How to Run Better, Get Stronger & Avoid Injury | Dr Chris Bramah | Ep 65

0:00Chris Bramah, welcome to the podcast. No, thank you very much for inviting me on. I know we've been talking about this for a while, so I finally got around to organizing our calendars. Yeah, no, you're a busy man, hard to get hold of. Yeah, I mean, you are becoming equally as difficult to get hold of as I am. I mean, I thought I was bad for replying to messages, but I think you're worse than me now. I should have actually referred to you as Dr Chris Bramah because you are a doctor. for the people that may not know who you are we'd just be able to explain who you are what you do and your background okay so um yes i guess i am my formal name is dr chris brammer i'm a physio by background who's spent the last 15 plus years working in elite sport i guess predominantly with elite athletes ranging from your sprinters all the way up to you in endurance runners um i'm also researching biomechanics so my phd was actually looking at running technique and how running technique might influence injury and whether or not we can change that to improve injury outcomes with people and so that's kind of shaped what I do now and I guess on a day-to-day basis I work at the Manchester Institute of Health and Performance and my role is around rehabbing athletes from complex injuries working with Olympians or athletes various different levels and then the unique aspect to what I do is I use complicated biomechanics technology to look at the way people move be it running change of direction and how well they generate force and try to use that information to help them either understand why we get recurrent injuries what we can do in terms of optimizing return to sport and how we can perhaps try and enhance performance who are some of the people that you work with well so i spent a lot of my time working for british athletics and team gb i did that between 2014, sort of took my foot off the gas on that around 2019, but kind of stopped that in 2022.

1:55So I guess I did a lot of work with the endurance program at that point. So if you think of any GB international endurance runner, I've probably had the experience of working with them. Your household names that, um, sort of people will commonly know from social media that I will have worked with regularly include like your Eilish McCalgans, your Philly Bowden. Um, but because of that time I got to spend on training camps and championships I was pretty fortunate to work with um the likes of like Samoa Farah is probably one of the highest profile people that I got to work with um and now on a day-to-day basis I'll still work with like the team New Balance athletes um and I work with a lot of Premier League football clubs now I'm trying to help them on advising them I guess on suitability of return to play complex injuries and things like that and then your background yourself are you were you in sports yeah so actually as a kid I started out trying to be a sprinter and I tried to run 400s up until my mid-20s and I guess during that time I was really fortunate that the group I trained with was with a lot of high-profile international 400 meter runners so some of them had won Olympic medals European championships so I guess my experience as an athlete as a youngster has shaped everything I do in my career now and in particular being in a group of that sort of caliber there's a lot of coaching focus that had always been on technique so how can we move better to try and shape tenths or hundredths of a second off our personal best and then so I you know that already like sort of bred the obsession I guess with movement patterns and high performance unfortunately my dream was I wanted to be a GB athlete but I guess like many stories um I'd either get injured or just wasn't really of that sort of standard enough so I quickly sort of pivoted realized I wasn't going to be an athlete for Team GB so tried to become a physio for Team GB and that kind of led me into what I was going to do I think when you get injured and you chase high performance yourself you inevitably then pushed into a career that's either going to probably be sports science or physio for me it was physio and when i left uni got the chance to work in rugby league so i worked in super league you're a northerner so i'm you know uh lee leopards will have been your sort of like hometown so for me it was salford red devils that i was working with at the time i did that for a fair few years which is an absolute great laugh working with those guys and being part of that team why is it that like every physio starts off at a rugby team is it just because of the the amount of injuries i feel like every physio starts off at rugby so i'll be honest like i had no interest in rugby before i got the job in it and it took me ages to learn it but one of the beauties of that is everybody is broken at all the time so like you are definitely going to upskill very quick having to work in a rugby setting because players break quite a lot and there's a high demand to try to get people back on the on the pitch safely and as quickly as possible so i love the fact that I think that's one of my motivations in any part of my career is that high performance drive to get people back that's what really sort of motivates me so it was it was a great opportunity and then I sort of fell in love with the beauty of the game you're still a fan now um I would say not so much now no no I think for me my 100 passion has always been athletics growing up in that I think track and field for me and uh running is out and out my favorite sport purely because having been in it and worked with athletes in that arena is you're always striving for 100 % the best so your body needs to be in as close to 100 % a condition as it possibly can be to train and therefore push the boundaries of what human performance are and I think as a physio that's a really cool challenge is how do you keep people able to execute day in day out and that just makes that sport for me ultimate passion.

5:51I love watching it. I think it's seeing the guys on that world stage, it's amazing to watch people move and seeing like some of the feats that they can achieve. Yeah. Right now it's the Ultimate Championships. Is that right? Yeah. World Ultimate Championships. Yeah. I was watching that last night. Pretty good. Jakob. Yeah. Jakob Ingrid Britson has had a phenomenal year actually. Great 5K win at Europeans and another solid win last night. Yeah. Returning from injury as well. Yeah. Yeah. Well, he is one of those specimens in human performance. Yeah. So when it comes to kind of like your job role, you mentioned that you have an obsession with how people move and how to kind of like optimize that.

6:32How do you even start that? Like what kind of tests do you do on a day-to-day basis with these athletes? Yeah. So I think it can vary the tests that you can do. You can go relatively simple and relatively complex. When I started out on trying to understand movement of athletes, I went really complex. So I used like cool 3D kit where you'd have these infrared cameras that are worth like 20 grand a piece, attach all these little reflective markers onto people and reconstruct the skeleton. And we started that way from a research sense. And as I sort of dug into my whole PhD of trying to understand what good inverted commas looks like, very quickly realized that for a lot of these different things, you can actually generally assess them from just watching somebody run with a slow motion camera, like on a treadmill.

7:20So for me, it's in terms of understanding and assessing the way people move, it's trying to kind of go, well, what does movement look like from a high performance perspective and from an injury-free perspective? And then can I assess them with like a slow-mo 2D camera? And I think you can and for me over the years i've developed simple checklists of certain things i'd always look for um that for me are different uh features that i think ideally i want you to look like this if you are to try to optimize your performance yeah and for the kind of like average person that is listening to this and they want to improve uh their running form stuff like that like what would them things be that you'd say to them like what would you want to look for to try and improve yeah so it kind of brings in firstly like this whole this whole question which i've had as i guess people have challenged me with my entire career which is which is is there a normal way to run and i think a normal way to run defense depends on what you actually want to do so if you only are going to run a couple of times per week i actually don't think technique hugely matters because what technique does is it influences how you store and return energy so that therein lies your performance element and it also influences how you stress different parts of the body which therein lies like your injury element but ultimately if you're not running a huge amount of miles per week or times per week it kind of doesn't really matter right you can move in a variety of different ways but what we sort of found from a lot of my earlier research was that as you start to increase the demands of running so somebody who wants to actually perform better do more miles the actual bandwidth of movement patterns in people become like more tapered towards a similar style so in those instances there is like a couple of features that I'd always look for so generally if I was viewing someone from side on I'd look at what they do at touchdown and specifically I have kind of three main features I kind of want the foot close to the center of mass as possible so close to the body as possible the shin should be like relatively straight aligned and and their like torso or trunk should be balanced between being too upright or too far forward so generally we're looking for like 10 degrees forward lean and those features at touchdown and having that style is about minimizing the amount of breaking you're doing so we'll have all seen that classic person who really reaches out and over strides what they're doing in each stride is effectively breaking and that's going to slow them down and it's going to increase their energy cost so at contact i kind of want to see a foot close to the body really as they move into the middle phase of running so as they get the body over over over the foot what you want to really avoid is excessive sinking so you kind of look into if you looked at someone's pelvis what you don't want to see it do is like sort of bob up and down excessively because again if you lower it it's like doing a squat you're absorbing a lot of force there and you're going to have to ultimately return it again for your next stride.

