The Hidden Science Of Pain & Performance | Alex Morell | S3EP.07

0:00Mr. Alex Morrell, welcome to the Without Limits podcast. Thank you for having me, mate. It's been a long time coming, to be honest. You've been pretty instrumental in my life of recent years in keeping me fit and healthy. I've obviously pushed the body pretty hard for a number of years, but more recently into new sports, new environments. And, you know, as often happens when you tie the line, you end up breaking. And you've been pretty instrumental, like I say, in keeping me fit and just being a sounding board and looking after me. so I appreciate all that help you've given me and now I get to talk to you about physio, rehab and prehab and we've got 60 minutes or so to make it sound sexy because this is something that you know all too well many people don't really care for until it's too late and I think in the sports and in the areas that we find ourselves training and coaching in and also now with what people are looking to do with their bodies, it's going to become all the more real and prevalent for people, particularly as they begin to age and like I say explore new stimuluses, new sports.

1:01So hopefully there's going to be so much value for people in this episode. There's a little bit of pressure on me there to add some sex appeal to rehab, but we'll roll with it. We'll get there. Before we start, in usual fashion, I'll ask everyone what Without Limits mean to them. So what does Without Limits mean to you?

1:22When I texted you yesterday asking about what questions you were going to ask, I knew this was going to come. I try not to overthink it. In the same way, you've very kindly acknowledged that you feel I've been quite instrumental in some of the things that you've done in the last few years. I would say likewise. And I think from my perspective, Without Limits has really transformed over the last three, four, five years for me in terms of not actually knowing where the boundary ends. and one of the most sort of I always draw back to it one of the most sort of impactful books I've ever read was Nassim Taleb about becoming antifragile and I try and carry that over into lots of different elements of my life both personally and professionally I think with a professional head-on there's a huge tendency within like the medical rehab type world to push people down this sort of like fragile mindset and almost right these are your limits when actually i think the the job of me as a professional is to open someone up and actually we talk about this as a team at move actually expanding someone's vision about what is possible with their body and where they can take it beyond it just been from a rehab perspective but then from a personal perspective what i've achieved over the last four years far exceeds even my wildest of dreams like i always wanted to just work in sport worked in sport loved it and then wanted to reclaim a little bit more balance within my life start having a family having the time to and the freedom to to do what i wanted to do and i left sport to work 15 hours a week and match my salary I'm not working 15 hours a week anymore but all of the goals and ambitions that I ever sort of dreamt about about far been exceeded far quicker than I could ever imagine and I think for me now I just don't put a limit on it I'm a bit like I'm gonna try and I'm gonna give it everything and I'll sacrifice the things I'm comfortable sacrificing it sacrificing I've I've gone on a journey of understanding myself and knowing where my values are and I will never sacrifice things around work, sorry, around family and things like that.

3:57But outside of that, I'll do what I believe needs to be done to achieve it. And if I don't quite get there, then it's a learning opportunity. It sounds cliche, but it genuinely is. and if I don't reach the top of Everest, I might just reach base camp, but there's a significant amount of progress from where I was and where in the past I maybe wouldn't have probably tried or had the confidence to try. Yeah, that's powerful. And there's quite a few bits there to unpack. I think, you know, ultimately, let's just use me as an example here. When it comes to like picking the physio, you know, given traditional kind of perceptions of what physiotherapy is, you know, you're broken, it's going to get you back to a baseline.

4:35You know, that wasn't going to be sufficient for someone that's looking to achieve what I want to achieve with my body and so the reason I was attracted to you is because the way you think about physiotherapy it's actually the way you think about life right and if anyone follows you it's what you've done with your business it's now what you've done with your family it's what you've done with your own you know your own training and also what you've done with your clients you've not necessarily taken them back to a baseline where in fact you haven't you've taken them back to going beyond where they were before they got injured so I think you are someone obviously that lives without limits I think a lot of your recent content is is very um is a sort of testament to that uh and you you referenced there kind of being in professional sport and then coming across the physiotherapy and i think many people maybe like me the traditional experiences of physiotherapy and perception of what a physiotherapy physiotherapist is again probably speaks to the fact that we might not find it too sexy and want to listen to what a physio says um but why should someone listen to you what is your kind of experience and how have you got to where you are as a professional?

