

654
00:32:25,400 --> 00:32:28,640
about a more appropriate toe box
and atomic. 

655
00:32:28,640 --> 00:32:30,000
So based on what you're 
experiencing. 

656
00:32:30,000 --> 00:32:33,360
So because Topo typically does 
the drops a little bit better, I

657
00:32:33,360 --> 00:32:34,880
know Ultra's now working on 
that. 

658
00:32:35,200 --> 00:32:38,240
Topo's been a go to, but now 
with some of the flow and some 

659
00:32:38,240 --> 00:32:41,240
of the other shoes, we may have 
some additional options for 

660
00:32:41,240 --> 00:32:45,160
those of us looking at this from
a medical and rehab management 

661
00:32:45,160 --> 00:32:46,840
standpoint. 
Totally. 

662
00:32:48,200 --> 00:32:51,440
Before we start talking about 
what can I do to prevent this 

663
00:32:51,440 --> 00:32:54,560
from coming, I want to 1st talk 
about another region of the 

664
00:32:54,560 --> 00:32:56,280
foot. 
Now we're going back to the the 

665
00:32:56,280 --> 00:32:59,760
planner, the bottom surface, the
heel, typically where people are

666
00:32:59,760 --> 00:33:02,360
having what they may just call 
plantar fasciitis. 

667
00:33:02,360 --> 00:33:04,920
Whether, although we've talked 
about in previous episodes, can 

668
00:33:04,920 --> 00:33:08,680
be a lot of different things. 
Let's just start there. 

669
00:33:08,680 --> 00:33:12,360
What are some misconceptions 
that people have about plantar 

670
00:33:12,360 --> 00:33:14,680
fasciitis? 
Yeah, one of the biggest things 

671
00:33:14,680 --> 00:33:16,840
is that is I have the more 
common one that I've heard 

672
00:33:16,840 --> 00:33:19,080
recently is when people, when I 
say, oh, you have this plantar 

673
00:33:19,080 --> 00:33:21,160
fascia thing and like I have 
plantar fasciitis. 

674
00:33:21,160 --> 00:33:24,280
I'm like, no, it's a tissue. 
It's a really important tissue. 

675
00:33:24,280 --> 00:33:26,720
Like just because you have 
irritation doesn't necessarily 

676
00:33:26,720 --> 00:33:28,280
mean it's that. 
And just 'cause I talk about 

677
00:33:28,280 --> 00:33:29,600
this, I'm not talking about a 
pathology. 

678
00:33:29,600 --> 00:33:32,640
It's a tissue that you need. 
It's actually super important 

679
00:33:32,640 --> 00:33:35,960
for like your progression of 
gait, for natural stability and 

680
00:33:35,960 --> 00:33:37,320
all kinds of stuff. 
So you need it. 

681
00:33:37,840 --> 00:33:40,920
I just worked with somebody who 
had their plantar fascia rupture

682
00:33:41,440 --> 00:33:43,760
actually. 
And he's actually going to know 

683
00:33:43,960 --> 00:33:46,000
who I'm talking about because he
listened to the podcast. 

684
00:33:46,960 --> 00:33:50,880
But yeah, apparently too many 
cortisone shots and just, and he

685
00:33:50,880 --> 00:33:54,040
can correct me if I if I 
misinterpreted that when we're 

686
00:33:54,040 --> 00:33:56,160
talking. 
But yeah, it's unfortunate. 

687
00:33:56,160 --> 00:33:58,880
So it's a very important 
mechanism on the bottom of the 

688
00:33:58,880 --> 00:34:01,320
foot and there's a lot of 
misconception about it. 

689
00:34:01,480 --> 00:34:03,280
There's also a lot of 
misconception about treatment. 

690
00:34:03,280 --> 00:34:05,880
Like there's a lot of gurus out 
there going this is the perfect 

691
00:34:05,880 --> 00:34:07,680
treatment. 
And honestly, one of the best 

692
00:34:07,680 --> 00:34:10,920
things we've found is like time.
Like it just takes time. 

693
00:34:11,400 --> 00:34:13,840
To be honest. 
The clinical practice guidelines

694
00:34:13,840 --> 00:34:16,320
are are really frustrating for a
planet. 

695
00:34:17,280 --> 00:34:19,800
Yeah, they are. 
I think it's, it's a, it's a 

696
00:34:19,800 --> 00:34:23,600
tough one because we've talked 
about this and if you want to 

697
00:34:23,600 --> 00:34:25,400
tune out for the next two 
minutes, you can. 

698
00:34:25,760 --> 00:34:31,679
But just tagging the suffix itis
onto something says that the 

699
00:34:31,679 --> 00:34:35,000
reason why you're having this 
problem is because of 

700
00:34:35,000 --> 00:34:36,960
inflammation. 
And it's saying this is an 

701
00:34:36,960 --> 00:34:40,320
inflammation related problem. 
And I think that's one of the 

702
00:34:40,320 --> 00:34:44,560
misconceptions about plantar 
fasciopathy would be a, a word 

703
00:34:44,560 --> 00:34:48,080
that I would use that in place 
of this or plantar fascia pain 

704
00:34:48,320 --> 00:34:54,000
because the tissue itself can be
pain generating without any 

705
00:34:54,000 --> 00:34:56,280
inflammation. 
And that's important because 

706
00:34:56,280 --> 00:34:58,540
when it's inflammation, you 
treat it with anti 

707
00:34:58,540 --> 00:35:00,600
inflammatories. 
This is oversimplification, but 

708
00:35:00,600 --> 00:35:03,480
in general you're going to take 
things that are going to calm 

709
00:35:03,480 --> 00:35:06,200
down inflammation. 
Maybe that's ice, some sort of 

710
00:35:06,200 --> 00:35:09,920
cold, maybe some sort of non 
steroidal anti-inflammatory like

711
00:35:10,080 --> 00:35:11,960
ibuprofen or something like 
that. 

712
00:35:13,520 --> 00:35:18,000
But a lot of times it's not a 
true inflammatory condition 

713
00:35:18,000 --> 00:35:20,920
that's leading to your symptoms.
It's changes in the tissue 

714
00:35:20,920 --> 00:35:23,840
quality, which is leading to 
some sort of pain sensation or 

715
00:35:23,840 --> 00:35:25,680
something else incompletely 
because there's lots of 

716
00:35:25,680 --> 00:35:27,600
different nerves that pass 
through here and other tendons 

717
00:35:27,600 --> 00:35:31,040
that can cause pain that mimic 
plantar fascia issues. 

718
00:35:31,840 --> 00:35:34,840
And so I think that's one of the
biggest misconceptions is what's

719
00:35:34,840 --> 00:35:38,200
actually causing it. 
And that does mean that the 

720
00:35:38,360 --> 00:35:40,520
treatment looks very different, 
because if it's not 

721
00:35:40,560 --> 00:35:44,160
inflammatory, you're really 
thinking about optimal load 

722
00:35:44,160 --> 00:35:46,120
management. 
You want enough load to make 

723
00:35:46,120 --> 00:35:49,360
sure that you're continuing to 
promote healthy tissue, but not 

724
00:35:49,360 --> 00:35:51,560
too much load to create 
irritation. 