10:22So you kind of want to minimize that pelvis bob and that'd be the only thing I look for at that point. And then finally, it's like as they get through that swing phase of swinging in the air is do they sort of punch the knee forward in there, which can be a quite a simple cue because if they can get the knee back in front of their body before the next stride, you basically put your foot in a better position to be able to attack the ground and, you know, optimize then how you store and return elastic energy so they're some of my main features from a performance sense get your foot underneath your body and don't sink are going to be my two things and is there anything that obviously that's very hard just if you said that to someone very hard for them to execute yeah but is there any kind of key things or techniques that you give to people to try and improve this yeah so i always like if i was to view those things with people i always like simple cues and simple like externally focused cues we often see in like scientific literature if you make people focus too much on like what the knee is doing what the ankle is doing all this stuff it actually reduces performance so we we use a term of like externally focused cues which basically means focusing on the outcome or the feeling that you want from the movement and that often is associated with changing movement patterns better and better performance so the simple things i use for people is to make sure like they feel like they keep the hips up and they push the ground away or they can attack the ground from above and those are my simple things if if you feel like you're moving the ground away from you and your hips are staying high nine times out of ten you're probably going to have a decent running pattern and the other thing that people can actually do and i often use quite a lot is just monitoring the cadence yeah so most watches will look at your step frequency and yes i'll accept step frequency and your cadence will vary from person to person but for most of us on average it should really sit somewhere between 175 185 and is that on an easy run or like does it change depending on the speed that you go yeah so if you're going to go slow so if you're going to be like 50 minute per 10k it's going to be much lower so you might think that there's probably sat more towards the 165 end of the spectrum and if you're going to go for like um you know i mean what are you running for higher it's like 320ks yeah yeah so if you're running 320ks it's probably should be theoretically higher than 180 so you might be looking at 190 to more towards 200 steps per minute but for steady state runs that range between i don't know i work in minutes per mile so that range between like a eight minute mile down to a 6 20 minute mile that range should probably sit between 175 5185 roughly yeah it's interesting i don't know i don't know whether this is a good thing or bad thing but when i was trying to improve kind of like my running technique i'd listen to a metronome when i was running and i do all my running to a metronome all my easy runs anyway and i just felt like it just kept me not getting lazy with the contact time on the ground just I felt snappy if that makes sense and it also kept me so consistent with my easy run pacing my easy run pacing was always a 430 if I was listening to a metronome whereas like it'd drop a little bit lower or I might be a little bit faster if I wasn't listening to and I was listening to music instead or something like that so I felt like I was so much more consistent but for me after starting that i don't know it was weird like the first couple of runs felt like really odd and then i got used to it and then i realized i could increase my volume because i think it was because i wasn't overstriding and wasn't doing that breaking and all that force going you know through the legs like there was less of that yeah and that means that each run is less taxing and then you can do more runs yeah so interestingly like my one of my studies i think i published back in like 2019.

14:24So we took a group of injured runners who had your classic overstride, like really, or really bad technique, again, inverted commas for the word bad. But the intervention I actually got them to do was if the technique was poor, we increased the step rate, got them to listen to a metronome and monitor on the watch. And for those people that had knee injuries at the time, and it very quickly changed their technique more towards like a, again, optimal type model. But also we found in a short period of time, reduced pain in the knees and allow them to get the volume back up to what it was beforehand.

14:55And in essence, I think for me, manipulating step rate and keeping your step rate quite high has quite a few functional benefits. I think it does stop over stride. So then you minimize the total amount of breaking force you're having to absorb, which then actually takes the stress off the knees for one. It generally takes down the overall force on the whole body as well. So actually it becomes less demanding per stride and um it creates a better alignment of certain limbs and pre-activation of muscles so you find like if you tell someone to increase their step rate muscles activate before they hit the ground so then they're in a better position to actually stabilize the joints versus when you get tired and you're a little bit lazy i often say to people when you get tired and lazy it's the ground attacking you versus increase your step frequency and you attack the ground you're better prepared when you're attacking the ground to stabilize your joints than if it's a shock yeah you're kind of just like more switched on yeah no i definitely agree with that when obviously like you say you you see like a broad range of runners but what are the most common injuries that you come across i kind of bucket injuries in two different themes like there's volume-based injuries and then speed-based injuries so your volume-based injuries like are those when athletes are trying to chase lots of long slow miles and the most predominant volume based injury we tend to see hit the knee and particularly like what we call runner's knee is the patellofemoral joint that's the one that tends to get the most overloaded there is runner's knee itb syndrome or is that something different no i've runner's knee itb syndrome is something different and that's often like pain that's right on the outside of the knee whereas you run as knee patellofemoral pain is pain in the in the front localized around that sort of patella region um itb is is not as common as actually it's reported to be the most common one is around that patella joint um so this is slightly different i mean someone gets itb syndrome my general advice is shut that down because those are ones that are absolute nightmare to work with sometimes if you let them get out of hand patella femoral so front of the knee tend to be a little bit easier um but i call them volume based injuries and primarily it's because when you're doing slower and longer miles we see the knee joint is the one that takes the most brunt of like absorbing force and returning it so all the stress localizes to the knee and then the opposite end of the spectrum is we see like your speed-based injuries it's obviously sprinters you're going to see hammies but in like your endurance runners those who have more percentage of track-based workouts or middle distance runners who are trying to run a lot of their runs at faster paces the load actually shifts to the Achilles.

17:41So lower limb injuries then tend to be the predominant thing that we see. And like, interestingly, and this is, I guess, the geek in me, a few years ago, we did a couple of studies that looked at when you increase speed, what happens to stress on joints? And basically we found the knee, the faster you run, the more the stress was reduced on the knee. But the stress on the Achilles just goes up and up and up. so if you rob slow volume for high speed you just shift in stress from one area to another and what would be the things to overcome these so say for example we start off with the runner's knee like how would you go about overcoming that would you reduce your volume yeah i mean first first of all like i always think what happens is we can get stuck into these injury cycles where we start with pain and then what pain does to our body is it leads to a lot of dysfunction.

18:35So we'll like compensate, we'll unload certain areas and those compensations can actually exacerbate pain sometimes and stress on areas. So we end up in this vicious cycle of we compensate for the injury because of pain. We overload a different area and we get another injury. So my initial general premise for managing most of them is shut them down. First of all, I always say, don't let a niggle become a nightmare. So if something starts like kicking off or is painful or doesn't feel right, I generally shut it straight down because what you're doing is buying yourself a bit of time for the body to start healing it.

19:10And I like a step by step approach. So I'd probably then return to some form of gym based loading exercise, particularly around that area, because it will allow you to sort of see in a controlled way, how well that joint or tissue is tolerating force. So like a knee, for example, if you overload that knee, shut it down until it's calmed. Then I'd have probably started with like basic squats or leg extensions. If it tolerated that, I might think right now I'll just return and add in an easy run. That builds you a bit more confidence that's going to tolerate what you're doing and stops you from letting it become a complete nightmare.

19:47Because the big mistakes I see with most runners who pick up injuries is they, we love to run, right? So we just then ignore the pain that we're feeling and continue to try and muddle on and push on through it and that often then results in that niggle getting worse any sort of injury around the area becoming worse and before you know it that's a night that is a nightmare to manage the longer you've had it the longer it takes to get rid of it versus nip it in the bud and often it can be just a short turnaround time yeah i've definitely felt that in the past where like uh you overcompensate or i don't know if this is a case as well where muscles actually switch off yep yep yeah 100 so um we do see that like once you put injury in a particular tissue the body has a very good way of like trying to redirect where it recruits muscles so if you like injure a calf for example the nervous system will want to shut that calf completely off because it will just try to protect you from doing further damage to it but the problem with that is that it means that actually you are perhaps more vulnerable to overloading somewhere completely different or when you are returning to load if you're not recruiting and activating that area effectively that you're not developing its resilience to subsequent running so actually you think it's fine but now it's much weaker than it was before so the next run is less prepared to deal with so how would you go about like fixing that um i've had issues before where like say i had knee pain and i don't know if this makes sense but i feel like my quad hasn't switched or it switches off and then even when i'm doing like a leg extension like i can't really feel that connectivity yeah um how would you go about fixing that do you need to get rid of the pain first to switch the muscle back on yep yep 100 like if pain is in the system you will struggle to recruit that muscle used to see that was the first thing i learned in rugby really it's like i'd have players that come in with a massively ballooned knee that just injured the knee and two days later they'd come back and i remember one of the australian players coming in and just like literally picking up his quad and dropping it and going, man, where's my quad gone?

21:50It's just disappeared. And it's all because the pain will drive inhibition around that specific area. So what you've got to do is drive the pain down first of all. And then the second thing is about how we reload that tissue. So once that pain is down, the real art is how we find an exercise that allows me to re-engage that muscle in that area. And that literally is an art, right? So with a knee, might be leg extensions work. Might be that I have to use supported single leg squats. might even be that i just have to get someone to statically try and contract it repeatedly but once i find that way of actually getting them to switch it back on then you just chase that same thing you chase it you chase it you chase it and then you try to bring it back into different things for me i always have like layers of like i'll kind of go isolated function so switch the quad on with the leg extension into more um challenging tasks so that's where i like the use of running drills because all of a sudden i'm like okay now can we bring that muscle function or joint function into a movement pattern that is simulating what you're doing running wise and if we can do that there great now can we reintegrate into your run and then with tendons in particular is there kind of like a rehab protocol that you you go with that's kind of like different to treating like a muscle injury so say like a calf injury yeah tendons i think um a lot of the time are very misunderstood how we manage them right if it's patella tendon achilles tendon you know what most people will do is they'll just shut it down and rest and think that rest is going to make my tendon better but actually time off from loading activities has been shown to cause tendons to decondition so if you simply rest that tendon yes the pain might go away but structurally it becomes weaker over time so rest and then return to run is the worst approach ever the way tendons adapt is through high force loading so they actually like high strain they don't like speed running is classed as fast so that's kind of why they don't really like running if they're injured but what they do like is high force sustained over repeated loading bouts repeated times so really they should be let to settle first of all but then like actually exposed to heavy load so we use two approaches we either use isometric training where we just push against a heavy resistance for a duration so it might be like five seconds push offload five seconds repeat um or another thing we call heavy slow resistance so basically starting on an achilles might be a calf race starting for like 15 repetitions max then over a period of time adding a little bit more weight on going for 12 rep max all the way down to like your six rep max so tendons if you don't reload them they just will decondition and then people wonder why they then go back to run and very very quickly get into this that sort of recycle of injury and i also think that's kind of because people don't acknowledge or appreciate how much force is going through the body when we run is like glutes are the most the most cliche thing as being the main contribute for running right yeah they're the biggest muscle in the body and they're the propellers forward yeah but the actual factor is the majority of force is going to go through your ankle and your calf your calf contributes around 70 percent of the the total amount for verticals for keeping you up when you run and the force going through that it can exceed two times your body weight so i'm what 70 kilo human semi-kilo human i'm a semi-kilo guy so if i run i'm putting around 140 kilograms of force through my calf and achilles alone on each step which is crazy right yeah that is crazy that's uh that's some load so like how would you even go to building up kind of like that tolerance like obviously i don't know i feel like even i've thought this in the past i'm thinking oh well my calves hurt after I've been for a run so that must be enough calf training do is that correct or do you need to assist it within the gym as well to make sure that you don't get calf injuries um so I'm going to say something that's probably controversial for most strength and conditioning coaches and people who work in that space but working with if you're an endurance athlete or you're training endurance running and you are healthy with no calf or achilles problems I'm kind of happy to say that um your running should be enough to look after that calf now why i will say that is because as i've said like the demands on the calf are really high with each stride that you're accounting for when you run and if you're trying to increase your volume of training that's putting a lot of fatigue in the system so then if i'm also adding in now a load of gym calf based loading i'm adding further fatigue on a structure that's already fatigued right so for runners who and you're trying to chase high volume, if you're injury free, I think the priority then comes actually let some of your tissues recover.