5:33I think I'm quite lucky because I failed in my first attempt to become a physio. I always did really well at school without really trying, if I'm honest, and then went into A-level. After numerous arguments with my mom, I wasn't allowed to go to college. I was pushed into the formal education. Go to your A-levels and you'll go do a good university degree and X, Y, and Z after that. and I failed all my air levels had to reset every single module and I was unsuccessful in getting onto a physiotherapy degree but in hindsight that was a blessing because it meant that I went and did sports science and injury management was the degree title but it was sports science strength and conditioning with a module in sports rehab but actually that gave me a set of skills and an understanding of training primarily those two sort of disciplines which do largely interlink that when i went and actually started to try did well in that degree and got onto a master's in physiotherapy because i still knew that that was the route to get me into sport easier the sports rehab roles are there but they're not really they're taken up with physios and snc coaches who transitioned into that route and it also opened a door for me to go to Australia which was something that was sort of um in the picture at that time but it went I went and did my master's and the amount of education around strength and conditioning principles is literally non-existent we might have done one lecture and we were told to give three sets of 10.

7:13Irregardless of what the exercise prescription was it was like give clients three sets of 10 and we can deep dive into lots of different reasons why it's an nhs funded degree when you go and work in the nhs resource is at its absolute minimum and you need to play on the safe side and things like that but ultimately failing to get there made me a significantly better physio because i understood strength and conditioning and i could then apply those skills at knowledge base to actually rehab someone one in a way that is better it's going to take them and actually develop them athletically and and actually go right this is where you are at the moment potentially when we go through your testing these are some of the reasons why you've broken down and why you've got injured this is the needs analysis of what you want to get back to and these are the the steps that we're going to take to do that and we just reverse engineer that but without the strength and conditioning principles that i'd already learned it would be impossible and you can see why so many physios get funneled into i'm going to do treatment i'm going to do massage manipulation dry needling acupuncture as a primary service and then i'm going to give you three sets of ten glute exercises because they don't get told any different and i know what from my perspective where i put my training hat on i know what i would enjoy a lot more yeah very good and again i think that speaks to part of the reason why you know i identified you as someone that i could trust to sort of look after my training it's because that strength and conditioning background can you unpack a little bit more because i know you were in professional sport with with rugby league what did you learn there about strength and conditioning and then also the desire to go on to physiotherapy and have you combined yeah what was your your um your understanding of combining the two and how important they could be for for someone in that acute phase after injury but then also that long-term approach to getting them back on the pitch and developing in their athletic qualities?

9:08I think one of the first things that I always reflect on from working in professional rugby, and it's absolutely crazy what rugby league and rugby union athletes, I've worked in both disciplines, put their bodies through for the salary that they actually earn and what they're going to have after their career. But what they're able to put their body through is unbelievable. and it it really made me realize what the human body is capable of it is the most adaptable organism on the planet um and yes you may need to have some serious discussions around well-being and things like that um and this when you're making a decision whether someone's going to play or not it's my opinion a doctor's opinion the player's opinion which is the most important and then the coaching staff's opinion.

9:59But what players actually play with that spectators don't know about is absolutely incredible. And that, for me, I've taken out of sport. And obviously everyone's mindset is slightly different towards it, but actually trying to instill the belief that the human body is really resilient and we just need to feed it the right things and the right inputs, both from a physiological and a physical perspective to build its strength, power, whatever physical quality it is, but in turn doing that in a progressive way and giving appropriate feedback to highlight to the person so that mentally and from a psychological perspective they see themselves getting better, they feel better, and in turn their perceived confidence, resilience, everything like that rises.

10:51And I think that's one of the most impactful things I've taken from working in rugby. From a strength and conditioning perspective and linking it to physio, all that rehab is is strength and conditioning under a constraint of the injury. And we need to, whenever I work with anybody, whether it's your gran or whether it's a professional athlete, the thing I want to establish as early as possible is a decent blueprint of what that person's physical capabilities are. Because that tells me a lot about where they are currently versus where they want to be. And, yes, you may have, and we work with a lot of people with ACL injuries, Achilles ruptures that are significant injuries.

