Pełna transkrypcja odcinka 482: My 3 Part Framework To Treat Any Running Injury

content only. 00:02:20.942 --> 00:02:23.295 I am not your physical therapist. 00:02:23.295 --> 00:02:26.717 There is no patient-provider relationship between us, all right? 00:02:26.717 --> 00:02:32.344 And if you are unsure, please go get evaluated by a doctor or a physical therapist in person. 00:02:32.617 --> 00:02:35.969 This podcast is intended for educational purposes only. 00:02:36.504 --> 00:02:43.108 So- What I'm gonna be sh- teaching you today is what I call the EAT framework, E-A-T. 00:02:43.134 --> 00:02:53.519 Or some I kind of joke around about it'cause it's yes, you can eat your pain, and people think, oh, w- we're, they think of, binge eating or things like that, where you just eat to ignore the pain. 00:02:53.519 --> 00:02:54.854 That's not what we're talking about today. 00:02:54.858 --> 00:03:01.163 So the framework that gonna- we're gonna be working with today is the EAT framework, so E-A-T. 00:03:01.377 --> 00:03:03.941 Evaluate, assess, and treat. 00:03:03.962 --> 00:03:08.310 Those are the three steps that I use for any kind of pain that I see. 00:03:08.507 --> 00:03:09.705 So the first part... 00:03:09.944 --> 00:03:20.288 Oh, before I jump in, before I jump into the framework and g- walk you through this, I want to let you know that I am launching a new one-on-one coaching program with me. 00:03:20.536 --> 00:03:28.455 I'm gonna be working with people in a much more intimate way, in a much more personalized way, an individualized way. 00:03:28.625 --> 00:03:30.622 it's one-on-one coaching with me. 00:03:30.622 --> 00:03:32.694 You have a lot of access, okay? 00:03:32.723 --> 00:03:42.247 Daily access, physical therapist in your pocket, running coach in your pocket, so that you can get the attention that you want. 00:03:42.318 --> 00:03:52.973 It- so maybe this program, it would be for you if you have a really big goal and you are unsure how to get there, and you want some really personalized guidance along the way. 00:03:53.252 --> 00:04:04.645 It can be for you if you are dealing with some sort of pain or injury, and you're not sure how to get back into running safely, not only now, but also how to progress so that pain doesn't come back. 00:04:04.856 --> 00:04:05.413 it's... 00:04:06.094 --> 00:04:13.562 What I do is a combination of physical therapy and life coaching, essentially, because, yes, the physical side is important. 00:04:13.575 --> 00:04:23.692 What you do, your exercise, the things that we're gonna be talking about in this episode, like mobility, stability, strength work, making sure that running is integrated in a way that works with your strength training. 00:04:23.711 --> 00:04:26.086 That part is very important. 00:04:26.317 --> 00:04:31.300 And I often tell my patients and my clients, that's honestly kind of the easy part. 00:04:31.536 --> 00:04:39.204 Because the part that is not addressed in typical physical therapy or even in typical running coaching is the mental side of things. 00:04:39.204 --> 00:04:42.125 It's all of the mental blocks that are getting in your way. 00:04:42.125 --> 00:04:51.451 It's that underlying subconscious fear of movement, of trying, of, maybe you've had an injury in the past and there's part of you that might be scared of re-injuring yourself. 00:04:51.714 --> 00:04:52.987 Maybe you're getting older. 00:04:52.987 --> 00:04:59.358 Especially my ladies over 40, if you're in perimenopause and menopause- Your body's not reacting the same way that it used to. 00:04:59.584 --> 00:05:03.470 And so there is this very, it's an unknown time. 00:05:03.478 --> 00:05:07.639 You don't know exactly how your body's going to react and what to do. 00:05:07.672 --> 00:05:10.637 There's so much crappy information on the internet right now. 00:05:10.942 --> 00:05:22.430 And so I really have had this desire to start working with people in a more personalized way where I can really help you overcome these blocks, not just the physical blocks, but the mental blocks as well. 00:05:22.432 --> 00:05:27.420 So if you are interested in this one-on-one coaching program, please send me an email. 00:05:27.490 --> 00:05:30.822 My email is angie@realliferunners.com. 00:05:31.170 --> 00:05:39.807 That is gonna be the best way for you to, let's just start a chat, if you are curious about this program and wondering if it might be a good f- fit for you, shoot me an email. 00:05:39.975 --> 00:05:48.382 tell me what's going on, what you're working towards, maybe what obstacles you've been facing if you want to, and then we can chat a little bit more and see if this is a good fit. 00:05:48.389 --> 00:05:52.372 So angie@realliferunners.com, send me an email if you're interested. 00:05:52.798 --> 00:05:57.331 Okay, so let's jump in to my EAT framework, right? 00:05:57.331 --> 00:06:01.858 So step one is evaluation, and the evaluation has two parts. 00:06:02.115 --> 00:06:05.148 So the first part is the subjective history. 00:06:05.160 --> 00:06:12.860 Now, this is where I start with any patient in physical therapy that I have ever treated in my past 20 years, and it also is where I start with my clients as well. 00:06:12.860 --> 00:06:20.380 I wanna know a little bit about what's going on, what it, what's been happening in your life before this pain started. 00:06:20.822 --> 00:06:23.000 So I, I look at a couple of things. 00:06:23.002 --> 00:06:25.607 Number one, I look at the, what I call the pain story. 00:06:25.608 --> 00:06:27.339 So where is the pain? 00:06:27.360 --> 00:06:28.632 When did it start? 00:06:28.646 --> 00:06:30.517 How long have you been experiencing this thing? 00:06:30.716 --> 00:06:32.305 what makes it better or worse? 00:06:32.509 --> 00:06:33.939 The quality of the pain. 00:06:33.951 --> 00:06:35.177 Is it a dull pain? 00:06:35.180 --> 00:06:38.865 Is it aching, stabbing, sharp, shooting, burning? 00:06:39.091 --> 00:06:40.524 the trend of the pain. 00:06:40.533 --> 00:06:41.444 Is it getting better? 00:06:41.444 --> 00:06:42.317

Is it getting worse? 00:06:42.322 --> 00:06:43.737 Is it kinda staying the same? 00:06:43.970 --> 00:06:51.033 And then, of course, I like to always ask everyone's favorite question, which is, on a scale of 0 to 10, how bad is your pain right now? 00:06:51.261 --> 00:06:54.351 people for some reason have, do not like answering that question. 00:06:54.365 --> 00:07:00.492 They're like, it's so subjective, and I have a really high pain tolerance." And it's that's fine, but your pain is yours, right? 00:07:00.494 --> 00:07:02.074 It's, it is subjective. 00:07:02.084 --> 00:07:03.064 You are correct. 00:07:03.360 --> 00:07:12.560 But they've actually done a lot of research on the pain scale, and they sho- have shown that it is a reliable and valid way to measure pain, because pain is subjective. 00:07:12.810 --> 00:07:18.319 And so your 5 out of 10 pain, it may or may not be the same as someone else's 5 out of 10 pain. 00:07:18.572 --> 00:07:20.579 So it, but that doesn't really matter. 00:07:20.581 --> 00:07:30.007 It just matters how it feels to you, how it's limiting you right now, what it, what, adjustments you've had to make in your life or in your training because of this pain. 00:07:30.370 --> 00:07:37.288 So I like to get a really full and comprehensive picture about what exactly is going on in that person's body. 00:07:37.288 --> 00:07:39.101 Like, why is this person having pain? 00:07:39.103 --> 00:07:40.199 What does that pain look like? 00:07:40.581 --> 00:07:50.160 The second thing that I like to do, especially with my runners, now, I do this with all my patients, but especially with my runners Is I try to figure out what could have caused this pain. 00:07:50.358 --> 00:07:53.237 So some people have a very specific thing that they can point to. 00:07:53.238 --> 00:08:03.122 They have an acute event of,"I stepped off a curb and rolled my ankle." Okay, we got a, we have a very good thing to point to there of this is the mechanism of what brought this pain on. 00:08:03.404 --> 00:08:06.023 But with runners, oftentimes it isn't that clear-cut. 00:08:06.059 --> 00:08:10.204 A lot of running injuries, most running injuries, are overuse injuries. 00:08:10.204 --> 00:08:14.095 They're repetitive-use injuries, because r- running is a very repetitive sport. 