26:54And the calf is an important one to let recover in my opinion, because those force demands are so high. If it becomes fatigued, it's actually really easy for that to like develop an injury versus your glutes when you run, like they are working no way near their max capacity for a steady state run. So you can go in the gym and load the hell out of that. And it coped with a bit of fatigue the next day. Whereas time and time again, calf, I feel I'm like playing with fire a little bit especially with some of the elite middle distance guys if I'm going to load up them up with a load of calf raises and then ask them to run fast on the track the next day um so with the exception of if it's healthy I kind of like leave it alone and unless I think it's a big injury risk for that person now if they've got a history of achilles or calf problems then that's probably where we need to look at how we condition that person to deal with it and if you did want to just kind of like supplement your calf training in the gym i've been told to do more kind of like isometric work over actual repetitions of like calf raises yeah why would you why would someone do isometrics instead yeah so i'm a huge advocate for isometrics particularly around the calf mainly because um isometrics are associated with developing less muscle damage so when you feel dons after a workout it's often because we've created some local level of muscle damage which puts fatigue in the system now isometric contractions allow you to push really high force so you can work at a high percentage of your maximum without causing that same level of muscle damage so we get really good stimulus on on the tendon on the calf complex for it to adapt but it recovers significantly quicker so you know they're one of my exceptions are if i'm working with an elite endurance athlete who wants to run a lot my only calf loading i'm really going to go is going to be isometric concentric up and down creates metabolic stress so you just get a good pump on the muscle it creates a lot of metabolites in the area it feels fatigued and sore and the eccentric component will also lead to like tissue damage and muscle damage so you're just fatiguing it so i'm there's the additional bit of like if you can lift a weight up you're not working anywhere near your maximum because you're lifting it up you're moving it versus if you push against something that's a fixed immovable resistance you can apply 100 % of your max effort to that object so i found over time like i do a lot of testing so i'll profile limbs and i generally find if i use your classic up and down approach so isotonics i can profile calf strength and get nowhere like those plateau then if i switch to isometrics so they're just pushing against the bar short three or five seconds really hard efforts their strength can actually start bouncing up and up and up and that's just because it's working that muscle to a higher i guess intent yeah and will it uh stop hypertrophy as well or reduce the chance of hypertrophy because you don't really as a runner you probably don't really want hypertrophy within the the lower limbs yeah yeah that is true like lower limbs you want to keep them like knee down you want to keep as light as possible because it's associated with better economy um firstly i think like isometrics you can still get hypertrophy with it but the likelihood is probably going to be a little bit smaller than classic resistance training i think the the idea of doing strength training for endurance runners though and the fear of putting mass is sort of become a it is a little bit of a myth because actually the level of endurance volume that people are putting in um often means it is really quite difficult to build like mass and put on bulk so generally i'd say to most endurance runners like you know bodybuilders will complain that they can't get the calf muscle to develop right you'll have heard that so if an endurance runner can go in do some calf raises and build a big calf i'm like wow you've got some some skill there some genetics yeah so i think the endurance running volume often negates the mass production so generally i wouldn't be as afraid of that and then there's the added benefits that even if you did get a small change in mass knowing that lifting heavy will increase tendon stiffness so tendon stiffness is like how good your springs will work when you run is actually really beneficial so for endurance runners that thing of getting in a gym and lifting heavy weights has been shown to improve running economy quite considerably so i think what everybody knows is the super shoes right do you remember nike's original marketing campaign of like how much the super shoes improve your running by i didn't watch it i don't think no they originally said like the super shoes improve your running economy by four percent oh yeah because they were called the four percent yeah yeah night four percent and so everybody went out and was buying them but if you look at like like studies pooled overall and strength training in endurance runners the improvement could be anywhere up to like seven to 11 in running economy so everyone like run out to buy all these shoes that give me a four percent advantage versus actually a gym membership and just lifting some weights probably going to give me a far bigger gain yeah and what is the reason behind that is that like less time to fatigue when a couple of things it's thought that if you can improve your max strength capacity to run at a given intensity and produce force at a given intensity is easier so increase your ceiling everything else is easier yep yep so that's one and then the other bit is like actually lifting heavy weights makes um things like your tendons stiffer so your tendons are big springs that actually store and return elastic energy so the the functionally stiffer they are better of a spring the better they are at like making you a kind of economical when you're yeah and then a lot of people say like if they fared at the back half of the marathon this way oh i need to do my gym work yeah is that is that truth um well i'm gonna say the priority 101 is probably review your physiology and actually your training like because fundamentally if you if we want to improve endurance running performance it's like build the engine first so that's your vo2 max you run an economy that comes from your training but strength training does have a role to play here so there's a really cool study published a few years back by now by um rich bligrove's group from loughborough university and rich is a great snc coach and sports scientist and what they did in that study was they they took a load of marathon runners and they gave one group uh snc like so strength training and plyometrics to do and the other group nothing and these are in well-trained individuals as well mind and looked at how it influenced their running economy so in well-trained runners the strength training didn't really change their economy at baseline but what they found was those who had done the strength training maintained their economy better later in the marathon whereas those without the strength training actually started to drop off ah right okay so the i think they referred to it as like the strength training can help build running resilience so you can maintain your form maintain your economy for longer and that's probably the more pertinent effect in your trained athletes in if we're not well trained generally doing some strength training will probably make us faster full stop yeah so everyone get into the gym we talked about like the kind of like calf and low limb injuries the knee injuries yeah um what about kind of like hip dominant injuries or like maybe maybe lower back as well like are they linked do you see many of them within like your profession yeah we don't see huge amounts like they are definitely a lower percentage of like injuries that account in endurance runners you can get some so there's like burces on the side of your hip that can sometimes flare up or tendons on the side of your hip that can sometimes become exacerbated those are the ones which like you'll feel pain on the outer side of your hip often associated with trying to like rack up really long miles and like long runs and it's that just that repeated cyclical loading of your leg that kind of sets them off um lower back injuries not so much so um i think if we start seeing lower back injuries yeah around runners we've sort of got to weigh up if there's any other factors that might have contributed to them i think yeah no it's uh it's interesting obviously uh i asked that question because i've had so many like lower back injuries um and i've spoke to many kind of like physios along the way and they say that if you have got kind of like back injuries and you might not have done it through running you might have done it through something else but it can make parts of your leg like inefficient so you may get a hamstring tear or you might make a car tear and it's actually down to your lower back yeah a bulging disc in your back rather than the actual muscle itself yeah so the effectively spinal function well you got your spine and all your nerves pass out through your spine and down the lower legs.