725
00:35:52,760 --> 00:35:57,560
And it's honestly a real bugger 
of a condition, not because it 

726
00:35:57,560 --> 00:36:01,080
can't be helped, but because how
it gets helped looks different 

727
00:36:01,320 --> 00:36:04,640
for every single person. 
But along those lines, we're 

728
00:36:04,640 --> 00:36:07,560
going to go into kind of this 
kind of tricky topic. 

729
00:36:08,160 --> 00:36:12,680
What do you recommend for people
to do the best to maintain a 

730
00:36:12,680 --> 00:36:15,840
healthy foot from heel to toe? 
Like what? 

731
00:36:16,040 --> 00:36:18,720
What things? 
If I could do these three 

732
00:36:18,720 --> 00:36:22,000
things, it doesn't need to be 3.
What would you recommend that 

733
00:36:22,000 --> 00:36:24,000
people do to keep their feet 
healthy? 

734
00:36:24,160 --> 00:36:28,320
Let me clarify, by the way, that
this is not bulletproof, that 

735
00:36:28,320 --> 00:36:31,040
when we talked about trying to 
keep them healthy, you know, 

736
00:36:31,240 --> 00:36:33,920
running, all this stuff, people 
get injured for a variety of 

737
00:36:33,920 --> 00:36:36,200
reasons and it's not always 
because of the activity you're 

738
00:36:36,200 --> 00:36:38,240
doing. 
You may have heard me ask 

739
00:36:38,240 --> 00:36:40,160
Nathan, how is sleep, nutrition,
all this kind of stuff? 

740
00:36:40,320 --> 00:36:44,000
There's all kinds of things that
influence pain, injuries and 

741
00:36:44,000 --> 00:36:46,200
things like that. 
So this stuff is good. 

742
00:36:46,200 --> 00:36:48,600
It will not make you, it will 
not prevent totally because 

743
00:36:48,600 --> 00:36:53,160
stuff happened, but it certainly
can reduce your risk for sure. 

744
00:36:53,440 --> 00:36:56,920
So one thing that I really, 
really, really, really enjoy is 

745
00:36:56,920 --> 00:36:59,480
any, the first thing is going to
be any kind of strength 

746
00:36:59,480 --> 00:37:02,920
training, any kind of stuff that
gets you out of a shoe that 

747
00:37:02,920 --> 00:37:07,080
starts working on appropriate 
loading with higher intensity, 

748
00:37:07,080 --> 00:37:11,080
lower Rep ranges that build some
resilience, be it bone, be it 

749
00:37:11,560 --> 00:37:14,960
the muscles in the area. 
A good strength training, a 

750
00:37:14,960 --> 00:37:17,520
little power training stuff can 
be very, very helpful. 

751
00:37:17,520 --> 00:37:20,360
And it doesn't have to be 1000 
things just like one or two, 

752
00:37:20,360 --> 00:37:24,080
like little cap, like heavy 
weighted calf raises, maybe some

753
00:37:24,400 --> 00:37:26,880
double M hops that when you're 
barefoot, like things that 

754
00:37:26,880 --> 00:37:30,080
really engage some of the foot 
muscles lower less can be 

755
00:37:30,080 --> 00:37:31,920
really, really helpful just 
because we know strength 

756
00:37:31,920 --> 00:37:35,480
training tends to do a little 
bit better job of reducing risk 

757
00:37:35,480 --> 00:37:37,040
of injury. 
The other thing that would 

758
00:37:37,040 --> 00:37:39,800
really encourage people if they 
are able to, and not everybody 

759
00:37:39,800 --> 00:37:44,200
can do this, is to spend some 
time barefoot, be it like around

760
00:37:44,200 --> 00:37:47,560
the house if possible, not all 
the time because that can also 

761
00:37:47,560 --> 00:37:51,040
put you at risk for things like 
plantar fasciitis and 

762
00:37:51,040 --> 00:37:53,320
irritations. 
But just spending a little time 

763
00:37:53,320 --> 00:37:57,800
outside of shoes just going can 
I like just expose my muscles to

764
00:37:57,800 --> 00:37:59,360
working a little bit, things 
like that. 

765
00:37:59,360 --> 00:38:02,560
Not everybody can do that. 
I'm smiling, Matt. 

766
00:38:02,680 --> 00:38:06,920
I'm smiling because I was in my 
head, I was thinking, how am I 

767
00:38:06,920 --> 00:38:10,320
going to recommend that people 
spend time and spend time 

768
00:38:10,320 --> 00:38:14,000
barefoot or in some sort of 
minimal issue knowing that 

769
00:38:14,000 --> 00:38:15,680
that's not appropriate for 
everybody? 

770
00:38:15,680 --> 00:38:18,160
So you, you like said the exact 
thing I wanted to say. 

771
00:38:18,240 --> 00:38:22,120
Like we know this isn't possible
for everyone, but if you're in 

772
00:38:22,120 --> 00:38:24,800
the category where it is. 
Yeah, like I haven't. 

773
00:38:24,800 --> 00:38:28,680
If you happen to have a minimal 
shoe like I I love 0, by the 

774
00:38:28,680 --> 00:38:30,760
way, and that it's a great shoe 
to walk around. 

775
00:38:30,760 --> 00:38:32,760
And they actually make a leather
version, which has been great 

776
00:38:32,760 --> 00:38:34,800
for more professionals. 
They have gotten some good 

777
00:38:34,800 --> 00:38:36,320
compliments too. 
But I think it's also because a 

778
00:38:36,320 --> 00:38:38,760
lot of my students wear zeros as
well. 

779
00:38:39,560 --> 00:38:42,080
But it's a great way. 
I just have to be careful 

780
00:38:42,080 --> 00:38:44,400
because I know if I wear them 
for like a long day, my feet are

781
00:38:44,400 --> 00:38:46,400
going to ache. 
So you have to be kind of 

782
00:38:46,400 --> 00:38:47,800
strategic in building up to 
them. 

783
00:38:47,800 --> 00:38:49,840
But that's another really good 
way. 

784
00:38:49,840 --> 00:38:53,000
Those would be kind of my big 
two. 

785
00:38:54,200 --> 00:38:57,680
I think this is always up in the
air and for people that are 

786
00:38:57,680 --> 00:39:00,120
hyper mobile, this may not be 
the best option. 

787
00:39:00,320 --> 00:39:02,880
But if you're someone that's a 
little stiffer, just working on 

788
00:39:02,880 --> 00:39:04,880
a little bit of mobility would 
be helpful. 

789
00:39:05,080 --> 00:39:08,920
And just going, can I make sure 
I have some range of motion in 

790
00:39:08,920 --> 00:39:11,800
my ankle, some my calf, you 
know, making sure my big toe 

791
00:39:11,800 --> 00:39:14,120
joint moves Because like once 
you start losing that stuff, it 

792
00:39:14,120 --> 00:39:16,920
really changes gait. 
So if you could do that a little

793
00:39:16,920 --> 00:39:19,240
bit, that's great. 
For people that are hyper 

794
00:39:19,240 --> 00:39:21,440
mobile, that's probably not the 
best option because you already 

795
00:39:21,440 --> 00:39:22,960
have a lot of motion. 
You're going to probably want to

796
00:39:22,960 --> 00:39:26,880
focus more on strengthening and 
stiffening, but those are going 

797
00:39:26,880 --> 00:39:29,080
to be like big three. 
Would you have any other ones 

798
00:39:29,080 --> 00:39:31,560
that you would? 
Add Yeah, the ones that were in 

799
00:39:31,560 --> 00:39:36,400
my mind where one of them had to
do with the control and 

800
00:39:36,400 --> 00:39:39,400
robustness of the muscles of the
foot, the intrinsic muscles. 