00:08:14.463 --> 00:08:19.468 And so it's one of those things where the body just slowly breaks down over time. 00:08:19.521 --> 00:08:24.531 And so for a lot of people, it seems like this pain kind of came on out of nowhere. 00:08:25.053 --> 00:08:26.389 And I know this myself. 00:08:26.389 --> 00:08:31.721 Recently, I've experienced a couple different instances of pain, one of'em that I'm still dealing with right now. 00:08:31.915 --> 00:08:34.105 I think I told you guys about on the podcast. 00:08:34.129 --> 00:08:35.750 I know I've talked about it on social media. 00:08:36.039 --> 00:08:39.216 I developed some IT band pain at my knee because... 00:08:39.239 --> 00:08:56.244 And what I realized is part of what led to that pain was I started running with my dog, and I was, as I was training my dog how to run on a loose leash, basically I have this leash where I, tie it around my waist, and it's a bungee leash that attaches to the dog and his harness. 00:08:56.619 --> 00:09:01.774 And we'd be running along, and he'd decide that he wanted to just go smell something, right? 00:09:01.774 --> 00:09:05.464 Go sniff something in the bushes, and all of a sudden I'd be jerked over to the side. 00:09:05.474 --> 00:09:13.606 And I, at first, when we were, I was teaching him this, I just kept running, and I pulled him along with me, and that was obviously not a good idea. 00:09:13.625 --> 00:09:30.139 Because I think that's one of the big things that flared up my knee, because my body was really trying to stabilize myself during running, not just with the normal forces of running, but also now with this extreme lateral pull that was happening, that was jerking my body over to the side. 00:09:30.139 --> 00:09:35.765 Because he tended to run, he tends to run, on my right side, so it was my right knee that flared up because of that. 00:09:35.769 --> 00:09:45.206 And once I realized what was going on there, I was able to adjust a bunch of things, and I'll, I can talk to you about that later in, when I talk about treating the pain. 00:09:45.405 --> 00:09:48.217 But that is part of my load story, okay? 00:09:48.217 --> 00:10:00.022 That's, so I have the pain story of, g- I get, understand the pain and exactly what's happening in the body, and then I'm trying to figure out what I call the load story of what brought this on, what caused this pain. 00:10:00.255 --> 00:10:05.929 So as a runner, it's important to note, has there been recent changes in mileage? 00:10:06.533 --> 00:10:07.931 That was also something that I did. 00:10:07.931 --> 00:10:10.605 I had decided to give the dog more exercise. 00:10:10.634 --> 00:10:17.780 I would start, I would t- take my daily walks with him and turn them into just slow, easy run walks. 00:10:18.053 --> 00:10:20.191 And it wasn't, the, the runs were easy. 00:10:20.191 --> 00:10:23.620 We were stopping a lot for him to sniff or pee or whatever it was. 00:10:23.893 --> 00:10:30.283 So it wasn't like it in- added a lot of intensity, but it definitely added, load to my body because running is different than walking. 00:10:30.807 --> 00:10:31.171 All right? 00:10:31.398 --> 00:10:32.989 is there changes in intensity? 00:10:33.006 --> 00:10:34.147 That's, I just talked about that. 00:10:34.261 --> 00:10:36.013 Have you recently changed your shoes? 00:10:36.245 --> 00:10:37.763 Are you running on different surfaces? 00:10:37.765 --> 00:10:46.144 maybe you are used to running on softer tr- surfaces like dirt trails and now you are on the road, or are you running on some sort of banked surface? 00:10:46.148 --> 00:10:52.861 A lot of times when people run on the roads, or maybe you've moved recently and so your running

path and, surfaces have changed. 00:10:53.436 --> 00:10:55.746 All of these things are important information. 00:10:55.981 --> 00:10:57.625 Have you started a new strength program? 00:10:57.984 --> 00:10:59.259 are you strength training at all? 00:10:59.264 --> 00:11:01.933 that's something that we have to address regardless. 00:11:02.288 --> 00:11:04.346 and then I always ask about lifestyle. 00:11:04.350 --> 00:11:13.163 We have to ask about lifestyle, and this is one of those things as a physical therapist that we didn't really learn as, as well. 00:11:13.164 --> 00:11:28.780 I don't think when I went through my PT training, it like, obviously we're supposed to talk to them about their lifestyle, but I think that, as I've been working for the last 20 years, I've realized just how important lifestyle choices are here, and how important sleep. 00:11:28.965 --> 00:11:36.591 asking people about how much sleep they're getting per night, and if they're getting quality sleep, and if they wake up feeling rested or if they wake up feeling exhausted. 00:11:36.847 --> 00:11:38.572 look- looking at their stress levels. 00:11:38.575 --> 00:11:47.230 this is something that's super important because stress keeps your nervous system in, an activated state, and it's hard for your body to relax and recover. 00:11:47.230 --> 00:11:57.111 And when your body is constantly in that stressed-out state, your body doesn't get over into what's called parasympathetic nervous system activation, which is that rest and recovery. 00:11:57.113 --> 00:12:00.575 That's when your body can actually recover from the harder workouts. 00:12:00.799 --> 00:12:06.485 So if you have a very high stress load, that is making it harder for your body to recover from your workouts. 00:12:06.822 --> 00:12:08.090 And then, of course, fueling. 00:12:08.274 --> 00:12:13.407 and this is one of the things as a PT that, that I do much differently as a coach than I did as a PT. 00:12:13.429 --> 00:12:20.759 Because as PTs, we are taught to stay in our lane, and you're not a nutritionist, you're not an RD, and I agree with that. 00:12:20.774 --> 00:12:21.248 I'm not. 00:12:21.488 --> 00:12:26.400 I am Actually, I'm not a registered dietician, I am a certified nutrition coach. 00:12:26.400 --> 00:12:29.477 That's one of the things that I have, gotten in the past few years. 00:12:30.125 --> 00:12:32.076 but that there's a difference, right? 00:12:32.183 --> 00:12:40.373 Registered dieticians are allowed to prescribe nutrition plans specifically to help diseases and certain conditions. 00:12:40.400 --> 00:12:51.687 As a nutrition coach, I'm able to talk to people about their nutrition and make suggestions and advice, but not diagnose and not, I d- I don't have prescriptive types of nutrition plans. 00:12:51.893 --> 00:12:52.895 So that is the difference. 00:12:52.899 --> 00:12:55.335 But as a runner, your fueling is so important. 00:12:55.453 --> 00:13:06.011 If you are not eating enough, then your body

does not have the fuel that it needs to perform, and it also doesn't have the building blocks that it needs to recover. 00:13:06.022 --> 00:13:22.779 Because whenever you work out, you are breaking your body down, and it is during rest and recovery that body builds back stronger than it was before, as long as you have enough recovery and as long as you are giving the body enough food so that it actually has the building blocks that it needs to recover. 00:13:22.990 --> 00:13:27.587 Because when you break your muscles down, they need protein to build stronger muscles. 00:13:27.639 --> 00:13:44.686 There's something called muscle protein synthesis that we want to, we want to activate in our body after a workout, and that includes, like you have to make sure that you're eating enough dietary protein to help, kickstart that process and also to allow that process to continue to build stronger muscles. 00:13:45.062 --> 00:13:45.438 All right? 00:13:45.442 --> 00:13:47.412 So we have to look at all of these things. 00:13:47.438 --> 00:13:55.248 we also, one of the big things that I've been starting to look at more in recent years is hormonal status and status w- of menopause. 00:13:55.250 --> 00:13:56.716 are you pre-menopausal? 00:13:56.725 --> 00:13:58.285 Are you in your 20s or your 30s? 00:13:58.307 --> 00:13:59.488 Are you perimenopausal? 00:13:59.496 --> 00:14:00.639 Are you post-menopausal? 00:14:00.866 --> 00:14:07.321 Because your ho- hormone status, especially as a woman, makes a big difference in how your body responds to all these things. 