36:02So if we have any injuries around the lower back, it can affect the, I guess we call it like the neural flow. Technical word is like axoplasmic flow, but basically it can affect the function of the nerves that supply the muscles of the lower leg. So that can lead to things like the muscle doesn't activate as quick or can't contract as hard. So actually makes that lower limb muscle more vulnerable and so you know it's one of those important aspects that we do ask like when an injury occurs it's like okay have you got any history of lower back injuries and we have got to consider it so things like hamstrings and calves for muscle type injuries i think that's a really big player that needs to be like considered and addressed there yeah i i just got given the advice of uh especially like if you've had like a herniated disc or anything like after travel just try and avoid running yeah like the day of travel so say for example you have a flight or you have a long car journey like if you can cross train don't don't actually put that impact where you add an apply metric low to your lower body because you can increase risk there moving on to kind of like warm-up drills and stuff like that uh what is a typical warm-up that you like to see your clients do before kind of like a running session yeah yeah cool i think there's like nice differentiator there between running session and just a general run i think for sometimes i get asked like what should we do before we go out to run and should we do a lot of activation type things the honest answer is unless you have a specific problem or unless you're feeling tight and sore generally we should all just be able to run out the door um however when it's coming for like more intensity in terms of specific sessions and the demand on the body is greater and therefore I actually think the preparation needs to build adequately to not only prepare your body for actually that session but also work as an internal self-screen as is my body ready for this session and so I kind of like those to look like just gentle warm-up jogging first of all to sort of raise the heart rate then I use a lot of like mobility type exercises first of all so that might be things like leg swings and I use ones where you lay on the floor and you like leg swings on the floor so trying to touch your hands out to the side knee hugs and doing the same thing face down those mobility exercises there and then for me i always say to people that's your internal check-in so as you're doing that what anything does anything feel sore does anything feel specifically tight is that abnormal compared to usual that should allow you to think well you spend a bit more time warming this area up or could start to feed into an early warning sign that you might want to take the sting out of the session.

38:47They'd go from mobility and then that's where I use drills. So drills for me have so many different benefits. Yes, we can use them for movement patterns, but in a warmup, that's just about progressively increasing the intensity of the demands. So it was like, it can be like light level skipping, little pogo drills, high knee type drills. What I'm basically doing there is slowly building up the impact, slowly building up the speed of my leg movements and slowly building up the range of movement that I go through. And again, I always say to people, that again is your check-in. It's like anything feel abnormal here.

39:22That should then feed into some strides. And then after strides, then I'd start to probably go for like a sub max rep first of all and build into it that way. Going through that process for me, not only does it just like prep your body for those demands of higher speed and higher intensity, but it just gives you a bit of like a self-checking as like should I really be doing this today or should I just can the session and go home I mean that's one of the the big insights I kind of got from spending time around some of like the world's best athletes right was that sometimes they turn up to a track with a planned session in mind they might have done their warm-up and then automatically just gone no I'm just gonna go for a run today I'm just gonna can it I might come back tomorrow and do the session how often does that happen like obviously it shouldn't happen regularly but like there's like what i'm trying to get across is like if that happened to me i'd probably be devastated or i'd be too stubborn and be like i've turned up to this session i'm going to do the session no matter what like they probably don't feel like that right yeah not always well they definitely don't feel like that i think some athletes you look at i'm not going to mention I'm not mentioning any names in these people but you probably imagine the type of people who they were where when we'd be on like a camp right everybody would turn up to the track in the morning because that person had told them like yeah got a session planned on this day could do with your support down at the track for like pacing timing things like that you turn up and they wouldn't be there and you'd like message them or phone them and be like yeah I've you know just getting up now I'll be there in half an hour and then half an hour later they'd be like nah I'm canning the session today and they wouldn't bat an eyelid about it and at the time everybody criticized that approach and was like oh this person's so disorganized or I can't believe it they're just like late for training and stuff like this but they were some of the world's best athletes and then my reflection back on that was like actually I think these people are just really good at listening to the body and making a decision of when it's go time and when it's not because ultimately for all of us to build the engine and to basically shape ourselves into the way that's going to give us the best performance it really comes down to consistency so it's not about having single hero sessions and those every single one of those sessions being as hard as possible it's about consistently being able to chip off the days get the work done without breaking down and what inherently we do is we set out a plan or get given a plan and feel like we need to stick to that in a rigid sense but that plan didn't account for how your body might change and feel on a day-to-day basis didn't account for if you had a bad night's sleep didn't account for if you had a long drive and now you're really stiff the next day so if you rigidly stick to it you potentially run the risk of like overcooking yourself and one thing about those really high performance guys i think was the self-efficacy and self-belief to know that yeah i don't have to do this session today and I'm still going to be the best.

42:17Where does that come from do you think? I think there's probably like an environmental factors and sort of some innate psychological traits within people so like environmental factors I think and our support systems when we sort of grow up and when we're in in sport and the people we surround ourselves with I think can often breed and help us develop that confidence in what we're doing because we don't doubt ourselves all the time and then you know over periods of time when if you get success off doing it that way it further reinforces and feeds into that habit but i think environment is probably a really big one for like what's your social support system like what's your coaching environment what the people like behind you are they championing you are they giving you a a rain check when you're just getting ahead of yourself um or you know are they feeding into negative and bad behaviors that you constantly feel like you need to just prove your worth on a session have you noticed like any similarities between like the top performers that you've treated like that being one maybe oh 100 i think when you look at those really high performance guys i think psychologically they seem to have like a couple of very similar traits so from my observation one of the traits that they seem to hold is they all have a degree of grit about them so grit being like that ability to persevere even despite any negative thing happening just that dogged attitude that i'm going to do this no matter what and they have that higher amount of self-efficacy and confidence so they believe in what they're going to do and and also there's that element of, I guess, self-motivation to learn and viewing any scenario as another opportunity to perform.

44:08So if anything negative happens to an elite performer, most often some of them will view it as a challenge to overcome. So they've got a goal-oriented mindset. That's a challenge to me. It's not a barrier. And I think those collective things seem to be quite common in those people who are big high achievers because we're all going to have instances that are going to moments that are going to be negative be it injury be it poor performance but one thing that the best seem to be able to do is reflect on it box that off quite quickly and rise to the next occasion rather than stay dwelling in that negative moment and letting it affect subsequent behaviors and performances yeah no i feel i definitely feel that across the board like a lot of people have said recently whoever i spoke to uh they've said that you need to believe it before it becomes true if you don't believe it then it's never going to happen yeah yeah there are arguments that like you know our psychological delusion yeah well you look at some of i guess you're publicly common like athletes that you'd see your athletes like your conor mcgregor in the the UFC type scenario or Jakob Ingebrigtsen or even like this year you listen to interviews from Josh Kerr and a lot of these guys or these people they'll come out and they'll literally put their belief on the line it's like this is what I'm here to do I'm here to win I'm here to break the world record I believe I can do it and they're willing to like hang their beliefs out there and go for it and I think that if we want to achieve something great in life why would we like hide away from saying it if we you know and not believe in ourselves yeah like it sounds mad but obviously when Josh Kerr like announced like six months before he broke the record that he was going to break the record on that day like it's crazy that he actually went and did it and backed it up and I feel like everyone respects him for it and like it's huge respect for it but it's crazy that you can have that confidence and know that you're going to do that especially like when you know his PB before that was a couple of seconds difference and so on like it's it's crazy it's insane yeah it's that confidence that you get though from building the work year on year and having faith in your process and what you were doing and knowing that you've banked all of those like hard sessions and all of those days leading up to that that will give you that belief that you know what you are capable of yeah how much do genetics matter like versus like hard work and does it differ between more of like your your sprint athletes compared to kind of like your long distance yeah i don't think it differs i think genetics have a really high role to play right because like it's known that genetic factors will influence your vo2 max for example so we can vo2 max is one of those um performance determinants for endurance sport like how much oxygen can we consume when we exercise maximally right we can train that but largely it's going to be predetermined by our genetics.

47:16Similarly, like we see some genetic factors that are involved in how the structure of our tissues are made. So some people might have like weak tissues that is largely genetic. The problem there is they're not going to be able to have the robustness to hit high levels of training that they need to, to develop that engine. So genetic factors are a hundred percent at play, but they are not going to like define somebody's success if they don't have all the other ingredients in that mix and they're also not going to stop us from succeeding unless if we have all the other ingredients in so you can have the best genetics in the world but if you're in a poor training environment got negative social influences and just not getting the work done you're never going to be able to exploit that versus somebody who then is able to like consistently achieve the training maximize their own individual potential you know maybe might not break a world record right but might still be able to compete on a world stage and might still be able to put themselves in the right place at the right time to to win a medal or um you know win a comp or whatever that is yeah i think that that genetic argument and performance argument high rock's world champs this year like the amount of chaos that occurred in that men's solo event kind of showed that that leaderboard changed all the time So you probably got some people who are just genetically gifted in there and some of the people who've just worked really hard to get there.

48:46And the way that race played out on the day will have completely flipped and changed that podium. So I don't like the idea that, I mean, maybe it's because I'm not genetically gifted and therefore I don't want to believe this, but I don't like the idea that genetics are going to constrain me. But I do think that they have a big role to play if they're nurtured in the right way. Yeah, no, I agree. and I think for me personally I think there's some sports like High Rocks I don't know why but I think because it's so new I feel like working hard and being disciplined and all the traits away from just genetics like play a huge role and probably a bigger role than just genetics because we've seen people that maybe we've seen people that are world champions now like tim uh tim was world champion last year he has been in the sports since 2018 and he's always been kind of like in and around the elite 15 but it's took him eight years to become world champion so he's racked up that consistency yeah it's consistency it's hard work and as well but there obviously is an element of genetics involved as well because a lot of the athletes have been professional in other sports i think at the moment high road is really is really interesting one because i think because it's so new and the like the the physical and physiological determinants of success in that sport aren't entirely understood at this moment in time it means that we're not able to like there's lots of ways to approach training and nobody has got the actual training that works for success completely nailed on so consequently we're not really able to exploit those most genetically gifted people but if you look at how it's developed over like since like 2019 to now the running element people have gone yeah that's important and the actual running speeds have really ramped up so people are starting to know what the training demands are i think once people fully understand more of those like specific physiology and genetic and physical makeups that make success, you'll start to see more of those just genetically gifted people who are suited to the event, like flourishing.