801
00:39:39,400 --> 00:39:41,280
So in that category, I had two 
things. 

802
00:39:41,680 --> 00:39:45,760
One is to, if you can go 
barefoot or you barefoot or use 

803
00:39:45,760 --> 00:39:48,160
a minimalist shoe for daily 
stuff. 

804
00:39:48,920 --> 00:39:52,560
The second thing would be while 
you're sitting in your office 

805
00:39:52,560 --> 00:39:56,440
chair or at breakfast or 
whatever doing toe yoga. 

806
00:39:56,440 --> 00:39:59,560
And so if you just YouTube toe 
yoga, you're going to see lots 

807
00:39:59,560 --> 00:40:01,920
of different ways, but the idea 
is you're just learning and 

808
00:40:01,920 --> 00:40:04,800
practicing how to move your toes
independent of one another, 

809
00:40:04,920 --> 00:40:07,000
which is activating all of these
intrinsic muscles. 

810
00:40:07,000 --> 00:40:10,080
So for me thing one was hey, 
work on your intrinsic foot 

811
00:40:10,080 --> 00:40:12,920
muscles, get them active either.
Through barefoot walking or toe 

812
00:40:12,920 --> 00:40:14,880
yoga. 
The second thing that I was 

813
00:40:14,880 --> 00:40:19,640
going to recommend is if you are
someone with less mobility, work

814
00:40:19,640 --> 00:40:23,480
on making sure you have enough 
dorsiflexion at least like at a 

815
00:40:23,480 --> 00:40:25,880
minimum. 
And so there's a really nice 

816
00:40:25,880 --> 00:40:29,640
exercise that you can do a 
stretch and immobilization of 

817
00:40:29,640 --> 00:40:32,520
your joint at the same time 
where you put like a little belt

818
00:40:32,640 --> 00:40:35,960
underneath your malleoli that 
goes across the front of your 

819
00:40:35,960 --> 00:40:38,040
ankle and you kind of lunge into
it a little bit. 

820
00:40:38,200 --> 00:40:40,760
And you just kind of rock back 
and forth and work on some 

821
00:40:41,040 --> 00:40:44,720
getting your, you know, shin 
over your toes, just working on 

822
00:40:44,720 --> 00:40:48,520
enough of that motion. 
So a way that I have recommended

823
00:40:48,640 --> 00:40:52,920
kind of like on your own testing
if you need more mobility is go 

824
00:40:52,920 --> 00:40:57,080
do like 1/2 meal by a wall. 
Take your hand the width of your

825
00:40:57,080 --> 00:41:00,120
hand and move your toe that far 
away from the wall. 

826
00:41:00,520 --> 00:41:03,360
And then if you can't lunge 
forward and touch your knee to 

827
00:41:03,360 --> 00:41:07,120
the wall without your heel 
coming up, maybe work on your 

828
00:41:07,120 --> 00:41:10,000
dorsiflexion range of motion. 
That's usually a recommendation 

829
00:41:10,000 --> 00:41:13,320
that I have for people. 
So, so thing one was the 

830
00:41:13,320 --> 00:41:16,800
intrinsics thing 2 was enough 
ankle dorsiflexion, range of 

831
00:41:16,800 --> 00:41:18,840
motion. 
There's more complexity. 

832
00:41:18,840 --> 00:41:21,640
But again, I'm going with like 
if you've only got a couple 

833
00:41:21,640 --> 00:41:24,880
things. 
And then the third thing that I 

834
00:41:24,880 --> 00:41:31,000
was going to say was total soft 
tissue mobility, so calf length 

835
00:41:31,200 --> 00:41:34,600
and hamstring length. 
So everything on the backside of

836
00:41:34,600 --> 00:41:37,280
your leg, just making sure that 
you have enough flexibility 

837
00:41:37,280 --> 00:41:39,160
there. 
Again, if you are someone who 

838
00:41:39,160 --> 00:41:42,280
doesn't have a lot of length, 
then you should stretch and make

839
00:41:42,280 --> 00:41:44,640
sure that you have enough. 
So that'd be my third thing. 

840
00:41:44,640 --> 00:41:47,840
And then I was going to add a 
calf strengthening as well and 

841
00:41:47,840 --> 00:41:50,480
just having a nice strong lots 
of load through that calf 

842
00:41:50,480 --> 00:41:54,600
complex, knowing that the calf 
and the muscles that line the 

843
00:41:54,600 --> 00:41:58,160
deep compartment in our our calf
like our tibialis posterior and 

844
00:41:58,160 --> 00:42:01,880
some of the other flexors those 
if we can keep them strong, 

845
00:42:01,880 --> 00:42:03,760
they're going to support the 
arch as well. 

846
00:42:03,760 --> 00:42:06,160
So those were going to be my 
4:00. 

847
00:42:06,200 --> 00:42:08,400
So I think we're on the same 
page with a lot of that. 

848
00:42:10,560 --> 00:42:15,360
Okay, we're going to do one 
other pain location and we're 

849
00:42:15,360 --> 00:42:18,280
going to talk about some of the 
similar things. 

850
00:42:18,280 --> 00:42:21,000
And this is like anterior knee 
pain. 

851
00:42:21,000 --> 00:42:23,800
So we're not talking about like 
meniscus things. 

852
00:42:23,800 --> 00:42:25,600
We're not talking about that 
kind of stuff. 

853
00:42:25,600 --> 00:42:28,120
We're talking about kind of 
this, oh, I've got pain either 

854
00:42:28,120 --> 00:42:31,760
on my patellar tendon or 
underneath my kneecap, kind of 

855
00:42:31,760 --> 00:42:35,480
right in the front. 
So the first question I want to 

856
00:42:35,480 --> 00:42:37,840
ask you is what are some 
potential things that are 

857
00:42:37,840 --> 00:42:40,440
causing pain in that region? 
Right. 

858
00:42:40,520 --> 00:42:43,880
So one of the big ones obviously
is like Patel Formal, they call 

859
00:42:43,880 --> 00:42:46,160
Patel Formal pain Center, which 
could be 1000 different things, 

860
00:42:46,640 --> 00:42:49,760
but you can have a really common
one they see and you said 

861
00:42:50,480 --> 00:42:54,000
underneath or behind, you're 
just generally that area just. 

862
00:42:54,000 --> 00:42:56,200
Yeah, behind. 
It can be behind the kneecap 

863
00:42:56,680 --> 00:42:59,240
like inferior or below. 
Yeah. 

864
00:42:59,280 --> 00:43:02,360
So if somebody's got symptoms 
behind the kneecap, that can 

865
00:43:02,360 --> 00:43:04,720
some sometimes be a little bit 
of what's called patellofemoral 

866
00:43:04,720 --> 00:43:07,520
syndrome, where you got the 
Patella the back of it's just a 

867
00:43:07,520 --> 00:43:10,760
little bit irritated, might be 
moving a little bit too much in 

868
00:43:10,760 --> 00:43:13,840
One Direction or you might have 
some hip stuff that's going on. 