00:14:07.916 --> 00:14:16.192 And then of course, history of prior injuries, because if you have a history of prior injury, you are more likely to re-injure that tissue. 00:14:16.197 --> 00:14:29.548 They've done a lot of research studies about this phenomenon, that, once you, once the integrity of a tissue gets disrupted through an injury, that tissue is more likely to get injured again, okay? 00:14:29.549 --> 00:14:35.144 So we have to really, pay attention there and get a, a full picture on what exactly is going on. 00:14:35.426 --> 00:14:43.855 Because oftentimes the cause of pain isn't just a body part, it is a change in load. 00:14:44.163 --> 00:14:46.352 A lot of times we are overloading the body. 00:14:46.424 --> 00:14:47.361 Al- almost always. 00:14:47.363 --> 00:14:47.686 I don't... 00:14:47.806 --> 00:15:00.498 You guys know I don't like to really make sweeping generalizations, but I would say that the number one cause essentially of pain and injury is overloading the body to a point where the body's not able to handle it. 00:15:00.510 --> 00:15:10.808 Even if it is an acute injury, like stepping off the side of, stepping off of a curb and twisting your ankle, the body was not able to handle that quick change in position. 00:15:11.014 --> 00:15:13.452 the body was not able to stabilize itself fast enough. 00:15:13.452 --> 00:15:22.461 So the load that was applied to the body of stepping off the curb with, the speed, the height of the curb, all the different things, there was a certain load that placed on the tissues. 00:15:22.671 --> 00:15:28.090 The tissues were too weak to respond or maybe didn't respond quick enough to right the body. 00:15:28.552 --> 00:15:35.768 so the load on the body was greater than what the body was able to handle, and that's what resulted in the pain and injury. 00:15:36.091 --> 00:15:44.005 And so that can happen in an acute fashion like I just talked about or in a more chronic, recurring type of way, like in running. 00:15:44.005 --> 00:15:54.488 if you are just constantly adding mileage and the body's just breaking down over time, that is training load that is added to the body that the body's not able to handle and leads to breakdown. 00:15:54.611 --> 00:15:54.985 Okay? 00:15:55.648 --> 00:16:01.432 So one of the big things that I want to mention of, this is part A, the subjective, history. 00:16:01.445 --> 00:16:07.841 Bef- as I talk to my clients or my patients- And I get the history of, what's going on. 00:16:07.841 --> 00:16:27.988 One of the big things that I do during this process is a screening, because there are certain things that do not respond well to physical therapy and require furth- further evaluation by a doctor or maybe some imaging to figure out what's going on and make sure that this problem isn't bigger than what PT can handle. 00:16:28.207 --> 00:16:34.860 So before anything else, I need to rule out what should not be self-managed, okay? 00:16:34.860 --> 00:16:37.953 What warrants further investigation? 00:16:38.188 --> 00:16:41.052 So there's some general red flags that I always look at. 00:16:41.052 --> 00:16:44.067 Number one is any sort of significant trauma. 00:16:44.078 --> 00:16:57.863 So if you get into an accident, if you have, a very, severe or, acute trauma, you always wanna get evaluated before you just jump into self-management, I think, especially if it's something if it's a big deal. 00:16:57.863 --> 00:17:01.585 If you fall and hit your head, always get evaluated, okay? 00:17:01.597 --> 00:17:04.500 Hitting your head is not something, to be messed with. 00:17:04.888 --> 00:17:06.835 If there's any sort of numbness or weakness. 00:17:06.858 --> 00:17:08.368 Now, this one is different, right? 00:17:08.369 --> 00:17:17.560 Because there are some very physical therapy treatable conditions that include numbness and weakness, but it's about the pattern of that numbness and weakness. 00:17:17.616 --> 00:17:18.511 is it getting better? 00:17:18.511 --> 00:17:19.453 Is it getting worse? 00:17:19.467 --> 00:17:21.606 What's causing that numbness or weakness? 00:17:22.207 --> 00:17:30.558 a- another big one is pain that does not change with movement or position, especially if that pain wakes you up at night, okay? 00:17:30.560 --> 00:17:34.417 So if this pain is unrelenting, you wanna get screened for that. 00:17:34.417 --> 00:17:37.440 You wanna go see a doctor and make sure that

there's nothing, worse going on. 00:17:37.440 --> 00:17:42.787 Now I'm not talking about, oh, when I roll over in bed, that wakes me up because my back hurts. 00:17:42.836 --> 00:17:45.132 that's position and movement-related, right? 00:17:45.394 --> 00:17:50.138 I'm talking about, if you're just laying and resting, you still have that pain, okay? 00:17:50.141 --> 00:17:53.553 We have to make sure that something is, something else is not going on. 00:17:54.095 --> 00:18:03.075 if there's any sort of unexplained weight loss, usually more than 10 pounds, if there's a fever that's associated with it, we wanna take care of that or, make sure we look at that. 00:18:03.338 --> 00:18:09.257 And then any sort of loss of bowel or bladder control needs to be immediately evaluated, okay? 00:18:09.257 --> 00:18:12.722 So those are some of the big general red flags that I look for. 00:18:13.067 --> 00:18:18.130 the other thing that I screen for is a bone stress injury, because we don't wanna mess with bone. 00:18:18.130 --> 00:18:30.300 And obviously as runners, stress fractures and bone stress injuries are a risk factor that we are prone to experience, especially based on hormonal status, okay? 00:18:30.580 --> 00:18:47.163 So there is, a kind of a risk context that goes in here of if you are someone that has had a recent or rapid l- increase in your load, maybe some, before, there are people that have been sedentary and decide that they're going to train for a marathon. 00:18:47.173 --> 00:18:51.538 That is a recent and rapid load increase that the body might not be able to handle. 00:18:51.787 --> 00:18:53.313 so that would be a risk factor. 00:18:53.482 --> 00:18:56.990 if you've h- ever had a prior bone stress injury, that's a risk factor. 00:18:57.098 --> 00:19:06.959 If you have low energy availability or you've, you're just not eating enough food, if you're trying to restrict, you're trying to diet, you've lost weight recently. 00:19:07.007 --> 00:19:16.904 if you have irregular or missing periods, that can be tricky when it comes to perimenopause and menopause because we- we're losing our periods and our periods are becoming more irregular. 00:19:17.477 --> 00:19:19.557 lower bone density after menopause. 00:19:19.563 --> 00:19:25.648 these are all risk factors that I listen for, and if I hear them, my at- antenna starts to go up. 00:19:25.954 --> 00:19:35.068 And then when I look at, screening, then- I always wanna make sure that with a bone stress injury, because bones just need time to heal. 00:19:35.095 --> 00:19:41.464 there's not a good way to work through a bone stress injury, which I'll talk about a little bit more in the treatment se- section. 00:19:41.828 --> 00:19:54.528 But if there is, some of the, the red flags that I look for bone stress injuries are pinpoint tenderness over a bone, a patient that has progressed-- or sorry, not patient, a pain that has progressed from after running. 00:19:54.545 --> 00:20:04.211 maybe the pain used to