11:34And in the acute phases, we can't do a lot directly to the injury, but there's significant amounts that we can do to make them a better athlete, even at that stage, providing we're not increasing risk of infection through sweating and things like that, that is going to pay off in the long run. So, for example, let's run through an ACL rehab. Your aerobic capacity is X. Let's say it's 50 for an ease of number. And we want to get you to 70 because that's what we know from the research base is a minimum standard for someone that plays your sport. We can start working on that from as early as physically possible, where actually a lot of rehab approaches miss that because and what ends up happening is you don't just stay at 50 because you're not dealing with that physical quality and creating an adaptation and forcing adaptation through training you decondition and actually when you go back and play sport you're less fit than when you started and let's say you play rugby it's an 80 minute game you're 60 minutes into the game and your fitness which was at 50 when you got injured you've gone back at 40 you're accumulating fatigue far quick far earlier in the game so even though you've gone through a rehab program which has worked on strength and power and things like that your aerobic capacity is letting you down and actually degrading those physical qualities earlier and in turn your risk of injury is increasing not and that's from an injury risk perspective like if we actually just go all right how well are you performing well you're less fit than where you were at the beginning.

13:15So you're performing worse. Yeah, really good. You mentioned something there that's quite made me smile about I suppose just the pain tolerance of professional rugby players or athletes in general. I had someone on the podcast recently that we're talking about that ability just to get up and get sessions done when muscles are sore and you're fatigued, which is sometimes the right thing to be doing. This understanding of like, I guess, pain. rugby players you know have a surgery that most people would try and get done the next day at the end of the season and they kind of play with that so what's your in your experience with like the everyday person versus the rugby player people's experience of pain how should we approach pain when we feel it i think and this isn't me by the way saying that i'm putting rugby players on a pedestal and saying that what they do is right.

14:10If you have a traumatic injury that needs dealing with, we should look at getting it dealt with. But in performance sport, the lens at which you look at certain things through changes slightly. You've got to think and factor in so many different things at the stage of the season. Have we got important games coming up? For the athlete, there's contract talks. If you're not playing, Are you less likely to get a contract? Is your contract salary going to be reduced? It's so multifactorial in terms of the sporting side of things that I mentioned. But in terms of sport, in terms of pain, to keep it as simple as possible, pain is a sensation, which is an output of the brain and the nervous system.

14:57And that output is derived from the inputs that are coming in. So your brain always knows where your body is in space. If I touch you, it understands that something's touched you. If a muscle stretches, a muscle contracts, it knows all the time what's going on. And it's picking up these inputs. And it's constantly making decisions to keep you safe. Your brain and your nervous system's number one priority is going to be keep you safe and keep you alive. and if it perceives these inputs as a problem a potential reaction of the brain and the nervous system is to create a painful sensation like if i touched um a hob my brain knows that that from the input bang straight in take your hand off create pain stop you doing what you're doing physical because of the physical trauma but there can also be there's a lot of people that have scans that don't have a problem that have pain because there's this mismatch between the input and what the brain feels safe with and that's a game where that initial blueprint blueprint as part of the assessment is really really important because we can go right you're trying to you're trying to complete these tasks and that's going to put this input into your brain and into your nervous system but you're trying to complete these tasks at a level which is below what physically we want you to be at so it's no wonder that that's stressing the brain and stressing the nervous system and that in turn is creating this painful sensation reducing range of motion because of muscle tone all these protective reactions that my job as the physio and the the rehab coach is to go right these are the things that we need to put into the system alongside some potentially specific movement patterns that we want to work on alongside building the physical quality of strength and power and things like that that actually reassures the brain and the nervous system that it can tolerate the demands that have been placed on it i.e the input so then it doesn't have to have that protective response with the painful reaction can i train that so so it's physical training is that increasing my capacity to deal with with pain is there ways in which people can can train that absolutely just just a following a progressive training plan is going to increase the capacity is a good word yeah tolerance it's essentially widening your buffer for error and you want to build as big a base to reach as high a peak as possible and in the base is strength and aerobic capacity i've spoke about this at the summit and stuff like that last year with you guys and there's different physical qualities which do hold more precedent from an injury prevention perspective.