869
00:43:13,840 --> 00:43:15,640
You can have referral. 
The other thing that's really 

870
00:43:15,640 --> 00:43:20,800
common is patellofemoral like 
tendon, like a cellar tendon. 

871
00:43:20,920 --> 00:43:22,320
Tendonopathies are really 
common. 

872
00:43:22,520 --> 00:43:25,480
The tendonitis are not as common
because it's hard to tell when 

873
00:43:25,480 --> 00:43:28,400
they started most by the time 
when they actually flare, most 

874
00:43:28,400 --> 00:43:31,680
of them are going on a lot 
longer than not to freak people 

875
00:43:31,680 --> 00:43:32,720
out. 
Like tendonopathies. 

876
00:43:32,720 --> 00:43:34,520
You don't have to have pain to 
have a tendonopathy. 

877
00:43:34,680 --> 00:43:37,560
Like they go on for a while and 
then suddenly they flare their 

878
00:43:37,560 --> 00:43:40,640
head and you're like I and don't
ask us with no idea. 

879
00:43:40,640 --> 00:43:42,920
Like I wish I could tell you 
this is absolutely the reason. 

880
00:43:42,920 --> 00:43:45,800
No, you overloaded it long 
beforehand. 

881
00:43:46,040 --> 00:43:49,680
It's just for whatever reason 
the weird combination of stress,

882
00:43:49,680 --> 00:43:52,560
inappropriate sleep, nutrition, 
overtraining, like some weird 

883
00:43:52,560 --> 00:43:54,440
combination made you have 
symptoms. 

884
00:43:55,240 --> 00:43:59,440
Yeah, so it's that complex. 
But those are two really common 

885
00:43:59,560 --> 00:44:03,760
ones that I observe. 
The other not as common one is 

886
00:44:03,760 --> 00:44:06,480
there are some people that they 
can either get referred hip 

887
00:44:06,480 --> 00:44:09,880
stuff into the knee or hip or 
lumbar spine as well as 

888
00:44:09,880 --> 00:44:11,600
sometimes some people with IT 
band stuff. 

889
00:44:11,600 --> 00:44:14,120
So some of the connections can 
sometimes cause some 

890
00:44:14,120 --> 00:44:17,720
patellofemoral type stuff. 
But the actual like strain of 

891
00:44:17,720 --> 00:44:20,520
the tissue of like the tissue 
behind the Patella as well as 

892
00:44:20,520 --> 00:44:23,680
like tendinopathies of the 
patellar tendon are the kind of 

893
00:44:23,680 --> 00:44:25,640
really big ones. 
Are there any ones I'm missing? 

894
00:44:26,520 --> 00:44:29,480
The only one I would consider 
adding depending on kind of your

895
00:44:29,480 --> 00:44:33,280
family history and your age and 
like previous injuries, that's 

896
00:44:33,280 --> 00:44:36,720
another area where you can have 
one type of osteoarthritis. 

897
00:44:36,720 --> 00:44:39,840
So if you have like retro 
patellar osteoarthritis, that's 

898
00:44:39,840 --> 00:44:42,880
where you could start to get 
some some discomfort there as 

899
00:44:42,880 --> 00:44:45,960
well. 
So let's talk about how shoes 

900
00:44:46,000 --> 00:44:52,240
interact with this region. 
So how, how confident can we be 

901
00:44:52,240 --> 00:44:55,800
that shoes can influence 
anterior knee stress? 

902
00:44:57,200 --> 00:44:59,040
And I think we're particularly 
talking about anterior knee 

903
00:44:59,040 --> 00:45:02,840
stress and not like medial knee 
stress or lateral or posterior. 

904
00:45:03,080 --> 00:45:06,600
I will be honest that I get as 
we move further away from the 

905
00:45:06,600 --> 00:45:11,360
ankle, I get less confident with
how we can influence this stuff.

906
00:45:11,480 --> 00:45:13,880
And I say this because I've seen
this go, I'm going to say a few 

907
00:45:13,880 --> 00:45:15,840
things and we go. 
And I've also seen the opposite 

908
00:45:15,840 --> 00:45:18,360
happen when we have these 
factors. 

909
00:45:18,360 --> 00:45:21,120
So like the stereotype that 
probably see is going yeah, I 

910
00:45:21,120 --> 00:45:25,480
would expect a lower drop shoe 
to or and a less rocket shoe to 

911
00:45:25,480 --> 00:45:29,240
reduce stress on the knee. 
I have also seen the the 

912
00:45:29,240 --> 00:45:32,200
opposite I would sit. 
I would also assume that a 

913
00:45:32,240 --> 00:45:35,000
higher heel drop mean the 
difference between the front and

914
00:45:35,000 --> 00:45:38,400
the back of the shoe in terms of
height would increase the stress

915
00:45:38,680 --> 00:45:41,960
on the anterior knee. 
I have also seen the opposite 

916
00:45:41,960 --> 00:45:45,240
happen, right, because we know 
the like higher drop rocket 

917
00:45:45,240 --> 00:45:49,240
shoes tend to increase workload 
up into the knee and the hip. 

918
00:45:49,880 --> 00:45:53,800
Lower drop less rocker shoes 
tend to have higher workload at 

919
00:45:53,800 --> 00:45:57,000
the foot and ankle. 
However, when we talk, also have

920
00:45:57,000 --> 00:45:59,520
to realize that things interplay
all the time. 

921
00:45:59,680 --> 00:46:02,160
And so that's the common thing. 
I go, hey, if I want to reduce 

922
00:46:02,160 --> 00:46:05,480
symptoms, I'm probably going to 
look at a lower drop less 

923
00:46:05,480 --> 00:46:08,920
aggressively rocker shoe. 
But knowing I need to do this, 

924
00:46:08,920 --> 00:46:11,520
looking at them because I've 
also people that have like no 

925
00:46:11,520 --> 00:46:14,640
ankle mobility and I go, oh, 
let's get a lower drop shoe and 

926
00:46:14,640 --> 00:46:17,400
it makes their knee worse 
because they're actually now 

927
00:46:17,400 --> 00:46:19,720
having to compensate more 
slamming into it. 

928
00:46:19,960 --> 00:46:22,320
So that's where it's like, and 
they'll let the same thing with 

929
00:46:22,320 --> 00:46:24,400
the rocket shoe were like, OK, 
cool. 

930
00:46:24,520 --> 00:46:27,360
Now I took away their ability to
actually get for a progression 

931
00:46:27,360 --> 00:46:31,160
and they're going to get it from
excessive movement anteriorly at

932
00:46:31,160 --> 00:46:34,640
the knee to try to maintain that
forward stuff. 

933
00:46:34,640 --> 00:46:38,640
And so like it's gets worse. 
So it depends. 

934
00:46:38,640 --> 00:46:42,280
I know people hate the phrase. 
It depends, but just know that 

935
00:46:42,360 --> 00:46:46,280
it's less set in stone as you 
get to the knee and even less as

936
00:46:46,280 --> 00:46:49,800
you start getting to the hip. 
I totally agree with you. 