come on after you were done running, and then it was during running, and then it was when you were walking, and then it was just when you were resting or at night, okay? 00:20:04.211 --> 00:20:07.356 So you have to look at that pain progression over time. 00:20:07.740 --> 00:20:11.402 if you're hopping and that's elicits the pain, that's a red flag. 00:20:11.611 --> 00:20:17.624 i- if it's not showing any improvement or if it's getting worse after one to two weeks of reduced load. 00:20:17.950 --> 00:20:20.797 and then I always look at higher risk sites as well. 00:20:20.797 --> 00:20:34.923 So if it's present in the groin, the hip, the top of the foot, the front of the shin, the base of the fifth metatarsal, which is the outside of your foot, the little-- like the, the bone that's attached to your little toe on the outside of your foot, or the sacrum, okay? 00:20:34.923 --> 00:20:36.261 Like that tailbone area. 00:20:36.266 --> 00:20:39.932 So those are the high risk sites for bone stress injuries. 00:20:39.954 --> 00:20:47.942 And if you're having pain in any of those areas that kind of respond the way that I just mentioned, those types of things need you to see a doctor. 00:20:47.951 --> 00:20:50.098 maybe get some imaging done, maybe get an X-ray. 00:20:50.490 --> 00:20:55.348 The key here, though, to remember is that, not all bone stress injuries show up on an X-ray. 00:20:55.348 --> 00:21:02.855 A lot of times, especially if it's just a little stress fracture, depending on the severity of the stress injury, they might not show up on X-ray. 00:21:02.855 --> 00:21:05.623 You might need to get an MRI or a CT scan. 00:21:05.623 --> 00:21:14.546 So the doctor's always gonna do an X-ray first, and th- they're gonna, a lot of times those X-rays come back negative, but they're actually false negatives, meaning the X-ray just didn't catch it. 00:21:14.557 --> 00:21:15.398 It just didn't see it. 00:21:15.409 --> 00:21:19.662 Maybe the angle was wrong, and they just weren't able to see it or the crack was really small. 00:21:19.868 --> 00:21:27.599 so again If your pain is responding that way, and if it's, again, if it's not getting better, if it's getting worse over time, go back to the doctor. 00:21:27.662 --> 00:21:27.950 All right? 00:21:27.950 --> 00:21:35.176 Because just because you had one clear X-ray doesn't mean that there's no stress fracture or bone injury present. 00:21:35.190 --> 00:21:35.423 Okay? 00:21:35.423 --> 00:21:36.324 So keep that in mind. 00:21:37.406 --> 00:21:46.748 The second thing I look at, I th- this, this episode's gonna be a little bit longer than I expected, so stick with me, guys,'cause we're only through, part A of part of evaluation. 00:21:46.751 --> 00:21:55.953 But we'll- the rest of it I think w- r- are gonna go, is gonna go a little bit faster because I think it's really important for us to do a comprehensive evaluation. 00:21:55.962 --> 00:22:12.929 And this is one of the ways, this is one of the reasons that

I can actually do virtual PT sessions and virtual coaching because so much of it is really understanding what's going on in the patient's body, what's going on, what kind of pain pattern is happening, what's happening with the lifestyle and the load and all of that. 00:22:12.942 --> 00:22:16.194 That gives us so much information, so don't skimp on that. 00:22:16.712 --> 00:22:20.261 the second part of the evaluation is what I call the objective testings. 00:22:20.277 --> 00:22:20.407 Okay? 00:22:20.410 --> 00:22:21.856 So part A was subjective. 00:22:21.886 --> 00:22:23.214 That's getting all the history. 00:22:23.545 --> 00:22:25.444 Part B is the objective testing. 00:22:25.446 --> 00:22:32.330 So this is where I actually go in and Put the patient or the client through certain movements. 00:22:32.507 --> 00:22:37.240 I can do this in person, I can do it virtually, I can do it with, people submitting videos to me. 00:22:37.515 --> 00:22:39.807 so I check out their mobility, number one. 00:22:39.808 --> 00:22:41.378 So there's a couple, things that I look at. 00:22:41.378 --> 00:22:42.338 Number one is mobility. 00:22:42.338 --> 00:22:51.263 That is the body's range of motion, your ability to move freely s- through a full range of motion in whatever joints it might be. 00:22:51.602 --> 00:22:54.740 And I always screen more than just the joint that is painful. 00:22:54.740 --> 00:22:57.965 So say you're having hip pain, I don't just look at the hip. 00:22:57.982 --> 00:23:00.220 I look at the knee, the ankle, the foot. 00:23:00.255 --> 00:23:09.343 I look at the spine as well, because oftentimes pain in one area can be caused by limitations in other areas. 00:23:09.595 --> 00:23:19.442 So low back pain is a great example, because if you're having low back pain, a lot of times pain in the lower back can be triggered by a lack of mobility in the hip. 00:23:19.729 --> 00:23:30.992 So if your hip does not have full and fluid and free range of motion, the lower back oftentimes will kick in to help so that'Cause that movement's gotta come from somewhere, and your body compensates. 00:23:30.992 --> 00:23:32.394 Your body is so amazing. 00:23:32.594 --> 00:23:36.710 Your body always finds a way to get the job done until it breaks down, basically. 00:23:36.979 --> 00:23:40.766 so I always look at the, the joints above and below at minimum. 00:23:40.784 --> 00:23:44.263 Oftentime I'll do a full body screening because everything is connected. 00:23:44.941 --> 00:23:53.124 the second thing I look at is stability, which is c- your ability to control your body through that full range of motion and its movement quality, okay? 00:23:53.174 --> 00:23:55.664 how much control do you have doing these certain motions? 00:23:55.673 --> 00:24:04.823 So that includes things like balance, training, static balance, which is just s- a- your ability to balance without movement, and then dynamic balance as well. 00:24:04.824 --> 00:24:09.664 are you able to balance if your leg is moving, if your arms are moving, if your eyes are closed? 00:24:09.691 --> 00:24:21.041 the- there's a lot of different factors that go into your body's balance system, and if your sense of balance and stability is off, then oftentimes other muscles are kicking in, compensation patterns. 00:24:21.061 --> 00:24:30.997 We see a lot of, patterns where other muscles are trying to help out because the muscle that's supposed to be doing its job is too weak or it's not able to activate at the proper time. 00:24:31.259 --> 00:24:32.805 And we see compensation patterns. 00:24:32.807 --> 00:24:34.305 So I take a look at all of those things. 00:24:34.935 --> 00:24:39.045 I look at strength, and see what the area of that, of your body can handle there. 00:24:39.287 --> 00:24:44.384 And then I, w- especially with my runners, I have, like functional tests that I like to do. 00:24:44.388 --> 00:24:49.026 So things like, single leg calf raises, step downs, single leg squats. 00:24:49.259 --> 00:24:53.519 I have an overhead squat test that I put people through, hopping on one leg. 00:24:53.673 --> 00:25:06.878 again, these are to see how the body's able to tolerate load and capacity, and I like to get benchmarks as lo- again, as long as there's no bone stress injury present or any red flags present, that helps me to track progress better. 00:25:07.609 --> 00:25:08.020 All right? 00:25:08.594 --> 00:25:09.613 So that's step one. 00:25:09.619 --> 00:25:15.919 Step one is a very comprehensive evaluation so that we get a, a good, really good picture, get all the information. 00:25:15.919 --> 00:25:29.257 I think of myself as a detective, and I want you to think of yourself as a detective here as well if you are doing this with yourself, is, okay, what are the clues that I need to see that will help me interpret what this pain is trying to tell me? 00:25:29.488 --> 00:25:33.182 Because pain is one of the ways that your body is trying to communicate with you. 00:25:33.182 --> 00:25:37.718 Your body is telling you that the load is too much, and we have to figure out why. 00:25:37.829 --> 00:25:39.392 Okay, why is the load too much? 00:25:39.393 --> 00:25:40.622 Have you increased your mileage? 00:25:40.863 --> 00:25:43.165 Are you not doing proper strength training and mobility work? 00:25:43.224 --> 00:25:49.192 Why is your body not able to tolerate this load, and h- what are you gonna do to help fix it? 00:25:49.204 --> 00:25:51.964 Okay, so comprehensive evaluation is step one. 00:25:52.412 --> 00:25:53.852 Step two is A. 00:25:53.886 --> 00:25:58.480 Okay, so now we're going into the A of EAT, and A stands for assessment. 00:25:58.481 --> 00:26:12.454 So what I do is I take all of the information that I just gathered in the evaluation and I put it together and synthesize it to come up with a- my idea of what exactly is going on here, which deficits matter, and what to work on first. 00:26:12.463 --> 00:26:14.260 So it's like the triage of it all. 00:26:14.260