51:08If you could place your bets within kind of like a hierarchical space on like what are the genetics that would make the best hierarchical athlete? Would it be tall? Would it be small? Would it be great VO2 max? Or would it be like more explosive muscle fibers rather than type two muscle fibers? I'm going to put my hat on. I'm going to say VO2 max is going to be a massive component for that, primarily because VO2 max is obviously about how much oxygen you can consume, right? And to perform the strength elements of some of those stations, you need a decent degree of muscle mass. The problem with having muscle mass for an endurance runner is that it increases the energy cost to run.

51:53So actually, you need a really high VO2 max to cope with the demand of your muscle mass and to make you move. so that is going to be like a big one is you'll find those people have a massive engine vo2 max the other bit then is i'm going to just go like what i think is same for most sports is you need to have a genetic predisposition to more robust and resilient collagen tissues so body tissues because the training is just so demanding if you don't have robust tissues i think people will break down because they won't be able to hit the same endurance volumes and the same strength volumes on top of it yeah do you think the the future hyerox athlete will be smaller um or bigger than the current i think the current average probably about 82 to 84 kilograms yeah weight in the male section like would do you think that's going to decrease or do you think that's going to increase i think it's going i think your perfect athlete right is a male decathlete or a female heptathlete okay why because those athletes have to have that perfect balance between strength skill and endurance because they've all got to do an endurance component with it um so i i think mass will stay around the same and height would be a big advantage because height will give you bigger levers that make the ergs easier so rowing 100 easier wall balls 100 easier because less height to throw that ball smaller you are smaller you are the height you've got to throw it the more force you've got to put in to throw it up um so is it a faster rep speed though i don't know um theoretically it's going to slow them down as they've got to move through a bigger range on the way down so it might slow them down in that instance but i definitely think it would just make them more economical at that station um just like me you are much taller than me so for you it's like less height to throw that ball whereas yeah i'm pretty well you've got the burpees though so does that is that better for a smaller person um i think again there's kind of a balance here because a taller person is gonna you know be able to jump longer on the broad jump aspect of it but then those bigger levers is that like statistically true like long jumpers are taller oh i don't know if the stats are around long jumpers are generally taller i mean or broad jump in should i say but yeah if you've got longer levers you will 100 be able to create bigger talk okay around those levers to create more force in the ground and go further and most often historically we've seen people struggle right to deal with big levers and to generate the necessary force but take then a usain bolt as an example someone who learned how to manipulate his big levers and create the relevant amount of force all of a sudden increases his step band can go faster yeah it is really really fascinating um in terms of kind of like the gym yep we'll start with runners but are there like key exercises runners should be doing in the gym yeah yeah and that's an interesting one um so when it comes from an endurance running just generic conditioning perspective i kind of break programs down into um a double leg max strength exercise, single leg max strength exercise, and then some sort of focused accessory bits that might complement or benefit people.

55:16So if I just go, when you're in the gym, what you're trying to do is build the physical qualities that are necessary for that event that you're competing in. And ultimately for running, the physical qualities are needed to create, absorb force as you hit the ground, create force to propel you forwards and stabilize on one leg. That's kind of it really. So I'd always go with a max strength lift and I try to keep it simple. It depends on the skill of the person. If they're complete novice, leg press, hack squat machine, absolutely happy with machines. Are they going full range or are they going half?

55:49Because you see a lot of runners doing like half squats because they say there's no need for the full range. Yeah. I think there's a time and a place for both, but if I was to pick one, I'd have just gone half range. Why half range? Probably because it'll allow you to lift heavier weight, which would be a bigger stimulus for your tendon. when you go full range you're going to compromise the load that you can lift and then the range would create the partial range as well would enhance your strength through greater weight lifted in those specific running ranges so you think like the knee it's going to only move really between like zero and 40 degrees in stance so it's not going anywhere near past a half squat for most runners so i'm kind of happy with like half depth happy with machines or a back squat if you're competent at back squat if they're not or they've got history low back problems i'd have just gone track bar deadlift allows me to still really push high forces in controlled ways at single leg max lifts again i'd have i'd go relatively straightforward so i'd have kind of either used like a i like split stance track bar deadlifts so you don't get the split stance and lift or single leg leg press bulgarian split squat i think they're great for i guess inverted commas ironing out asymmetries um but working in a unilateral fashion so one leg which is what we're going to do when we run then i often just like to complement other things in around there like hamstrings i think are overlooked in endurance runners they're not well conditioned in the event so i think they get neglected easy so use either like single leg romanian deadlifts which have a balance component to it and hit that tissue and then maybe if the calf complex is something we need like a simple isometric calf push with the with the hamstring just going back on so you've got hip dominant yeah hamstring exercises and you've got a knee dominant yeah hamstring exercise so like a hamstring curl would be knee dominant and then you'd have something from the hip maybe an idl that is going to be more of a hip dominant yeah um for running which is more important to work on for an endurance runner i'd have gone hip dominant right function function the reason being is because we largely think the knee dominant ones are about helping us slow the leg down as it flicks out in front of us when we swing okay but endurance running the force demands at that point pretty low however when we hit the ground the hip portion of the hamstrings is utilized to sort of propel our hips and extend our hips so we can go through the air so i generally for endurance runners first of all would buy us a hip dominant one because i think it has more functional demand as we run to sort of project ourselves forward sprinter i kind of think you need a balance between the two yeah now it's really interesting because i train out of like a crossfit style gym and we're lucky enough to have a leg curl but most crossfit gyms don't really have a leg curl yeah so everything's very hip dominant unless you're doing nordic curls which i don't know when the last time you walked into a crossfit gym and people were doing nordic curls but uh everything's really hip dominant whether it's a power clean whether it's an rdl whether it's a deadlift um so for me i found when starting to do like more running i was really weak with like you say the curling aspect yeah i needed to work on that a little bit more yeah yeah so that's where you start to find these nuances for like running performance the the additional bits that we then end up needing to actually work on to enhance that um is there is there a thing with um is there a test between quad strength and hamstring strength as well which is an indicator on whether you're going to get injured or not yeah people used to use this as a ratio called hamstring to quad ratio and um i saw it come up at some conferences i was speaking at last year and to be honest i thought that was buried way back in the 90s but it appears like it still comes out um there was this concept that if your quads were excessively stronger than your hamstrings it increased your injury risk um i don't that concept hasn't held strongly true over the years um because the idea was about how your quads would create greater speed of your leg as it flicks out but that's just a load of rubbish perfectly honest um i think it becomes down to like sport specific instances we've seen loads of occasions in football specifically where the quads are actually too weak and that's why they're getting a hammy injury because instead of being know to slow themselves down they can't bend the knee so they just collapse forward and the hammy goes oh right okay um so i think it is a thing and it still goes like floats around but the evidence is just not robust for it and i think that is a little rubbish how important is it in the gym to work on all these like tiny muscles so muscles that you're stabilizing muscles yep yeah Yeah.

1:00:44I'm going to say I don't like time wasting things. I remember when I came into you and I showed you all the exercises I've been doing and you said, you're fucking just wasting your time here. You're spending it like, and to be fair, a lot of people tell the piss out of me. They say you spend more time faffing than you do training. And the faffing is all the kind of like tiny exercises. It might be clamshells. It might be hip airplanes. it might be bouncing on one leg all that kind of stuff that you get told you need to do as a runner for longevity um if the if the faff is taken away from your ability to execute the training sessions you need to do hard um and just putting more fatigue in the system then from in my opinion it's just complete faff so unless there's a specific reason i i am weak in that area and it's contributing to ongoing niggles i think all this band related stuff of turning my foot in and out against a light resistance band or um clam based type exercises i think just they're a bit um there's just a bit excessive sometimes and there's only so much you can fit in the day so the reality is you've got to prioritize is like what do i want to gain out of my training am i here to try and perform or am i here to try and prevent injury um and you know to add it i just think you don't want to take away from that like performance is what you want to do and if those small level exercises mean that they're producing even lower levels of fatigue i mean my max lift is now lower than it what it could have been it's compromising where i could get simple performance gains yeah i have noticed a big improvement just by taking a step back scrapping the tiny exercise and just doing more kind of like heavy compound lifts and getting strong in them areas so say for example i want to strengthen my glutes before i might have been doing uh standing on one leg balancing uh banded exercises now i'm just doing a heavy hip thrust yep yep and i feel so much better see if we're to get muscles to adapt or tissues to adapt we kind of need to work them close to their ceiling so my thing that i'm not a fan of the faffy stuff is that if it's not touching the ceiling of that tissue's ability it's just not going to adapt it's not going to Like I'm not going to get my biceps bigger by doing a really light level bicep curl.