937
00:46:49,800 --> 00:46:53,920
I when I think about the 
features, it's rocker and drop 

938
00:46:54,040 --> 00:46:57,320
and flexibility. 
So if you have a very stiff 

939
00:46:57,320 --> 00:47:01,480
rocker, the theory is that that 
shifts load up from the ankle to

940
00:47:01,480 --> 00:47:03,480
the knee. 
If you have a very high drop 

941
00:47:03,480 --> 00:47:05,960
shoe, in theory that shifts load
up to the knee. 

942
00:47:06,160 --> 00:47:10,640
If you have a very flexible 
shoe, lower drop, you're looking

943
00:47:10,640 --> 00:47:12,120
at more work for the foot and 
ankle. 

944
00:47:12,520 --> 00:47:15,360
But it's not just the feature of
the shoe, it's how people choose

945
00:47:15,360 --> 00:47:17,640
to run in a different type of 
environment. 

946
00:47:17,640 --> 00:47:22,000
So I think that you can take 
those ideas and if you're like, 

947
00:47:22,000 --> 00:47:26,040
I've had recurrent knee pain, 
take those ideas and maybe try 

948
00:47:26,040 --> 00:47:29,840
something with it, like so go 
find a more lower drop flexible 

949
00:47:29,840 --> 00:47:33,120
shoe. 
I mean, like I feel like this, I

950
00:47:33,120 --> 00:47:35,040
didn't, it's just the only shoe 
I have near me. 

951
00:47:35,040 --> 00:47:38,840
But like a flexible shoe like 
the Flo 2 from ultra, it's 

952
00:47:38,840 --> 00:47:42,520
flexible and it's lower drop. 
That's the exact type of profile

953
00:47:42,520 --> 00:47:44,800
shoe that you could consider 
trying and just seeing. 

954
00:47:44,800 --> 00:47:47,200
Does this actually seem to 
change how much I feel at my 

955
00:47:47,200 --> 00:47:49,320
knee? 
If you don't, maybe a shoe is 

956
00:47:49,320 --> 00:47:52,040
just not your your answer. 
You've heard us say a million 

957
00:47:52,040 --> 00:47:55,280
times that shoes are like the 1%
when it comes to injury, not the

958
00:47:55,280 --> 00:47:57,400
99. 
So you got to work on the 99 as 

959
00:47:57,400 --> 00:47:59,400
well. 
But this is that extra thing. 

960
00:47:59,400 --> 00:48:02,160
It's like, OK, maybe go try 
those out and see if that holds 

961
00:48:02,520 --> 00:48:04,040
true, if that holds true for 
you. 

962
00:48:05,440 --> 00:48:08,680
So I, I agree completely. 
Now let's talk about what sort 

963
00:48:08,680 --> 00:48:11,600
of tips would you have for 
somebody who they want to 

964
00:48:11,600 --> 00:48:14,960
prevent their knee anterior side
of the knee from bugging them? 

965
00:48:14,960 --> 00:48:15,840
What would you have them do? 
I'm. 

966
00:48:16,560 --> 00:48:18,840
Going to go back to the first 
thing I said that I think 

967
00:48:18,840 --> 00:48:20,880
strengthening is really, really 
important. 

968
00:48:21,480 --> 00:48:23,200
If you'd asked me this, 
probably. 

969
00:48:23,200 --> 00:48:26,320
Wait, hold on. 
I'm going to cut you off because

970
00:48:26,320 --> 00:48:28,920
I have to say one of the thing 
that's really important. 

971
00:48:29,800 --> 00:48:32,080
If you've got knee pain and 
you're like, I want to change my

972
00:48:32,080 --> 00:48:34,440
shoes to decrease stress on my 
knee and you're going to go to a

973
00:48:34,440 --> 00:48:36,840
very low or zero drop shoe 
that's really flexible. 

974
00:48:36,920 --> 00:48:39,600
But you don't know if you have 
the calf readiness for it and 

975
00:48:39,600 --> 00:48:40,760
you haven't been training your 
foot. 

976
00:48:40,760 --> 00:48:42,920
You don't want to make a 
transition from something crazy 

977
00:48:42,920 --> 00:48:45,040
like if you've been training in 
super shoes only and you're 

978
00:48:45,040 --> 00:48:47,520
going to go transition to 
something super flexible, you 

979
00:48:47,520 --> 00:48:50,280
don't want to do that because 
that's fast transition could 

980
00:48:50,280 --> 00:48:52,880
lead to way too much stress. 
The foot and ankle, you could 

981
00:48:52,880 --> 00:48:56,200
get some issues down there, so 
transition slowly. 

982
00:48:56,400 --> 00:49:00,240
Make sure that you do it wisely 
and get the robustness in your 

983
00:49:00,240 --> 00:49:02,680
calf and in your foot 
musculature and the bone 

984
00:49:02,680 --> 00:49:05,920
structures there. 
Before you would just flip the 

985
00:49:05,920 --> 00:49:08,800
switch too fast. 
OK, So what can help the knee? 

986
00:49:08,800 --> 00:49:12,680
Do not use shoes as bandages. 
They are tools. 

987
00:49:14,280 --> 00:49:16,240
Somebody said something to me 
that's freaked me out a little 

988
00:49:16,240 --> 00:49:19,640
bit, but like be be wary of the 
thing that disappears 

989
00:49:19,640 --> 00:49:22,600
immediately. 
It's like a do we actually fix 

990
00:49:22,600 --> 00:49:26,400
this? 
So just like, so if don't like, 

991
00:49:26,400 --> 00:49:29,120
oh, I had this injury and now I 
wear this shoe and it's gone. 

992
00:49:29,120 --> 00:49:32,440
Like though, you still need to 
address like, yes, we're all, 

993
00:49:32,600 --> 00:49:34,760
you know, runners, but you still
need to address the other. 

994
00:49:34,760 --> 00:49:39,440
I think this shoe is a maybe a 
piece of this and that's why I'm

995
00:49:39,440 --> 00:49:41,120
the next couple things. 
I'm probably not going to be 

996
00:49:41,120 --> 00:49:45,400
talking that much about shoes. 
The probably for knee stuff, one

997
00:49:45,400 --> 00:49:48,920
of the most important things 
that I would consider would be 

998
00:49:48,920 --> 00:49:50,440
maintaining very, very good 
strength. 

999
00:49:50,440 --> 00:49:52,040
And if you, this thing I was 
going to say is if you'd asked 

1000
00:49:52,040 --> 00:49:55,160
me 5 or so 5-10 years ago, I 
would have said, oh, focus on 

1001
00:49:55,160 --> 00:49:58,200
hip strength. 
That's you'd also need to have 

1002
00:49:58,200 --> 00:49:59,960
good quad strength, good 
hamstring strength. 

1003
00:50:00,120 --> 00:50:01,160
You need to be strong 
everywhere. 

1004
00:50:01,160 --> 00:50:03,640
So some good appropriate loading
and the same thing I talked 

1005
00:50:03,640 --> 00:50:06,520
about earlier, we're like, get 
some good weight through there. 

1006
00:50:06,520 --> 00:50:09,720
Get some lower repetit. 
Don't do your 2030 Rep, do your 

1007
00:50:09,720 --> 00:50:12,600
lower repetition. 
Be efficient, high weight, some 

1008
00:50:12,600 --> 00:50:14,920
good loading that builds good 
bone density, that builds good 

1009
00:50:14,920 --> 00:50:18,440
muscle capacity and we're really
work on strengthening both the 

1010
00:50:18,440 --> 00:50:21,840
knee and the hip is really, 
really, really important. 