--> 00:26:18.505 It's like taking all of the information and it's like,"Okay, here's the f- the complete picture. 00:26:18.527 --> 00:26:23.076 What do we need to focus on first?" Because a lot of times it's not one thing. 00:26:23.087 --> 00:26:26.739 Most of the time when I treat a patient, it's not one thing that we need to work on. 00:26:26.748 --> 00:26:28.468 There's multiple things that we need to work on. 00:26:28.785 --> 00:26:36.742 And so we always wanna go in order of importance, get an idea, my clinical assessment of what I think is going on here. 00:26:36.743 --> 00:26:48.798 Because a lot of times, I can't tell you how many times in the past 20 years I've gotten a diagnosis or a prescription from a doctor that says low back pain, and I'm like,"That is not that's a symptom, not a diagnosis." Okay? 00:26:48.798 --> 00:27:04.140 And even if they give me a diagnosis like degenerative disc disease or a disc herniation or something like that, that's giving me a diagnosis, but I still have to do this complete evaluation to see how that is presenting in the client. 00:27:04.153 --> 00:27:09.826 Maybe it's myself, maybe it's the person I'm treating, but every person presents slightly differently. 00:27:09.826 --> 00:27:25.701 Yes, there are the, the quote-unquote"textbook cases" of signs and things that you look for, but everybody responds a little bit differently and everybody's body is, different in the tissue response that occurs and the nervous system response and the guarding and all of that happens. 00:27:25.942 --> 00:27:28.310 and that can also depend on how long you've had this. 00:27:28.363 --> 00:27:36.249 something, somebody that's had lower back pain for two weeks is going to be a lot different than someone who's been dealing with this for two years, right? 00:27:36.971 --> 00:27:44.430 so in my assessment I put it all together, and one of the things that I look at here as well is what I call tissue irritability. 00:27:44.448 --> 00:27:47.942 So how- sensitive is this tissue? 00:27:47.952 --> 00:27:49.388 How irritable is this tissue? 00:27:49.397 --> 00:27:55.547 How easily does the pain flare up, and how quickly does it settle down? 00:27:55.549 --> 00:28:01.165 Because that's important, and that will help guide how aggressively we can load the tissue. 00:28:01.368 --> 00:28:21.921 Because if someone does a movement and it aggravates the tissue very quickly and then that pain lingers, we're gonna have to slow, progress that person much slower than someone who has, is able to tolerate a, say, five exercises or three rounds of a certain exercise before they start to have discomfort. 00:28:21.934 --> 00:28:26.155 And maybe they're able to after the session, the pain goes away relatively quickly. 00:28:26.375 --> 00:28:30.656 That's telling me that tissue is less irritable, and I'm gonna be able to progress that person quicker. 00:28:30.829 --> 00:28:33.384 So again, you know your body the best. 00:28:33.994 --> 00:28:36.443 You

have to know, how irritable is this? 00:28:36.444 --> 00:28:39.663 We have to make sure that we are progressing appropriately. 00:28:40.308 --> 00:28:43.958 And that takes us to step number three, which is treat, okay? 00:28:43.960 --> 00:28:45.124 This is the treatment plan. 00:28:45.125 --> 00:28:47.689 So we've got evaluate, assess, and treat. 00:28:47.962 --> 00:28:59.685 So the treatment plan, I've got some general principles that I go by when it comes to treatment, and then I'm gonna talk about the way that I look at exercises and then the way that I look at returning to running. 00:28:59.988 --> 00:29:02.615 So the general principles that I go by. 00:29:02.756 --> 00:29:14.117 Number one, we wanna make sure that your nervous system is safe because when, whenever we have pain or an injury, that, like I said before, that is your body's warning signal to you. 00:29:14.131 --> 00:29:19.593 That is one of the ways that your body is trying to communicate with you that something is wrong, that something needs your attention. 00:29:19.603 --> 00:29:20.876 I shouldn't say something is wrong. 00:29:21.165 --> 00:29:23.339 That something needs your attention here, right? 00:29:23.944 --> 00:29:29.066 And so when that happens, your nervous system goes on a high alert. 00:29:29.079 --> 00:29:34.512 it's scanning the area because your brain and your nervous system's job is to keep you safe and to keep you alive. 00:29:34.761 --> 00:29:41.929 So if you are having pain and injury, that is activating your nervous system and putting your body on higher levels of alert. 00:29:41.946 --> 00:29:48.391 we're like more on like code yellow or cor- code orange, like depending on our threat assessment. 00:29:48.403 --> 00:29:55.852 your nervous system literally does a threat assessment to see how bad this is and how worried you should be and how you should treat this. 00:29:56.457 --> 00:30:03.210 And so the number one thing we want to do when we start to treat any sort of pain is make sure that your nervous system feels safe. 00:30:03.490 --> 00:30:08.530 And the way that I like to do this is to make sure that people are not pushing through pain. 00:30:08.825 --> 00:30:10.977 Because a lot of times people say, no pain, no gain. 00:30:10.977 --> 00:30:19.162 We're just gonna push through it." But that keeps your nervous system activated, and you wanna make your nervous system feel safe, not feel more threatened. 00:30:19.374 --> 00:30:29.936 And so if you are doing a movement and you start to experience pain, and you just try to ignore it and push through it, that's teaching your nervous system that it's not safe, that movement is not safe. 00:30:29.942 --> 00:30:37.952 And a lot of times what happens is that the nervous system becomes even more guarded and- you start to lose even more motion. 00:30:37.961 --> 00:30:44.535 It starts to give you that pain signal, earlier before you even get to that, that limit of the pain. 00:30:45.048 --> 00:30:51.107 So what I always like to do and tell my patients to do is to move to the edge of pain, okay? 00:30:51.108 --> 00:31:01.786 So you wanna do a movement where you Maybe your start, you start to feel that pain, and then you stop, and you breathe through it right there, and then you back away, okay? 00:31:01.787 --> 00:31:05.162 I don't want you pushing through it, and I also don't want you completely avoiding it. 00:31:05.174 --> 00:31:07.583 We like to We have to find the edge, okay? 00:31:07.583 --> 00:31:11.545 Because the g- the goal is to allow the nervous system to feel safe. 00:31:11.878 --> 00:31:22.842 So I tell my patients, move until you start to feel the pain, kinda that edge of pain, take a deep breath right there, and then move away from it because that deep breath helps to calm your nervous system. 00:31:23.000 --> 00:31:36.767 And then we're gonna do it again, and we're gonna see just by doing that little technique where we move to the edge, take a deep breath, you could take multiple breaths if you want to, until you start to feel the tissues and feel your nervous system calm down, and then move away from it. 00:31:36.795 --> 00:31:44.957 We do that several times and just see does your range of motion improve just with that n- piece of nervous system regulation, okay? 00:31:44.959 --> 00:31:48.849 So that's number one is moving to the edge of pain, not moving through the pain. 00:31:49.386 --> 00:31:57.207 Number two would be the loading rule, like how much pain is okay for us to, work through or work with? 00:31:57.912 --> 00:32:07.622 One of the, one of my clinical principles that I've used is to stay at or below around a 4 out of 10, maximum like 5 out of 10. 00:32:07.833 --> 00:32:14.251 If someone gets above a five, if someone's like somewhere in the range of five through 10, we gotta pull back, we gotta modify, okay? 00:32:14.468 --> 00:32:19.462 If we are a 4 out of 10 or below, then we're okay to keep going at that level. 00:32:19.471 --> 00:32:22.701 That's one of the clinical tools that I use. 00:32:22.979 --> 00:32:28.192 Because a lot of tissues don't respond well to complete rest. 00:32:28.192 --> 00:32:29.493 we need to load the tissues. 00:32:29.496 --> 00:32:30.784 Your body was made to move. 00:32:31.078 --> 00:32:39.009 And so the key is always finding what is the safe amount of movement, what is the safe amount of load that I can place on this tissue without making it worse? 00:32:39.593 --> 00:32:47.761 So while we're doing the exercises or running or whatever it is that you're doing, I wanna stay at a pain level of 4 out of 10 or below. 00:32:48.166 --> 00:32:50.906 I don't want that pain level increasing during the session. 00:32:50.907 --> 00:32:57.298 So if you start at a four and throughout the session you're starting to get up into five, six, seven, we stop and we pull back, okay? 00:32:57.596 --> 00:33:08.619 even if you're st- starting at a two and we're noticing that, that pain's starting to increase over the