1:03:03And I always kind of think the same in terms of like clams with little bands. I could probably be there all day trying to work that muscle. So if I'm doing like really high volume reps, the only thing I'm potentially improving is its endurance capabilities. There's going to be minimal changes to actually its force production, its size and its tendon stiffness. So for me, then the faffery is a little bit about, well, what am I actually trying to get out of that exercise and how is that going to benefit me because there's too many myths that we just do this exercise and it's injury prevention when it actually that just does not hold up true what what are the some of like the biggest like myths that you've come across within the space because there's so much out there like there's so much information out there when it comes to uh any injury related stuff or how to get strong in the gym or anything like that yeah I think some of the myths are like, running's bad for your knees.

1:04:01That's a real big myth. It's like being excessively competitive and running through injuries is bad for your knees. Running in general is really good health for your knees. So that's a good one. Stretch tendons when they're like sore. So stretch my Achilles tendon or rest my Achilles tendon. That is also a massive myth. The endurance runners should just do low loads, high volumes in terms of strength training. that's a big myth. Endurance runners should lift heavy like the rest of us. Better for your tendons, better for force production. What other ones? Yeah, endurance runners are going to put on excessive mass by lifting.

1:04:41They're going to struggle. They won't put on excessive mass. I mean, I went through early in my mid-20s when my work was increasing and my 400 meter ability was decreasing. I went through a phase in my life where I was like, not running fast i'm just going to go in the gym and get massive and all my days that was hard to do to put on it muscle mass is not easy to do so for an endurance runner running significant amounts who thinks two to three times a week in a gym is going to stack on overly too much muscle mass that's a big myth yeah they're probably some of my major ones no and then with um oh i'll give you a bigger one anti-pronation shoes and get my gait analysis done in a running shop that's a controversial big myth but gait analysis is not going to prevent your injury to be fair i had someone i was talking to someone today and they just said oh they've just got some new insoles for their shoes and they've had to throw out all their old shoes and now they can only use like supported shoes yeah i'm not for that shoes are a really big myth right so So, you know, where this sort of theory sort of came from is, or you could argue that the anti-pronation idea and the gait analysis idea of your running shoe is a big marketing campaign to get you to buy more and different running shoes.

1:06:02When science has tried to... That's the tinfoil hat theory, yeah? Yeah, yeah, yeah. I agree with that, by the way. So when... But the bit that's backed is if you look at the science of using running shoes to prevent injuries, there's actually sort of minimal there, right? You can't, what we know is you can't seemingly prescribe shoes and reduce running injury rates. So that whole philosophy of I'll go to a shoe, assess my gait, and it will stop me from getting injured is literally a gamble. So when it comes to running shoes, they have the biggest myth associated with them. Whereas actually, if you break it down and be a bit more simplistic with it, the primary one-on-one factor is comfort is king.

1:06:42so if it doesn't feel comfortable on your foot that is not going to be a good choice in shoe and what we do seemingly have some evidence to suggest is like if you cycle your shoes and change your shoes then that is more beneficial in terms of reducing the risk of developing an injury that's due to because you're spreading out the load on like if you're wearing the same shoes all the time and it bends at the same point then you're going to have more load going through that point of your foot whereas if you change the type of shoes that you wear then there's going to be different loads in different areas and it's just going to spread it out throughout the week yeah it's the idea of everything in moderation right okay if we do too much of the same thing our bandwidth for what we can cope with becomes very narrow we get very good at just running in these shoes in the same straight line on the same flat surface and the body will then reduce its ability to cope with variation.

1:07:37So all of a sudden, then if you were to change shoe, you get a dramatic change in stress. Your body can't cope with it because it comes too rigid in this path. The same respect of like, if you run in the same shoe over and over again, you're just stressing the same tissue over and over again. So the simple thing is moderation is key. Everything in moderation, mix up your shoes, make sure they're comfortable when you utilize them. We can be a bit nuanced and I've tried to be a bit more nuanced in terms of giving advice on what might be beneficial based on biomechanics but scientifically we cannot reduce injury rates and and what i'd say is like what how long have i spent researching running working in this space like probably research i started using doing biomechanics research in 2009 so if i've been doing it since 2009 and i still can't um give you conclusive advice on what shoe is going to prevent injury i don't understand how somebody else can that is a fair point but like yeah i agree with that what about um like collapsed arches and stuff like that like some people say oh if your arches are completely collapsed then you've got no chance um otherwise if you've just got weak arches you can strengthen them like is is all that kind of what's all that about so again i think that falls into this whole paradox of like prescribing shoes and trying to come up with themes of what might be the cause of our running injuries.

1:09:06It's not held true over years. And everybody is anatomically different, like first and foremost. And we adapt to our anatomy if we just gradually expose ourselves to any form of training. So if you have a flat arch or a high arch, as long as you're sort of gradual in how you apply training to yourself, your tissues adapt, you do a run everything gets a bit sore we all know that they get a bit stronger and over time we can build up our resilience through smart and sensible training now where um the other bits that people have to be careful of with collapsed arch is is it's like overly used as a term and overly diagnosed so we're kind of talking about two things there's the structure of the foot so the bones and ligaments and how well they support the arch and and they might be perfectly fine but somebody might have then a very well-developed muscles intrinsic foot muscles around the foot which makes their feet look flat so i've seen many times people come in and go i'm told i've got flat feet and collapsed arches and you look structurally and go well actually bones and ligaments like shape is absolutely perfectly fine but you've got this huge muscle on the inside that's really well developed that looks flat and it's just that muscle developing to cope with that person's foot anatomy me.

1:10:21So the collapsed arch concept, I think is again, another one of those myths. And like anything, our anatomy and our shape just changes the stress in our body, providing we train smart and we look after ourselves from a recovery perspective, we should adapt to everything. Orthotics and things like that, all they are doing in motion control shoes, all they're doing is just short-term shifting the forces somewhere else if i have the sore inside of my foot shove an orthotic in it i'm basically shifting the force to the outside of my foot so i'm giving it time to offload when i'm now out running and that's all it's doing is when we modify things in this way we're just redirecting force everywhere else by changing the technique it is super interesting because like i just see it as like it's a shortcut like it like anything else would be like you putting insoles in like you're just not willing to train your feet properly and maybe that's harsh I don't know but then there are some of the top athletes in the world that that do use insoles oh I can I can name Olympic gold medalists who have insoles in their shoes I mean I have insoles in my shoes I think the shortcut is what I guess is easy for us to see and as a physio most of us would probably go that's just a shortcut cheating your body should tolerate it but i i kind of accept it as a balance right is that sometimes if i for me if i put in an arch support it offloads some of the areas of my body and allows me to do more training miles right okay so what generally happens for most of us if we want to perform at high level we're going to push the boundaries of our physical capabilities so why do we get injured and we get niggles it's because well trying to push my body further than it's ever gone before i'm going to exploit the weak links in that chain so in some instances there are benefits in well how can i assist myself in making those you know in offloading that stress redistributing it so i can actually push the boundaries a little bit more it's the same what we see now when you see people run and do some of the sessions in super shoes um there's a again another really high level athlete years ago when super shoes first came out used to do their long runs it's sunday long runs in in them i remember asking i was just like why are you doing your sunday long runs in like super shoe and they were like well it's because i can run like low five minute mile in for 20 miles and feel perfectly fresh the next day so it just allowed them to push the boundaries a little bit more of what they were capable of so i see the argument against it we should build the individual tissue resilience but then in a high performance context if it's allowing me to push my body that little bit further and get that little bit more out of it, I also see the performance side of it.

1:13:04Yeah. I suppose that's why not just super shoes, but shoes have developed so much and what they've allowed to do is to do more volume. Yeah. Yeah, I suppose. It's hard, isn't it? It's a hard one. Like where's that line though? So the barefoot running concept was this idea that if you ran barefoot, you would develop the foot musculature to be less injured. now if you ever look at any of the scientific studies that have tried to transition people to barefoot running is there's a high rate of injuries when you oh it's impossible i've tried it myself yeah yeah and in those that are successful they have like they basically use a phasing in approach where they might get them to go barefoot for like i don't know three miles the first week four miles the second week etc etc you look at the build-up phase and i just look at it from a performance context and say yeah these guys stayed injury free but they're running a max 20 miles a week i want to run 50 miles a week so i get the concept it builds the foot musculature but the shoes are designed to stop our feet getting battered in the first place so we can train more miles so it really depends where do you want to sit do you want to run barefoot fine but i do not believe you'll be a high performance athlete and be able to do the training if you choose that concept yeah it's i agree there's probably not there's no olympic level or top performing runner that's running off barefoot is there not that i'm aware of somebody somebody would probably listen to this and then flag a name to both of us but to be fair there was one guy that's uh running the commonwealth games and he was it was a 10k because i was watching andy doing the 10k and i think after 2k he lost a shoe and finished the race yeah and still finished ahead of andy but lost his shoe and i was like how's he just ran like 8k at that pace yeah like you know 27 minute 10k or whatever yeah with one shoe on that's my that is mindset right there yeah i'm pretty certain he's not trained that way but um that is pure mindset of my shoes gone how I'm going to keep this going.