1011
00:50:22,200 --> 00:50:24,680
The other piece I would say to 
that is also kind of like we 

1012
00:50:24,680 --> 00:50:30,160
talked about earlier, make sure 
you have very good ankle, 

1013
00:50:30,160 --> 00:50:32,440
especially ankle dorsiflexion 
mobility. 

1014
00:50:32,640 --> 00:50:35,200
One of the things that I teach, 
because I help teach a or a 

1015
00:50:35,200 --> 00:50:38,480
prosthetic orthotics and gait 
course is when you lose 

1016
00:50:38,480 --> 00:50:41,760
dorsiflexion, you it's it's all 
going to go up to like tibial 

1017
00:50:41,760 --> 00:50:44,400
for progression is so important.
Tibia, tibia, fibula are the 

1018
00:50:44,400 --> 00:50:48,000
major bones of that lower leg. 
Those progressing appropriately 

1019
00:50:48,000 --> 00:50:49,560
is so important for forward 
gait. 

1020
00:50:49,800 --> 00:50:53,800
You lose that it's going to load
like the knee quite a bit, be it

1021
00:50:53,800 --> 00:50:55,760
hyperextending it, excessive 
flexion. 

1022
00:50:55,960 --> 00:50:59,480
So making sure kind of similar 
things that you have good 

1023
00:50:59,640 --> 00:51:02,400
dorsiflexion mobility is really 
important, but also that you 

1024
00:51:02,400 --> 00:51:04,640
have control of it is the other 
thing. 

1025
00:51:04,640 --> 00:51:08,000
And the other piece I'd probably
suggest outside of the classic, 

1026
00:51:08,000 --> 00:51:10,560
make sure you got good patellar 
mobility and good knee joint 

1027
00:51:10,560 --> 00:51:15,000
mobility is just working on some
good knee, ankle, hip stability,

1028
00:51:15,080 --> 00:51:16,800
right? 
Making sure that you've got good

1029
00:51:16,800 --> 00:51:19,400
movement control, making sure 
that you can tolerate, make sure

1030
00:51:19,400 --> 00:51:23,040
you're not getting any excessive
fast motions that might be 

1031
00:51:23,040 --> 00:51:26,160
annoying if you overtrain, like 
make sure you have good control.

1032
00:51:26,160 --> 00:51:29,920
How much motion a little bit 
less concerning, but do you have

1033
00:51:29,920 --> 00:51:32,720
control over this? 
Can you load it appropriately? 

1034
00:51:33,040 --> 00:51:35,760
Is probably one of the more 
bigger things that I would say. 

1035
00:51:36,280 --> 00:51:40,080
The other piece I will say just 
from a shoe perspective is, you 

1036
00:51:40,080 --> 00:51:42,520
know, make sure you've got a 
shoe that fits you right. 

1037
00:51:42,520 --> 00:51:44,360
Make sure it works for you. 
Make sure you know, because 

1038
00:51:44,360 --> 00:51:46,400
sometimes for some people, the 
knee is kind of the first thing 

1039
00:51:46,400 --> 00:51:48,240
that kind of goes, ah, this may 
not be working or this is 

1040
00:51:48,240 --> 00:51:50,520
wearing out. 
So you know, from a shock 

1041
00:51:50,520 --> 00:51:52,760
absorption Sexton, make sure 
your shoes are up to date. 

1042
00:51:53,360 --> 00:51:56,440
But the first three are probably
my bigger priority. 

1043
00:51:57,280 --> 00:51:59,160
Yeah, that's good. 
Anything you'd add? 

1044
00:51:59,680 --> 00:52:03,240
No, I'm, I'm, I've been debating
on a few things. 

1045
00:52:03,240 --> 00:52:05,520
OK. 
But the ones I was going to say 

1046
00:52:05,520 --> 00:52:08,680
for sure was enough ankle 
dorsiflexion mobility. 

1047
00:52:09,120 --> 00:52:12,720
And then I was going to say from
a strengthening perspective, the

1048
00:52:12,720 --> 00:52:17,360
really heavy tissue loading, you
know, really getting some 

1049
00:52:17,360 --> 00:52:22,600
Bulgarian split squats that are 
heavy or, or just like, or a 

1050
00:52:22,600 --> 00:52:26,280
regular squat that's heavy and 
then some hamstring specific 

1051
00:52:26,280 --> 00:52:28,360
loading. 
And then I was going to say like

1052
00:52:28,440 --> 00:52:34,360
glute control type exercises. 
So doing kind of lunges where 

1053
00:52:34,360 --> 00:52:37,560
you're really focusing on form, 
not because you need to move 

1054
00:52:37,560 --> 00:52:40,400
like that all the time, but it 
forces your muscles to 

1055
00:52:40,400 --> 00:52:43,080
coordinate with each other and 
work and just getting your brain

1056
00:52:43,080 --> 00:52:45,800
involved in that is important. 
So like if you're a runner and 

1057
00:52:45,800 --> 00:52:48,360
your knee kind of moves in and 
out, you've never had issues. 

1058
00:52:48,360 --> 00:52:49,840
That's not necessarily a 
problem. 

1059
00:52:50,120 --> 00:52:52,280
I mean, like, watch Connor Mance
run, right? 

1060
00:52:52,280 --> 00:52:55,240
Like he probably has femoral 
antversion or something that 

1061
00:52:55,320 --> 00:52:57,640
puts him into like the position 
that he's in. 

1062
00:52:57,920 --> 00:53:03,200
But I think it's good to work on
the hip for that control 

1063
00:53:03,200 --> 00:53:05,040
mechanism and like having that 
stability. 

1064
00:53:05,040 --> 00:53:08,360
So stability exercises, heavy 
lifting, ankle dorsiflexion, 

1065
00:53:10,760 --> 00:53:13,520
what I'm hesitant to say, but 
I'm going to talk about it. 

1066
00:53:13,520 --> 00:53:16,640
This is maybe not fully what I 
think, but it's something I 

1067
00:53:16,640 --> 00:53:20,120
think about and I sometimes 
apply to runners in specific 

1068
00:53:20,120 --> 00:53:23,240
circumstances regarding like 
healthy knees. 

1069
00:53:24,080 --> 00:53:30,840
If you're a newer runner, I I 
would consider paying attention 

1070
00:53:30,840 --> 00:53:33,520
to some of your running form 
things. 

1071
00:53:33,520 --> 00:53:38,960
So I have the privilege of doing
gait analysis on every freshman 

1072
00:53:38,960 --> 00:53:41,440
that comes through the cross 
country team. 

1073
00:53:41,720 --> 00:53:45,200
And then we also get to do 
running analysis on lots of 

1074
00:53:45,200 --> 00:53:48,800
other runners too. 
Something very common that I see

1075
00:53:48,800 --> 00:53:52,720
in the freshman who have 
recurrent knee pain is a really,

1076
00:53:52,720 --> 00:53:55,360
really low cadence. 
So there's not like a perfect 

1077
00:53:55,360 --> 00:53:57,600
number for cadence, but they 
have a very low cadence, like 

1078
00:53:57,600 --> 00:54:04,080
one 50s, like mid one 50s. 
And they also over stride a lot.