course of the session, I'll, sometimes I'll let it get up to a three or four, and then we'll pull back, okay? 00:33:08.666 --> 00:33:12.529 'Cause again, that 4 out of 10 rule is one of the, the ones that I use personally. 00:33:12.790 --> 00:33:18.017 I'm not saying that is the hard and fast rule by any means, and again, this is not medical advice, okay? 00:33:18.018 --> 00:33:19.243 That's just what I do. 00:33:19.758 --> 00:33:22.237 and then I also use what's called the 24-hour rule. 00:33:22.240 --> 00:33:33.237 So you go out for a run, you do a strength training session, whatever it is that you do, how does your body feel aft- like during the session, after the s- directly after the session, and then 24 hours later? 00:33:33.240 --> 00:33:37.238 Because some people will experience a delayed onset of pain. 00:33:37.238 --> 00:33:43.609 So we have to make sure that whatever you did the day before didn't aggravate the tissue so that your pain level is higher now. 00:33:43.609 --> 00:33:49.965 So if your pain level is the same or lower 24 hour l- hours later, then we are good to continue. 00:33:49.991 --> 00:33:58.316 Now- I say that with a small caveat because any time you are doing new exercises, you might experience some soreness, okay? 00:33:58.317 --> 00:34:00.095 And soreness is different than pain. 00:34:00.362 --> 00:34:06.223 I did an episode on the podcast, I think it was earlier this year, where I talked about the stoplight framework. 00:34:06.500 --> 00:34:10.764 so I can figure out, like, where, which, which episode that was. 00:34:10.789 --> 00:34:13.541 I wanna say it is episode 452. 00:34:13.541 --> 00:34:16.429 I just looked back, in my podcast list here. 00:34:16.949 --> 00:34:18.614 Check out episode 452. 00:34:18.614 --> 00:34:24.880 I think that is my, stoplight framework back on March 12th of 2026, all right? 00:34:25.139 --> 00:34:29.617 Because that's gonna tell you if it's safe to continue, if it's just soreness. 00:34:29.625 --> 00:34:32.280 it's helps you figure out is this soreness or is this pain? 00:34:32.315 --> 00:34:33.494 All right, so keep that in mind. 00:34:33.543 --> 00:34:41.331 But 24-hour rule, to make sure there's no increase in pain within that 24-hour period, then we- we're good to continue. 00:34:41.489 --> 00:34:43.554 if the pain does increase, then again, we pull back. 00:34:43.557 --> 00:34:44.440 That was too much, okay? 00:34:44.440 --> 00:34:48.331 That's the body telling you that what you did yesterday was a little too much. 00:34:48.331 --> 00:34:49.431 We gotta pull back a little bit. 00:34:50.081 --> 00:34:52.231 so that's Those are some of my general principles. 00:34:52.239 --> 00:34:55.849 Again, that most of the time I don't do full rest. 00:34:55.862 --> 00:34:59.302 I might do a temporary rest where, a couple of days. 00:34:59.596 --> 00:35:01.231 So I did this to myself. 00:35:01.233 --> 00:35:06.887 I, actually developed some pain in my, glutes and upper hamstrings a couple weeks ago. 00:35:07.251 --> 00:35:16.001 And so I took a couple days off just to let the tissue relax and come down, and then I used, the procedure that I'm g- going to be telling you about on how to get back into running, okay? 00:35:16.003 --> 00:35:19.896 So sometimes a couple of days rest is okay. 00:35:20.090 --> 00:35:25.123 I don't usually suggest, weeks of rest and, definitely not rest until the pain goes away. 00:35:25.123 --> 00:35:30.940 That's not what we're looking at anymore because most tissues need load, not full rest. 00:35:31.179 --> 00:35:32.599 but they need optimal load. 00:35:32.608 --> 00:35:36.840 They don't wanna-- we don't wanna overload them, because they're already weakened tissues. 00:35:36.840 --> 00:35:38.965 We wanna find that optimal load. 00:35:39.186 --> 00:35:45.144 And again, as always, the exceptions to that are bone stress injuries, fractures, complete ruptures. 00:35:45.177 --> 00:35:47.458 Those things are different Okay. 00:35:47.766 --> 00:35:49.474 Now, how do we progress exercise? 00:35:49.474 --> 00:35:50.896 What do we need to do with exercises? 00:35:50.905 --> 00:35:58.880 So there's always the same order that I use when I start to prescribe exercises for people, coming off of a pain or an injury. 00:35:59.282 --> 00:36:01.081 Number one is mobility. 00:36:01.150 --> 00:36:01.394 Okay? 00:36:01.394 --> 00:36:09.914 We have to restore normal range of motion, so I wanna find those restrictions in the tissue, and I found those in step one when I did my evaluation. 00:36:10.173 --> 00:36:13.795 We find those restrictions, and we start to reduce them. 00:36:14.059 --> 00:36:15.835 So that could be tissue restrictions. 00:36:15.836 --> 00:36:21.650 Maybe there's, a, an area of tissue that's really tight, and it can also be that nervous system safety that we already talked about. 00:36:21.650 --> 00:36:27.911 So restoring normal range of motion and full and free normal range of motion is step one. 00:36:28.565 --> 00:36:29.853 Step two is stability. 00:36:30.119 --> 00:36:35.739 So this is restoring movement control, and oftentimes I do these two steps together. 00:36:35.739 --> 00:36:35.943 Okay? 00:36:35.943 --> 00:36:42.306 It's not like I restore full range of motion and only focus on that before moving on to stability. 00:36:42.530 --> 00:36:52.684 I just make sure that we are always addressing mobility, and then st- I start to layer in stability, where we're still working on mobility, but then we're also gonna start layering in some, some stability. 00:36:52.684 --> 00:37:05.409 And stability is your body's ability to control your body through a full range of motion or through your currently available range of motion without compensation patterns. 00:37:05.460 --> 00:37:05.702 Okay? 00:37:05.702 --> 00:37:18.284 We have to find those compensation patterns'cause, like I said before, whenever we have a restriction or we have a weakness, other areas of the body are kicking in to try to help out, and that

leads your body to go into these faulty movement programs. 00:37:18.498 --> 00:37:23.650 So we have to figure out when that's happening, where's that, where that's happening, and fix that. 00:37:23.670 --> 00:37:23.958 Okay? 00:37:24.010 --> 00:37:37.097 the first part of that is bringing awareness to how your body's compensating, and oftentimes the, two of the most helpful tools here are doing movements in front of a mirror so you can see it and then number two, do videotaping yourself. 00:37:37.099 --> 00:37:37.380 Okay? 00:37:37.380 --> 00:37:43.583 Recording yourself performing these movements because sometimes the mirror, you don't really catch it, right? 00:37:43.583 --> 00:37:58.237 Because maybe, especially if you're having pain, you're doing the movement, and then you, feel it and you're like,"Ugh." So if you can record yourself doing it- And then go back later and watch it back and find w- what movement patterns or mo- movement compensations you're making. 00:37:58.494 --> 00:37:59.375 That's really helpful. 00:37:59.382 --> 00:38:03.762 So one of the common, tests that I like to use here would be the single leg squat test. 00:38:04.072 --> 00:38:08.735 And so for the single leg squat test, number one, are they able to do it, without using their hands? 00:38:08.735 --> 00:38:14.840 Are they able to sit down and stand up from a chair, sit down in a chair and then stand up using just one leg? 00:38:15.414 --> 00:38:19.168 Now again, you have to be careful because depending on what kind of pain and injury, that might irritate it. 00:38:19.469 --> 00:38:20.565 but are they able to do that? 00:38:20.565 --> 00:38:22.887 That's a, a really good functional test that I love to use. 00:38:23.483 --> 00:38:25.331 So number one, are they able to? 00:38:25.342 --> 00:38:28.846 Okay, if the answer is yes, are they able to do it without compensating? 