17:40Strength and aerobic capacity are the two. And then above that, we've got movement quality. We've got power from plyometrics. We've got all different physical qualities. But absolutely, the better you are athletically, the more likely or the more resilient to pain and injury you are. Do you put strength ahead of movement quality? I've gone back and forward on this a hell of a lot because...

18:08The answer is no, because we want to nail the movement quality and then apply strength to it. But once you start reaching those higher percentages from a strength perspective and you're training that adaptation, you're also going to get a reduction in movement quality just because you're stressing your body at such a level that it can't pick everything all at once. so you'll see people that lift world record deadlifts squats and things like that and you go that's poor technique but it's also a max max max max effort and the thing that earns the right to do that is the repetition the consistency over time and and by time i mean i don't mean months i mean years worth of training and laying a really big foundation again that allows you just that a bit more of a buffer from a movement quality perspective but all the time 99.9 percent of your time your strength work has to be underpinned with movement quality that's a really nice piece just to pick up on so people going into a new new training program or new training style or you know exposed to a new sport what you're suggesting is in training 90 plus percent of your time needs to be focused on movement quality or lifting within a constraint of maintaining good technique and again that's a little bit subjective but good technique with a view that when you're pushing above a 95 or 99 effort technique going out the window you've earned the right to be able to be there and you're still safe earned the right it's the perfect the perfect comment i can draw from a conversation i had last monday with one of my clients and he was really frustrated he'd done five by five uh front squats and he's like oh i've not put any weight on the bar and he's only been training consistently and progressively for six months but actually all five sets were at 90 of his three rep max and his quality of movement was significantly better even if he hadn't have increased the weight from the previous week and his movement quality had got better that is progressive overload that is seeing adaptations come to light and it'll make him more efficient and then allow him in the next block of training or over the next couple of boxer training to see the rewards having earned the right by improving his movement quality yeah i think that's again a really nice thing just a quick double click on because you see it in in our gym members here like i think because lifting more weight is obviously how people register that they're getting stronger but the the variance in set one to set two when the weight increases changes and i think it's something that you know i admire someone that lifts with a really great form when they're training and there's just no difference between set and set even their top set and you hear people that are very experienced lifters and you've just referenced it there talking about you know your warm-up sets looking like your top sets when we're not working at 95 plus percent and I think that's just really important for people to pick up on right now if we are thinking about this like longevity piece and training for life and trying to you know steer clear of injury across that journey it is really making sure that you're prioritizing really good technical movement or whatever movement quality looks like for you being able to replicate that through your working sets across different rooms absolutely you've had ollie patrick on here and he spoke about different things that are important to extending quality of life and muscle mass and strength are right up there in terms of the importance and if you can move a joint through more range of motion you're going to stimulate more muscle mass and you gain more strength off the back of that so both from a performance perspective right now but also longevity it's huge um so i think a large problem is the comparison piece isn't it and both the internal comparison of i need to progress every single week but is that is that a reaction to the external comparison of what people are doing in your immediate environment within the gym and the training session that you're in but also when you sit there scrolling you see someone like yourself who looks a certain way, performs a certain way, and I might go, right, I want to do that, so I need to get to those weights that Ollie's got to, but they haven't seen the 20 years' worth of repetition and consistency that someone's put in there.

22:23Honestly, the amount of people who we work with both online and in person, their main problem is that they just haven't done the basics savagely well consistently over time and built a bigger foundation before they've gone and tried to do the marathon, the ultra, the really fast 5K, the crossfit functional fitness competition, even the higher, like you can pick any modality. They just haven't earned the right to try and do what they're doing. Double days, I could just go on and on. Yeah, it's something that, you know, I get tagged in loads of training, people training, so lots of training footage on Instagram.