1079
00:54:04,080 --> 00:54:06,160
So they reach really far out in 
front of them. 

1080
00:54:06,800 --> 00:54:11,000
And that combination puts a lot 
of stress on the knee and I 

1081
00:54:11,000 --> 00:54:12,960
think contributes to some of 
their issues. 

1082
00:54:13,400 --> 00:54:17,440
And so if you happen to run with
a running watch, again, I'm 

1083
00:54:17,440 --> 00:54:21,040
being so cautious with saying 
this right now, but just kind of

1084
00:54:21,040 --> 00:54:25,920
take a peek at your cadence and 
if you're in the one 50s, maybe 

1085
00:54:25,920 --> 00:54:29,920
chat with APT about that, who 
who knows running and see what 

1086
00:54:29,920 --> 00:54:33,280
they would say about if you 
wanted to try to change your 

1087
00:54:33,280 --> 00:54:35,920
cadence, what might that look 
like? 

1088
00:54:35,920 --> 00:54:39,920
Because there are studies that 
show with five, this is from 

1089
00:54:39,920 --> 00:54:41,920
Brian Heiderscheitz lab in 
Madison. 

1090
00:54:42,440 --> 00:54:45,840
If you increase cadence by 5 to 
10% from your self selected 

1091
00:54:45,840 --> 00:54:47,240
cadence. 
So just like what you normally 

1092
00:54:47,240 --> 00:54:50,360
pick, there's significant 
decreases in Patel femoral 

1093
00:54:50,360 --> 00:54:53,640
loading. 
Those peak loads go way down and

1094
00:54:53,640 --> 00:54:57,840
overall workload at the knee 
shrinks by a good amount both at

1095
00:54:57,840 --> 00:55:01,920
5 and 10% above yourself 
selected cadence. 

1096
00:55:02,280 --> 00:55:05,000
And so that would be the other 
thing I would consider. 

1097
00:55:05,120 --> 00:55:08,000
Usually over the first three 
years of running, people's 

1098
00:55:08,000 --> 00:55:11,240
cadence increases naturally 
without any retraining. 

1099
00:55:11,600 --> 00:55:14,120
You just kind of learn how to 
run if you are getting into 

1100
00:55:14,120 --> 00:55:17,280
distance running. 
But if you're someone who's had 

1101
00:55:17,280 --> 00:55:20,120
any issues in the past, maybe 
you want to prevent it from 

1102
00:55:20,120 --> 00:55:21,640
coming on. 
You notice that you do have this

1103
00:55:21,640 --> 00:55:23,720
really low cadence. 
That's one you might want to 

1104
00:55:23,720 --> 00:55:25,640
consider. 
But I think that any sort of 

1105
00:55:25,640 --> 00:55:28,800
gate changes are really nice to 
do with a team just because you 

1106
00:55:28,800 --> 00:55:30,240
don't know what those changes 
are gonna do. 

1107
00:55:30,400 --> 00:55:34,000
So what's your reaction to that?
Can I challenge you on something

1108
00:55:34,000 --> 00:55:35,960
that I am? 
Yeah, for working on right now. 

1109
00:55:36,440 --> 00:55:38,800
So I have the privilege of 
having a lot of people that are 

1110
00:55:38,800 --> 00:55:40,560
smarter than me challenge me 
with things. 

1111
00:55:40,560 --> 00:55:45,000
And so a lot of my research, cuz
I do bio mechanics is looking at

1112
00:55:45,000 --> 00:55:46,960
like, hey, how are people moving
and stuff like that. 

1113
00:55:46,960 --> 00:55:51,240
And so in my PhD, we chose some 
pretty basic stuff, IE moments, 

1114
00:55:51,240 --> 00:55:54,720
which is like rotational forces 
essentially and powers at the at

1115
00:55:54,720 --> 00:55:57,600
each joint, ankle, knee, hip, 
looking at mouse runner's 

1116
00:55:57,600 --> 00:55:59,480
Achilles toenopathy. 
I'm now moving to the next stage

1117
00:55:59,480 --> 00:56:01,360
of my research. 
OK, I want to look at other 

1118
00:56:01,360 --> 00:56:05,600
runners and do other stuff and 
one of the challenges has been 

1119
00:56:05,600 --> 00:56:07,840
going are these really important
variables? 

1120
00:56:07,840 --> 00:56:09,960
And I'm like, well, obviously 
it's like foundational bio 

1121
00:56:09,960 --> 00:56:12,440
mechanics, but when you start 
looking at what's actually 

1122
00:56:12,440 --> 00:56:16,040
predicting injury performance, 
it's not right. 

1123
00:56:16,040 --> 00:56:18,200
And that's where all the stuff 
is coming out, whether it's 

1124
00:56:18,200 --> 00:56:21,320
talking about something called 
impulse or the thing that my 

1125
00:56:21,320 --> 00:56:23,160
brain is really on right now, 
which is called the reactive 

1126
00:56:23,160 --> 00:56:26,040
strength index. 
Going not just how much force 

1127
00:56:26,040 --> 00:56:27,960
you produce, but what do you do 
with it? 

1128
00:56:27,960 --> 00:56:31,240
Like how quickly can you get 
back off the ground is where my 

1129
00:56:31,240 --> 00:56:33,360
brain has been challenged with 
the look at and what I've been 

1130
00:56:33,360 --> 00:56:36,120
thinking and sitting going. 
I wonder if because people that 

1131
00:56:36,120 --> 00:56:40,080
tend to have a lower cadence to 
longer stride have a much longer

1132
00:56:40,400 --> 00:56:43,480
ground contact time. 
Yeah, that's a good point. 

1133
00:56:43,480 --> 00:56:45,800
Like duty cycle. 
Yeah, the duty cycle and another

1134
00:56:45,800 --> 00:56:48,360
thing is going, I wonder if that
has anything to do with their 

1135
00:56:48,360 --> 00:56:50,560
power and their ability and 
their reactive strength. 

1136
00:56:50,560 --> 00:56:54,080
It is better term than power to 
be able to get off the ground 

1137
00:56:54,080 --> 00:56:57,240
quick and just that's that's 
their movement strategy. 

1138
00:56:57,240 --> 00:57:01,120
So sometimes I wonder when we 
change cadence, are we looking 

1139
00:57:01,120 --> 00:57:04,000
at the right thing and we're 
giving them all the variables 

1140
00:57:04,000 --> 00:57:05,520
because it's the same thing with
shoes, right? 

1141
00:57:05,520 --> 00:57:08,000
Like I know Brian maybe doesn't 
want to like Brian Heidershire 

1142
00:57:08,000 --> 00:57:09,680
does want to hear this. 
But like if you change this 

1143
00:57:09,680 --> 00:57:12,920
bigger variable, what are the 
other things that happened that 

1144
00:57:12,920 --> 00:57:14,640
maybe you have it conditioned 
appropriate? 

1145
00:57:14,640 --> 00:57:17,840
Like did you get, did you teach 
them or give them the capacity 

1146
00:57:17,840 --> 00:57:19,600
to actually move their legs 
faster, right? 