1:15:13You must have a sore foot after that. Yeah. But yeah, nah, it's insane. When it comes to kind of like injuries and stuff like that, obviously we've talked about just like the common reasons people get injuries. Is there anything else like say lack of sleep, nutrition, stuff like that? Has there been any studies on, on basically being under fueled or having lack of sleep? Yeah, a hundred percent. Under fueling is a, is a major one. If you're not adequately refueled, it's what we refer to as relative energy deficit in sport and most often a lot of athletes will think that's an obvious thing if i'm just purposely restricting my eating but actually under fueling is just something that you can very simply get wrong without noticing it that might be you've not accounted for like how busy your work life is or how little sleep you've had etc and that can really tip the balance small changes in what fuel you intake relative to what you your expenditure is can dramatically increase the risk of injury particularly bone mineral injuries bone density yeah bone stress injuries have you ever come across like people just like even like pulling muscles or something if they're if they're more tired or if uh if they're under fueled and how how does that occur like i that in my mind it's like obviously it's stress and it's additional stress but is it like your body just saying right that's it so if you go broadly like what types of overarching types of running injuries of injuries have we got we've got like acute traumatic ones where you rugby you run into someone smashed your shoulders to pieces great then you've got overuse injuries we've got two types of overuse injuries you've got those that like gradually appear and those that suddenly appear so a pulled muscle sometimes we go oh that suddenly appeared it must be a traumatic type injury of that one high force moment it's not some of these pulled muscle injuries can be due to the accumulation of fatigue.

1:17:10Whenever you go out and run, you are damaging your body tissues. You start with a certain tolerance of what you can withstand. And the further you run, the more that tolerance of what you can withstand is going to drop and degrade. Now, what should happen is when we stop running and rest and refuel, that we recover and our tolerance gets bigger. But sometimes if we're not refueled well enough, or we've not had sufficient time to recover, that of which we can't ever predict what that would be, we might go into the next running session slightly more fatigued and with less tolerance than what we had that run before.

1:17:46So all of a sudden that same four mile run actually pushes me more towards stress over and over again. And it's those repeated bouts where I'm not getting full fuel or full recovery that's over time it's actually just weakening my body to then just a seemingly like easy run that I've done thousand times before causes my calf or my hamstrings just pop and it's actually an overuse injury that's just appeared in that one moment interesting and then when when you're refueling is it just a matter of calories or is it a matter of replacing your glycogen stores because say for example someone who's been out for a run and then is on a super like high fat high protein diet like a keto diet yeah versus someone else that's on like a high carb diet like is the i don't know if there's ever been any studies that have like seen injury rates off that maybe yeah i've not particularly looked at that if i'm perfectly honest but from a theoretical standpoint you go protein is king in terms of that's going to allow collagen synthesis and therefore your tissues to repair carbohydrates is going to be your energy fuel and your energy source which allows you to function and um to not necessarily fatigue in runs fats also are going to be your energy source um but they tend to be like more of you like slow burning type like energy fuel so only you want higher in i mean years ago i did it i went just complete carb free and i was injury free for ages but i always remember was you doing like a lot of high intensity stuff yeah i was still trying to run fours at the same time so still how do you feel off that because i felt like i had a diesel engine i could not get going it took me ages and ages to actually get myself going I felt like I had no pop.

1:19:29I felt like I just didn't have the explosive capabilities anymore. I was leaner than I had ever been in my life. Not an ounce of body fat looked shredded, but I just couldn't perform. And I think that was largely due to not having the energy availability from the carbs that would allow me to access that energy fast. Injury-wise, didn't really cause a problem, but you can easily see that. people who switch those diets away from like high carb diets and radically change them run the risk of getting that wrong and their energy imbalance being out we often there was a study done years ago that kind of looked at risk factors for bone stress injuries and it created a point scoring system um based on certain different factors and one of those was around nutritional changes so if you had a known eating disorder that was a big risk factor for developing in a bone stress injury.

1:20:23But if you had strict dietary restrictions or strict dietary requirements, that was also considered a risk factor, just not as high as a known eating disorder. And that's clearly because it's easy for that energy balance to just be lower than what we need. So I've seen it in the past where people, there was that Netflix series that came out years ago about, it's just like loads of examples of where people shift into solely plant-based diets. made them superhuman oh yeah yeah uh what was it called yeah but it was about all like the nfl players and stuff like that yeah there was various different cases but ultimately within the show it was always just n equals one case just one individual they report a good outcome one individual they report a good outcome but not actually robust scientific evidence and it was all like it turned out all to be like because there was that one there was that c-spiracy they're all like marketing schemes aren't they to make yeah obviously to make money yeah and One of the things I've 100 % seen is when people train high volumes and all of a sudden switch to vegetarian or vegan or all of a sudden I've just restricted dairy from a diet or gluten, energy availability changes rapidly because you've not necessarily accounted for that elsewhere and that increases that risk of injury.

1:21:39I've had loads of times people come in, complain of some form of pain, delve into it a bit more, tell you about a dietary change and I'm immediately thinking, okay, we've potentially got a bone injury here. yeah is there anything else people like come into you complaining about and it's just like an easy fix and it's more like a lifestyle factor more than anything um

1:22:05do you know what i think there's a lot of things are relatively easy fixes when you just for me right injury prevention or injury risk management i've tried to make it so complicated over the years and i actually don't think it's really complicated so most injuries i kind of think and other than in the high performance context in the general context most injuries are avoidable and i always say it centers around just three core requirements of a person one is train smart right so train smart means just gradually increase your training volume don't exponentially increase it like you scaling the side of the dorm wall right just take the slow scenic route up there yeah you've got less risk of dropping off and hurting yourself the other one is what i call building a robust chassis and building a robust chassis is basically just make sure you have some strength and conditioning in there and you train smart they will both build a robust chassis and then the other one is like recovering i say recover like a champion is basically like prioritize your recovery eat well actually take rest periods in between sleep well and ultimately listen to your body that's the biggest thing it's like i'd go to many uh running events and speak to running audiences and one of the things i'd always say is like oh how many of us can't walk down the stairs in a straight line in the morning we hold on the banisters and we crab walk sideways down and everyone's laughing and nodding putting hands up and then going how many of us still managed to go out for the run that morning people laugh and nod and you're simply like if i can't walk down the stairs in a straight line should i really go for that run or should i just buy myself a little bit more time to recover so i think these like components if you get those things train smart build a robust chassis recover like a champion they all interact but they're all about listening to your body and having an appropriate check-in with yourself which even i'm bad at my wife tells me off for it all the time yeah it's all right you saying it here but like when it comes to your own life oh no i'm terrible i i again i yeah i sleep minimal i think i sleep about five hours a night and i'll be up at 6 a.m either in the gym or running hard and yeah my wife will it's it's harder to implement it yourself and i get that and that's where people like me come in or people like our partners come in and you'll have been like this many times where you've been told to just stop being daft rein it in a little bit yeah for sure uh i think that's the the most important thing that i've changed recently is just getting a coach and listening to them and making sure i'm not just doing stuff for the pointless thing of just doing it if that makes sense um overdoing stuff should i say um what's obviously we mentioned before or at the start you are one of the busiest guys that i know i feel like what's the day-to-day looking like for you what are you researching as well what what do you find interesting obviously you've been in this game for a long time yeah what do you find interesting as well um so i struggle to get out of bed if i've not got either something that's going to stimulate my mind so that's where i like my research projects um because i just like trying to answer new questions and figure out new answers to things or if i've got a goal to attain and achieve in a physical context and a rehab context if you give me a high performance athlete in a pressured situation to manage that injury and turn it around that is what keeps me going that 100 will motivate me any day of the week is can we hit that competition I just get excited by that research wise as I said is about like keeping my mind occupied so using the people I work with to question what I do and then my research to try and answer that and I have loads of different sort of projects at the moment um we've got some phd students working um on trying to basically look at how muscles muscle forces and how they differ dependent on your technique that's one of the things we're looking at the other is how we can use some biomechanics technology so like you've seen the force plates you sort of jump on or you can push force into and it measures your force output looking in projects and how well that can predict success in return to sport or be associated it's injuries.

1:26:25So those things keep me occupied. General day to day, I'll generally get up at five, either run or be in the gym, home for breakfast with family, out to work. Every single work day can vary. So it can be like, I could be in the university delivering a lecture, or I could be in MIP, Manchester Institute of Health and Performance, assessing a Premier League footballer with staff and looking at that type of player, or rehabbing an Olympic athlete in a time pressured scenario um home for five family time and then generally between like nine ten to midnight i'll probably write some of my research papers or crack on with some reports um so hectic lifestyle um emails are just yeah constant battle for me yeah what uh what research are you doing at the moment um i guess my one of my current areas is around hamstring injuries and looking at biomechanical factors or by looking at technique that is associated with injury and hamstrings um so does the way we run influence the stress on that muscle and get us injured do you do you get to like pick what you research or someone like giving you that as a task no generally like i'm at a stage in my career now where um i drive the research agenda for myself so my general themes are around anything that's running injury related and anything that uses some form of biomechanics technology and and then if i'm interested in that area i'll drive that space we've got a few projects that then get funded by external partners that might be shaped a bit towards their agenda so there's like an nfl team we're sort of working with in the states at the moment um city football group has been another one that we've had projects with um so in those instances yes it will be aligned to my interest but the specific questions is probably more to what's going to change their practice do you ever research into a kind of like recovery like for injuries specifically say for example is there anything new and upcoming that you think um a lot of people at the moment like i feel like hyperbaric chambers are the rage i know they've been around forever but uh yeah like i feel like they're in now and people are saying one it's good for longevity but two like um recovering from injuries and stuff like that is there anything that you've researched or you've looked into that kind of like speeds up, pincerous?