23:05And if I don't share, it's for a number, it's for two reasons. One, I've shared too much that day, in which case I don't want to keep littering my stories with someone else's training footage. Although I'm, you know, I feel very privileged and grateful that people are tagging and are proud of what they're doing. Or two, it's because you're moving like shit. And a lot of the time it is the latter. And it pains me to know that someone will be on one of our programs and moving like that. And more often than not, I'll try and then try and coach them through the DMs or just like suggest ways in which they can try and improve and tidy up that technique.

23:34but it largely comes down to the fact that you know people do glorify what is the tonnage on the bar and that's the thing that they're proud of rightly so because it's a it's a objective way of um showing your strength but not at the uh at the um where you when you're sacrificing your technique and you know your body's all over the place so if you are listening to this and you do film yourself training um whether it's a squat or a deadlift or you know pick any movement if there is big variance in your sets when you're videoing yourself when you get to the sets that are slightly tougher um i suggest you're skipping steps and you're either going to lead to increased risk of injury or um you're skipping steps and you're actually going to cap out on strength you know capability because you're not going to go through full range of motion therefore taking advantage of um full strength capabilities moving into how do people get injured then how do injuries occur what's the you know we talked about sort of pain obviously some pain good pain some pain not we talked about trauma you know um it's very obvious for people if you you know for example on my knee you snap your ACL you're injured um but how do people get injured when it's not you know like a trauma or an injury where there's like you know in contact sport yeah so I will typically put them into two buckets really you've got your traumatic and I even put a post about this yesterday um your traumatic contact-based injuries which largely you're not going to be able to avoid it's just an unfortunate byproduct of the activity that you're doing or you've just been unlucky essentially outside of that the demands that you're placing upon your body under exceed your physical capabilities and well and i will say that with an asterisk because the analogy i always come back to and draw back to is man city spend millions and millions of pounds trying to keep their athletes fit and healthy throughout the season to the point where they roll up mattresses pillows fly them around the world have special sprays that they spray at home so their sleep conditions are the same as at home as when they're away trying to optimize everything and they still experience injuries i don't know what they're like physically but they're throwing millions at it and there's there is the luck element the the unknown the multifactorial i've had an argument with my missus i'm stuck in traffic i've got financial stress whatever it is all these things play into the the pain and the injury bucket but the things that you can control are the the physical qualities and how you how you perform athletically and the more the reason i pause is that i always i'm always hesitant about labeling it as athletically because there's a lot of people that won't think of themselves as athletic athletic or athletes but the same principles apply looking at it through a performance lens and going right these are the things that i want to do and i'm aiming for and i'm striving for and the this is where i currently am i need to lay these bricks to allow me to safely and effectively do that and whatever that those bricks are is specific to that one person and it all draws back to like i mentioned earlier the assessment the needs analysis is the thing that they want to get and reverse engineering what that process looks like and it's the same in so many different things like obviously i work with you guys and in boardroom and jimmy's network and it's like vision what's the end goal right where are you now reverse engineer what what steps you're going to take to get there but ultimately if if the things that you're trying to do exceed your capability even if we just go as simple as pick like picking something up off the floor and you feel your back go is that because you haven't got adequate range of motion through your hips so it's actually your body's ability to reach down and touch the floor on your right hand side has exceeded what it can do so your body and your brain has has had to borrow range of motion from somewhere else and it's not happy to do that whether that's caused physical damage that you'd see under scan and ultrasound and mri or whether that's just a protective response of the brain to say right stop what you're doing Ollie that's not right for you at the moment you need to address x y and z and go through the assessment to understand what x y and z are but essentially it all comes back to is what you're doing exceeding the demands that your body is able to tolerate at that moment in time so for the listener it's like let's say I've got a goal um and you know some people obviously just training for life and to make life feel a little bit easier but let's say we have a goal at Hyrox so either I haven't done the reverse engineering of Hyrox back to where the competition back to where I'm now and understand the needs of the training to get there or I've given myself not enough time in which case I'm having to accelerate my progress through the training therefore too much exposure and I'm and I'm breaking the kind of the two things are kind of intertwined absolutely yeah so are you suggesting uh obviously there's a best case scenario and then there's like some nuance to whether people you know need to do this are you suggesting that everyone should at start point I'm going to take on this goal go through some testing do a needs analysis of the of the training in the sport um and then let's say for example i've only got six weeks well that doesn't make sense because i can't get to the goal that i want it's either readjust my goal or move the date of the of the race i think putting my coach's hat on it all comes down to communication and feedback and setting appropriate expectations and there's been a lot of difficult discussions that i've had with people both healthy and injured who have and very respectfully have aspirational goals of what they want to achieve and that's fantastic and you'd never want to discourage that but it's actually right, let's go, this is your first, we'll use high rocks again this is your first high rocks, this is where you currently are you have this goal of let's say an hour and ten minutes but actually you've never even ran 8k before let alone layering fatigue on top of it and then all of the emotional factors of the day, which you'll never be able to quantify, but just the heightened heart rate and the excitement and the nerves of going in there is going to have a physiological effect and create probably just ambient levels of fatigue before you're even going into the event.