1147
00:57:19,600 --> 00:57:21,520
That's greater power. 
It's like, you know, you got to 

1148
00:57:21,520 --> 00:57:24,240
be able to get muscles to 
contract a little bit quicker, 

1149
00:57:24,240 --> 00:57:28,600
not necessarily as generating as
much force that you have to do 

1150
00:57:28,600 --> 00:57:31,680
with a longer stride and landing
really, really hard, but you got

1151
00:57:31,680 --> 00:57:33,640
to get things to move quicker. 
Is there a potential that you 

1152
00:57:33,640 --> 00:57:37,920
change, you've just switched and
that's I think where you're head

1153
00:57:37,920 --> 00:57:41,160
sitting, like, did you just 
switch the loading instead of 

1154
00:57:41,160 --> 00:57:43,720
actually addressing it? 
And so that's you're going. 

1155
00:57:43,760 --> 00:57:45,960
It does this group and I don't 
have the answer to this. 

1156
00:57:45,960 --> 00:57:47,720
This is the things that are 
rattling my brain because I'm 

1157
00:57:47,880 --> 00:57:50,000
unlike you, I'm trying to get 
access to our cross country 

1158
00:57:50,000 --> 00:57:51,880
team. 
I got to talk to some people 

1159
00:57:51,880 --> 00:57:54,640
that love to be able to take a 
look at them every year, but we 

1160
00:57:54,640 --> 00:57:57,480
don't have that relationship yet
in the George Trucks PT 

1161
00:57:57,560 --> 00:57:59,640
department. 
But I would love to add, I'm 

1162
00:57:59,640 --> 00:58:02,920
asking some of these questions 
going where do we need to look 

1163
00:58:02,920 --> 00:58:05,680
at if you change these things, 
is cadence going to fall in or 

1164
00:58:05,680 --> 00:58:07,880
is that the separate motor 
control problem? 

1165
00:58:08,480 --> 00:58:10,680
So that's where my brain is 
going, going what variables do 

1166
00:58:10,680 --> 00:58:13,240
we need to look at? 
And I'm just confused now. 

1167
00:58:14,000 --> 00:58:16,120
Yeah, totally. 
And I think what I think what's 

1168
00:58:16,120 --> 00:58:21,400
promising from what we currently
know about changes in cadence is

1169
00:58:21,400 --> 00:58:25,200
that most of the metrics that 
have been studied so far, the 

1170
00:58:25,200 --> 00:58:28,760
amount of demand goes down on 
pretty much everything. 

1171
00:58:29,400 --> 00:58:33,400
What goes up is mental 
involvement and fatigue due to 

1172
00:58:33,400 --> 00:58:36,560
cognitive demand. 
So like you're running the 

1173
00:58:36,560 --> 00:58:39,640
economy goes down when you first
change cadence because you have 

1174
00:58:39,640 --> 00:58:41,640
to work really hard to change 
your movement pattern because 

1175
00:58:41,640 --> 00:58:43,120
it's. 
And that takes a while. 

1176
00:58:43,640 --> 00:58:47,400
It takes a while when we when we
run or do any sort of what's 

1177
00:58:47,400 --> 00:58:50,480
called a continuous task. 
Walking or and running are two 

1178
00:58:50,480 --> 00:58:52,360
examples where you do the same 
thing over and over. 

1179
00:58:52,760 --> 00:58:57,080
Your body doesn't do that in the
same way that we throw a ball. 

1180
00:58:57,080 --> 00:59:00,520
Like when we throw a ball, we 
have like a specific way that we

1181
00:59:00,520 --> 00:59:04,520
use the movement patterns. 
When we go run, our brain says 

1182
00:59:04,520 --> 00:59:07,320
activate running sequence. 
This is oversimplified, but it 

1183
00:59:07,320 --> 00:59:10,800
says activate running sequence 
and you to start to run and to 

1184
00:59:10,800 --> 00:59:16,120
change that running sequence is 
so difficult because it is not 

1185
00:59:16,120 --> 00:59:18,680
in our like frontal cortex. 
It's not something that we're 

1186
00:59:18,680 --> 00:59:22,040
actively focusing on doing. 
It's just something that 

1187
00:59:22,040 --> 00:59:25,240
happens. 
It's subconscious in some ways. 

1188
00:59:25,240 --> 00:59:27,840
And so that becomes really 
tricky. 

1189
00:59:28,040 --> 00:59:31,920
Cadence is easier to manipulate 
because your brain can make the 

1190
00:59:31,920 --> 00:59:34,520
changes by running to a 
metronome, for example. 

1191
00:59:34,520 --> 00:59:39,040
But it's still a lot of mental 
work and makes you feel like a 

1192
00:59:39,040 --> 00:59:42,000
really fatigued runner, right? 
This is also my hesitation. 

1193
00:59:42,000 --> 00:59:44,880
A lot of times with things like 
foot strike and people I know, 

1194
00:59:44,880 --> 00:59:46,360
it's a go to like, yeah, change 
that. 

1195
00:59:46,720 --> 00:59:49,920
And like the changes and the 
amount of time involved in 

1196
00:59:49,920 --> 00:59:52,680
transitioning that making a 
permanent movement and the fact 

1197
00:59:52,680 --> 00:59:54,840
that most people have no idea 
how they're actually landing, 

1198
00:59:54,840 --> 00:59:59,400
even when they're trained well 
is like like, so it and not 

1199
00:59:59,400 --> 01:00:01,960
saying it's wrong. 
I'm just saying sometimes like 

1200
01:00:02,440 --> 01:00:05,320
do make sure that my priorities 
are like load management going, 

1201
01:00:05,320 --> 01:00:07,200
can you tolerate the load, 
things like that. 

1202
01:00:07,480 --> 01:00:10,120
And yeah, some of these can be 
helpful to change stuff, but 

1203
01:00:10,120 --> 01:00:13,560
like movements is difficult. 
Movement is really difficult to 

1204
01:00:13,560 --> 01:00:17,200
change. 
It is fantastic. 

1205
01:00:17,200 --> 01:00:19,640
Well, thank you all for coming 
on this journey with us. 

1206
01:00:19,640 --> 01:00:21,960
We would love to hear if there 
have been things that have been 

1207
01:00:21,960 --> 01:00:25,800
really helpful for you in 
managing your foot pain that 

1208
01:00:25,800 --> 01:00:27,840
you've had in the past or your 
knee pain that you've had in the

1209
01:00:27,840 --> 01:00:31,240
past, or just this kind of 
routine that you've gotten down 

1210
01:00:31,240 --> 01:00:32,880
that you found is really helpful
for you. 

1211
01:00:33,080 --> 01:00:36,080
Feel free to let us know what 
you've been thinking and doing. 

1212
01:00:37,120 --> 01:00:42,400
And we look forward to future 
conversations about how shoes 

1213
01:00:42,880 --> 01:00:46,760
may pop pay a such a small teen 
C ween C role in management of 

1214
01:00:46,760 --> 01:00:50,360
conditions and also talking 
about the bigger pieces like 

1215
01:00:50,360 --> 01:00:52,680
what can we do from an exercise 
perspective? 

1216
01:00:52,920 --> 01:00:56,920
And then even bigger than that, 
our overall lifestyle habits are

1217
01:00:56,920 --> 01:01:00,240
way more important than even one
small exercise. 

1218
01:01:00,240 --> 01:01:03,720
So again, thank you for coming 
on this journey and we look 

1219
01:01:03,720 --> 01:01:04,840
forward to talking to you next 
time.