1:28:51Yeah, I mean, I have this favorite phrase of mine, which is you can't cheat biology. So if I ever teach some of the young students and I'd be like, you can't cheat biology. And I'll rant, I generally rant that. Because often you get a lot of practitioners who pride themselves on returning things excessively quick. And you've got to bear in mind, like actually, has that tissue really healed, like ACL or hamstring? So you can't cheat biology for one. So I think speeding up recovery is very difficult because it's going to depend on the person. There is emerging evidence in a very controversial space around the use of peptides.

1:29:27And that's quite controversial at the moment because we don't really know how well regulated that is from a medical sense. But there's a lot of being done to look at how that can help people speed up injury at the moment. So I'd say I don't know enough about it myself, but I'd definitely say watch this space because it's either going to be like the next big thing or completely banned on a big medical danger. yeah because right now it's kind of like banned across all sports yeah like it's banned by water and stuff like that um i assume that's just because it's not actually been like researched enough yeah when you look i've looked into the research on it and the large proportion of it is just done in animals right predominantly rats um so you can't really start saying something is safe to use when it's not been uh studied in well-controlled trials in humans and looked at those adverse effects.

1:30:13Looks like they're doing a lot more in like America. Yeah. Like that stuff. I feel like everyone's driving them over there. All the tinfoil hat people are on peptides and stuff like that. But yeah, it's interesting. Obviously, like I said, I have bright chambers. I think are really good. Is there any other that you just recommend? Any other things? Like what about like sauna? Like is heat good? Is cold good? Like I know there's a lot of controversy around that at the moment. from an injury prevention i don't really necessarily i'm not going to sit on the fence for like say heat's great i think heat's great and sauna use is great for heat acclimation and performance enhancement because it does help to have added benefits in sort of changing aspects of your blood which is great for endurance performance cold i'm a huge fan of so call me a really cliche old physio but i literally ice absolutely everything um because i just think it has so many like additional benefits in terms of desensitizing an area so one of the things is when we have an injury even past the point of tissue healing sometimes people can be left with a degree of pain but the tissue is healed um and that can be due to changes in the nervous system around that local area so i'm quite a fan of just like whacking ice on things because i think it certainly helps to like reduce some of that um pain perception that we get and studies that have nicely shown that you know when you talk about your knee not firing up your quad well actually some studies have shown if you cool the joint down first it can increase the muscle activation around the area um so i'm a big fan of i'm a big fan of ice um i like that aspect heat i think gives you a performance bit but otherwise like if recovery and speeding up healing rest time protein collagen massage or not so massage is like it's going to give you short-term changes the short-term effects of massage are largely about reducing pain and giving you a short-term improvement in range of movement.

1:32:11Again, going to probably be hated by a lot of soft tissue therapists now, but I'm generally going to say manual therapy and soft tissue therapy is not going to heal an injured tissue. The only thing that heals tissues is either time, the body itself and how we load it effectively in the gym. That's the bit that's like missed by nine out of 10 physios is each tissue in the body responds differently to the type of load you put on it and most people will not consider what type of load do i need to get that tissue to adapt that is fundamental 101 for tissue recovery yeah that's what that's what did strike me when we had a session i came to you before world champs uh with the bad back uh i think i did it walking lunging with a big barbell you explain why i shouldn't be doing that yeah um but i remember coming into you and yes you assessed me like on the massage bed um you kind of released a couple of muscles but then we got straight into the gym yeah and you got me moving pain-free and i feel like that was like the the biggest difference compared to anyone else that i've really seen yeah anyone else i've seen like you normally just stay on the bed you do a session on the bed and then you you get up off the bed you feel stiff you go home and you you sleep yeah that's it but you one give me that confidence that i could actually move without pain in the gym but two give me some exercises which you were like ah this is actually going to fix you more than just me pressing into your back or whatever it was yeah my day you might massage has benefits but they're short term and if we don't combine them with other stuff that either gets the the tissues functioning the way that they need to or is there to promote optimal tissue healing that short term is not going to get us out of that hole later on yeah is there anything else you want to cover today i think you we've done like a pretty comprehensive discussion of like running related injuries i think oh hyrox is there anything that you'd look at like a typical hyroxa yeah that you see is there anything what you change about kind of like either their training uh their recovery anything like that yeah um so i think the hierarchy is really challenging um i've obviously personally tried to like train towards doing one and i think the challenge is the multiple different physical requirements that you need for that event you need to be a good runner you need to be able to produce max force um and you need to be able to like have good technique on specific stations so and you need really good muscular endurance so the challenge here is like they don't all those elements of training you can't fit into an entire week of someone's training so i think some of the errors that i see in people trying to train for high rocks is that you try to fit all components station work muscular endurance max strength and running into the same week um i think really for effective training programs it's about being smarter in how we periodize what specific qualities we're trying to get out so that might be somebody then knowing that i don't know a couple of months down the line they've got a competition they're going to work on a big strength block first and with some just base level aerobic running and then later on towards that competition start to be more specific in the technical element building endurance on those stations and the ability to run in a compromised state so switching more from like general physical preparation phases more towards specific later on rather than just trying to combine it all in one go i think is a big thing um then the the other error really is probably around the lack of appreciation for the physical qualities required to run well right so hyrox is largely the stations are around um moderate loads repeated over and over again and for running like you want tendons to be really springy and tendons are going to respond to really high loads to adapt so if it's just too much higher specific work i actually don't think we adapt the tendons in the way they need to for running so there's probably this element of thinking and remembering that actually elements of plyometrics and elements of just like high force even if it's just high force isometrics around plantar flexors quads etc are going to to be necessary to help my running and those are the bits i think that are neglected a little bit yeah no i uh i agree especially with the periodization what you mentioned like uh i think getting super specific probably like four to six weeks out from an event but prior to that like have your goals and focuses that you want to work on just pick one or two rather than like you there's probably like four or five components of the high rocks uh that you could be training all the time but you're just not going to get better if you do them all you're probably going to result in injury i probably i'll also say like uh like optimize your cross training like like don't go out the door running if you're sore yeah i just don't think maybe if you're a runner you know going doing double days running it might be necessary to kind of like build up the load uh but you've got to think you're only recovering from running yeah whereas like with high rocks you're recovering from so many other things as well what's the point if you if you really saw if you you know your calves are battered your achilles are sore and everything what's the point when running out the door when you could just do a bike or you could do a row you could do a ski you can work on so many other things yeah without like and rest and then and then go out the next day that's actually one of the projects we've we've currently gotten going as well so uh fran who's the physiologist over at mip um she's currently working on a project that's designed more about understanding what the like the physical and physiological demands are of a hyrox event so that their services and physiological services can provide each athlete with more of a bespoke profiling of going these are where your specific weaknesses are and where you are lacking in performance lacking in physiology or your physical qualities uh aren't as good as they could be so that way it's the hope that rather than everyone try to clutch at everything they can start to be a bit more tailored into like okay actually training these components at the bit where i'm going to get the biggest effect on my performance and so that's quite a cool project that we're trying to work on at the moment and personally what are you doing next are you you You said that you were going to do high rocks.

1:38:56Is that right? Yeah, I'm going to have a crack at Birmingham. Birmingham. And then I'm going to have a crack at Manchester as well. Oh, amazing. Open or pro? Birmingham, I'm going to go open. Okay. Like I've obviously not done one before, so I did not want to like completely juggle fire in that first instance. So learn the event first of all, try and figure out where my areas to improve are. And then pro, mainly because I want to just see, I like a challenge. So pro in January, yeah? Pro is going to be in January. So I like a challenge.

1:39:29So if I'm perfectly honest, actually, my wife, she destroys me at any high rocks related training. She was a high performing athlete. So really it was about her doing pro in Manchester. And I just said like, yeah, I'll do pro as well. So we're both doing solo pro. I think she'll be fine. I think I'm going to be the one who's got to pull my finger out and get some serious work. Who's going to get the fastest time? mate she is the epitome of like hold my beer and just drop a 320k on me any day of the week she she was a really good 815 runner um good 10k runner so even nowadays like she can just sit on the sofa for four weeks and still destroy me at a running event i love that um we talked about mixed doubles but i think the i would 100 be slowing her down well you'll have to give it a go um yeah best of luck with the event if you need any help you know where we are we said that we'll get a session in yeah yeah we've got to get a session in you've got to show me how far behind i actually am thank you for today oh thanks for the invite yeah amazing