00:38:28.846 --> 00:38:33.773 And some of the common compensation patterns I see are, the knee crashing in, okay? 00:38:33.773 --> 00:38:38.525 So they've got h- weakness in the hip, and so that knee kind of crashes in t- towards the middle. 00:38:38.670 --> 00:38:40.920 they lean over to the side. 00:38:40.932 --> 00:38:43.782 Maybe they have to put their other foot down because they lost their balance. 00:38:43.784 --> 00:38:45.538 maybe they do have to use their hands, right? 00:38:45.735 --> 00:38:52.706 So there's all these different compensation patterns that can give me clues on where the, movement is h- is breaking down. 00:38:53.001 --> 00:38:58.922 And so then we go through a process of movement or motor reprogramming and movement reeducation. 00:38:59.161 --> 00:39:04.251 and that's a really important thing for us to do no matter what level of pain or injury you have. 00:39:04.740 --> 00:39:06.572 And then part three is strength, okay? 00:39:06.572 --> 00:39:15.146 So once we've got mobility and stability built back up, then we can start to load the tissues a little bit more progressively speaking, right? 00:39:15.146 --> 00:39:27.983 We always wanna make sure that before we add load, before we add resistance to an exercise, the person is able to control that mo- motion and that movement fully without the resistance, right? 00:39:27.996 --> 00:39:33.358 If someone's already showing compensation patterns without a weight or without resistance, I'm not gonna add a weight to it. 00:39:33.369 --> 00:39:34.306 That's silly, right? 00:39:34.306 --> 00:39:43.429 We have to be- make sure that they're able to move freely, stabilize themselves without, extra resistance, and then we load the tissues. 00:39:43.445 --> 00:39:54.666 Then we start to build that strength and build the body's sys- ability to stabilize, even more Okay, so those are the three parts of exercises I use, mobility, stability, and then strength. 00:39:55.085 --> 00:39:56.619 And then what do we do with running? 00:39:56.625 --> 00:40:01.088 Okay, if there's a pain or an injury, the first thing we always wanna do is modify, okay? 00:40:01.088 --> 00:40:11.065 So if necessary at the beginning, you can take a couple days of rest, maybe up to a week just to let the tissues calm down and, reduce any sort of like acute inflammation that might be present. 00:40:11.791 --> 00:40:13.284 Then we wanna modify. 00:40:13.532 --> 00:40:16.532 So modifying looks like a couple of things. 00:40:16.608 --> 00:40:21.804 Number one, we wanna reduce load by about 50% at least, okay? 00:40:21.804 --> 00:40:26.474 So that's typically my first plan of action is like whatever you're doing, we're gonna cut it in half. 00:40:26.514 --> 00:40:35.077 So say you run 20 miles a week, right now though we're gonna cut it in half immediately and try out 10 miles a week and see how your body responds. 00:40:35.333 --> 00:40:39.898 Because just reducing the load might be enough to allow your body time to heal. 00:40:40.284 --> 00:40:47.545 if reducing the load or if running specifically is one of the things that's flaring up the pain, then we look at cross-training, okay? 00:40:47.545 --> 00:40:53.255 We look at cross-training options like elliptical, bike, swimming, some sort of, cross-training that you can do. 00:40:53.860 --> 00:41:01.411 or if you're able to do a little bit of a run but it's just that sustained running that becomes a problem, I put people on a run-walk plan, okay? 00:41:01.413 --> 00:41:07.012 That is one of the best tools to use where you just say run for a minute or two, then take a walking break. 00:41:07.016 --> 00:41:12.297 You run for a minute or two, you take a walking break, and you use intervals to build yourself back up. 00:41:12.521 --> 00:41:19.635 That helps to reduce the load on the tissues and build in recovery like straight into your run. 00:41:19.811 --> 00:41:32.018 So those walking breaks are allowing your body and your tissues to recover in between running intervals, so you're building the recovery directly into the run, which is then going to reduce the overall

load on the body. 00:41:32.250 --> 00:41:32.655 Okay? 00:41:33.155 --> 00:41:34.853 So those are some of the, the keys. 00:41:35.083 --> 00:41:42.773 And then if we reduce that load by 50%, we then assess and see how it responds, and then we're able to build up from there, okay? 00:41:42.791 --> 00:41:50.110 If 50% is good, then we can slowly increase again based on that tissue irritability and that nervous system safety we already talked about. 00:41:50.447 --> 00:41:54.059 if 50% is still irritating the tissue, then we reduce it even further, okay? 00:41:54.063 --> 00:42:04.019 The goal is to try to find the level that is not zero, but to try to find the level that your e- your body's able to tolerate without increasing the pain, okay? 00:42:04.019 --> 00:42:07.141 With the pain staying at that 4 out of 10 or below. 00:42:08.014 --> 00:42:11.657 And whenever I figure out, okay, w- when can we actually return to running? 00:42:11.657 --> 00:42:13.161 When can we start to increase the load? 00:42:13.608 --> 00:42:14.780 It's not time-based. 00:42:14.780 --> 00:42:16.675 Everybody wants to know how much time they need. 00:42:16.688 --> 00:42:17.452 is this two weeks? 00:42:17.452 --> 00:42:18.101 Is it four weeks? 00:42:18.101 --> 00:42:18.721 Is it six weeks? 00:42:18.731 --> 00:42:19.987 It depends, right? 00:42:19.987 --> 00:42:32.936 It depends on so many factors, and it depends on a lot of the things that we talked about in step one, in that evaluation, those lifestyle factors of how much sleep are you getting, how's your stress level, how's your nutrition, how's your hydration? 00:42:33.097 --> 00:42:40.972 Because all of those things are going to either put your tissues in a better state of healing or a reduced state of healing. 00:42:41.476 --> 00:42:50.155 Because what you choose in those lifestyle factors, makes a huge difference in s- in how your body responds and how your body is actually able to recover here. 00:42:50.829 --> 00:42:51.193 Okay? 00:42:51.503 --> 00:42:55.009 So what I say, it's not really time-based, it's criteria-based. 00:42:55.025 --> 00:42:58.018 We wanna make sure that you're able to function pain-free. 00:42:58.289 --> 00:43:13.900 We wanna get you out of pain kind of in your life outside of running, then we wanna make sure that you're pain-free during running, and then we can slowly increase your load, to make sure that we, you're able to pass those capacity tests that I talked about before as well. 00:43:14.117 --> 00:43:20.181 the single leg calf raises, the single leg sit to stands, the overhead squats, the hopping tests. 00:43:20.181 --> 00:43:30.824 those are some of the capacity tests that I like to put people through before we decide whether or not it's a good idea to either return to running or increase the running load. 00:43:31.420 --> 00:43:31.826 Okay? 00:43:32.132 --> 00:43:35.760 so some realistic timelines, because everybody wants a timeline. 00:43:36.065 --> 00:43:39.617 if it's a muscle injury,

that often takes weeks to heal. 00:43:39.909 --> 00:43:43.748 If it's a tendon, that might take more like months to heal fully. 00:43:43.788 --> 00:43:46.103 That doesn't mean you're not running during that time, okay? 00:43:46.106 --> 00:43:47.307 Especially tendons. 00:43:47.565 --> 00:43:50.018 a caveat, especially for tendons need loads. 00:43:50.128 --> 00:43:54.360 if you have an Achilles tendon issue, y- it wa- it needs to be loaded. 00:43:54.606 --> 00:43:56.233 The, the goal is not full rest. 00:43:56.235 --> 00:43:59.266 the goal, again, is optimal loading, okay? 00:43:59.266 --> 00:44:11.327 But you might notice some discomfort for a couple of months before that, that tendon is able to get back to pain-free, because tendons are what are- what's called avascular. 00:44:11.327 --> 00:44:13.510 They don't have as good of a blood supply. 00:44:13.512 --> 00:44:16.329 They do have some blood supply, depending on what kind of-- which tendon it is. 00:44:16.655 --> 00:44:20.005 But they don't have a fresh blood supply like, say, a muscle. 00:44:20.018 --> 00:44:25.114 muscles have so much fresh blood coming, so they tend to heal faster than tendons do. 00:44:25.688 --> 00:44:28.565 And then bones, are at least several weeks. 00:44:28.606 --> 00:44:32.284 a lot of times if there's a bone stress injury, it is full rest. 00:44:32.284 --> 00:44:56.048 Maybe it's a boot for, four to six weeks, depending on the severity of it, but you have to follow your physician's av- advice when it comes to any sort of bone injury And then with all of this, okay, yes, everything I just told you about the treatment with exercises and how to modify running, all of that is important, but we also have to fix the original root cause of the problem. 00:44:56.295 --> 00:44:58.737 And maybe that was just a load increase. 00:44:58.739 --> 00:45:01.190 Maybe it was that you ramped up your mileage too quickly. 00:45:01.902 --> 00:45:08.675 But there's also other factors at play here That includes, excuse me. 00:45:08.755 --> 00:45:10.172 Had to just take a little drink of water. 00:45:11.007 --> 00:45:13.047 My voice is getting a little, solo episode-y. 00:45:13.480 --> 00:45:20.829 I'm gonna take a quick sip real, real quick We have to also fix what caused the problem in the first place. 00:45:21.293 --> 00:45:32.067 So we have to make sure that the load is appropriate, that you're not ramping up your load too much, that you are strength training in, combination with your running. 00:45:32.067 --> 00:45:37.842 Because you cannot get away, especially if you are over 40, it is not a good idea for you to just run anymore. 00:45:37.849 --> 00:45:47.079 you have to be doing the strength, the stability, the mobility work that goes along to keep your body primed and ready for running. 00:45:47.552 --> 00:45:48.960 We have to look at your sleep. 00:45:49.141 --> 00:45:50.501 We have to look at your fueling. 00:45:50.501 --> 00:45:58.309 We have to fix some of those things because

if you have not been eating enough, if you've been dieting and restricting, there's a lot of people that decide they're gonna train... 00:45:58.376 --> 00:46:02.306 Want, they wanna lose weight, and so I'm gonna train for a marathon, or I'm gonna train for a half marathon. 00:46:02.307 --> 00:46:05.548 And so they're dieting and increasing the load at the same time. 00:46:05.753 --> 00:46:07.443 That is a recipe for disaster, okay? 00:46:07.443 --> 00:46:08.333 Do not do that. 00:46:08.500 --> 00:46:10.492 Do not l- allow anyone that to do that. 00:46:10.492 --> 00:46:11.391 It's not a good idea. 00:46:11.391 --> 00:46:15.373 It's a recipe that is just going to lead you to a bad place, okay? 00:46:16.043 --> 00:46:18.320 So that's what I've got for you guys. 00:46:18.329 --> 00:46:21.045 So that's evaluate, assess, and treat. 00:46:21.266 --> 00:46:28.865 And then on- once we're inside and we're looking at exercises, we're always looking at mobility, stability, and strength, okay? 00:46:29.141 --> 00:46:37.090 So we're always looking at load on the body because overload of the body is what essentially leads to all running injuries. 00:46:37.092 --> 00:46:41.431 your body, you are placing a load on your body that your body cannot handle. 00:46:41.641 --> 00:46:46.751 So the question is always, how can I increase my body's tolerance to load? 00:46:46.920 --> 00:47:01.278 You're gonna be able to increase your body's tolerance to load by improving your mobility, by improving your stability, by improving your strength, by making sure that you're eating enough, by making sure that you're sleeping enough, by making sure that you are managing stress appropriately. 00:47:01.815 --> 00:47:05.913 All of those things are going to increase your body's ability to tolerate load. 00:47:06.121 --> 00:47:08.264 And then of course, make sure that you have a good timeline. 00:47:08.264 --> 00:47:15.592 you're not trying to increase load so fast that your tissues are just breaking down before they're able to build back up stronger. 00:47:16.873 --> 00:47:18.123 That's what I got for you guys today. 00:47:18.132 --> 00:47:20.786 this was a super dense episode. 00:47:20.804 --> 00:47:25.338 This is probably one that you're gonna want to go back and listen to several times. 00:47:25.550 --> 00:47:30.043 This is definitely one you're gonna wanna share with your friends because l- literally, guys, this is what... 00:47:30.057 --> 00:47:32.556 This is how I treat any running injury. 00:47:32.557 --> 00:47:47.614 It's this process, this three-step framework, and then obviously there's the framework within the framework that I use as well to help you understand the pieces that every single person that is in pain needs to undergo. 00:47:47.728 --> 00:47:48.032 All right? 00:47:48.047 --> 00:47:48.780 This is not... 00:47:49.061 --> 00:47:50.391 There's really no exceptions here. 00:47:50.422 --> 00:47:51.679 I genuinely don't think. 00:47:51.684 --> 00:47:54.476 it's mobility, it's stability, it's strength, it's lifestyle. 00:47:54.478 --> 00:47:58.030 It's all the things that I've been harping on, throughout this whole episode. 00:47:58.030 --> 00:48:01.219 So if you enjoyed this, send it to someone. 00:48:01.219 --> 00:48:04.577 Number one, send it to someone who you think this is going to be helpful for. 00:48:04.664 --> 00:48:13.675 if y- if there's a runner that you know that is in pain or battling injury after injury, send them this episode This is such important information. 00:48:13.733 --> 00:48:14.126 All right? 00:48:14.126 --> 00:48:14.782 Let's share it. 00:48:15.023 --> 00:48:16.159 Don't keep it to yourself. 00:48:16.159 --> 00:48:17.442 Let's help more people in the world. 00:48:17.445 --> 00:48:19.505 I need your help to help more people. 00:48:19.518 --> 00:48:19.686 Okay? 00:48:19.686 --> 00:48:23.739 My goal is to help thousands and thousands of runners, maybe even millions one day. 00:48:24.023 --> 00:48:26.322 But I need your help to do that, because I'm only one person. 00:48:26.324 --> 00:48:27.744 So please share this with someone. 00:48:27.980 --> 00:48:34.139 if you haven't yet, please leave us a review on Apple Podcasts or on Spotify, because those reviews really do help. 00:48:34.143 --> 00:48:40.922 They help to show our podcast to new people, like when they open the app and, Spotify recommends podcasts to people. 00:48:41.391 --> 00:48:48.469 the more reviews and comments and likes that we have, the more likely those platforms are to show our podcast to new people. 00:48:48.786 --> 00:48:55.838 So anything that you can do there to help us out would be so greatly appreciated, because I have a mission to help runners get out of pain. 00:48:55.869 --> 00:48:57.750 And t- the more runners, the better. 00:48:57.751 --> 00:49:02.829 And if there's more of us, we can be little, our little Running Reconnected army out there trying to help more people, okay? 00:49:02.829 --> 00:49:05.146 You are an important part of this process, too. 00:49:05.588 --> 00:49:10.420 so thank you in advance for any of the help that you give the podcast, in any way. 00:49:10.429 --> 00:49:13.139 Just talking about it with your friends, sharing episodes. 00:49:13.224 --> 00:49:13.610 thank you. 00:49:14.166 --> 00:49:14.701 stay tuned. 00:49:15.068 --> 00:49:16.123 I've got running... 00:49:16.197 --> 00:49:19.664 Or sorry, injury-specific episodes coming up in the following weeks. 00:49:19.664 --> 00:49:21.507 They're probably not gonna be, back to back. 00:49:21.536 --> 00:49:24.360 Kevin and I will probably be putting other things in there. 00:49:24.360 --> 00:49:33.536 But it'll be a series that we have that's an ongoing series, that'll help you guys get better understandings of certain body parts and certain body, injuries and areas. 00:49:34.376 --> 00:49:42.045 And then again, if you are interested in that one-on-one coaching program, please email me at angie@realliferunners.com, okay? 00:49:42.047 --> 00:49:43.088 I would love to talk to you. 00:49:43.090 --> 00:49:50.744 I would love to help you more, to get out of pain or to rebuild, after perimenopause or menopause and do the right things. 00:49:50.748 --> 00:50:01.536 the scientific, evidence-based, clinically based things that actually work, that I talked about here in this episode, and not just the latest hacks and crap that you see on social media. 00:50:01.536 --> 00:50:03.753 So as always, guys, thanks for joining me. 00:50:03.753 --> 00:50:08.083 This has been the Running Reconnected podcast, episode number 482. 00:50:08.378 --> 00:50:10.077 Now get out there and run your life.