29:50And it's just from my, again, putting my coach's hat on, having honest discussions. if someone doesn't have access to someone like you because they've not been injured before and this is resonating they're understanding it but it's not resonating enough to go okay i'm going to get a coach what does that person do is it you know yeah the ideal is you know get on a program speak to a coach but is there something someone can do to assess themselves right now to know okay here's where my baseline is that i can move forward i know it's difficult with the context of the sport but absolutely i think you've just got to look at it logically and go right we'll go high rocks it's an 8k race with elements of fatigue on top of it can you do all of the components of that race independently before you even go into it could you run 8k could you do 100 wall balls could you carry a kettlebell as far as you need to go, could you do a max effort on a skier and a rower for 1k, if you can do all of those things then yes it's maybe an appropriate goal but you need to be able to develop the skill of doing those things in isolation before you add fatigue on top of it chaos on top, like you've done a lot of hierarchies, I've done a couple it is chaotic when you're out there so again that that is a factor within doing the event again let's use a half marathon i guess a good thing to actually talk about would be when i was working in professional sport and we were returning athlete back to um performance or back to play one of the sessions that was really important to us was a worst case scenario session and obviously with all of the the different tech and things like that we would understand a huge amount of data about you the athlete and we'd know in a half you might run 4 ,000 meters with 500 meters of high-speed running with X amount of axle decels and X amount of sprint efforts.

31:52So as part of my rehab planning, I would take you to 110 % of that session to know that you are physically capable of doing it. So there's the logical approach to it of can I do all of those things independently and have I got the physical qualities and the skill to do that and then can I do it with added layers of fatigue and chaos on top of it? But then actually to be really confident in avoiding injury, can I do more? So let's say you're doing a half marathon. Can you run 25K? I'm not saying that you need to do that in your training or anything like that. But again, if you can run 25K, you can pretty confidently say you're going to run the 21K.

32:36Yeah, I think this is the crux of it, right? like people coming into fitness the comparison or maybe the the influence or peer pressure of other people doing it not giving themselves enough time and then it goes back to that saying that we use a lot of earning the right we've touched on a few things here high rocks and half marathons obviously being the most prevalent of what a typical um someone coming from strength going into kind of hybrid fitness or functional fitness would look to take on as a challenge and rightly so you know two big two big moments two great things to train for what are the most common injuries you're finding now with the increase of running whether it's high rocks or half marathon for people to sort of maybe look out for and then we'll just discuss I sort of asked you what could people be doing right now if they don't have access to you we can maybe discuss how you'd construct a 10-15 minute prehab piece before a run or before a training session so people can start to tick that box and hopefully some of the listeners can take that away and then implement into their training can I come back to that I think one of the things when when I finished talk and I thought about TAR.

33:35And I think it's an important thing to understand the person's motivations for doing what they're doing. And obviously TAR was what, 200 and, what was it, 230? It was 270, I think. So for those that don't know, TAR was the trans-Alpine race that myself, Jen, Charlie and Miles did last year. 270k across the Alps, across seven days, 17 ,000 metres of elevation. And we took Alex as part of our support team. Bus driver. um so the reason i brought it up is i think it's important to know someone's motivation because there's no way that you can physically prepare yourself for something like that and an event and it came back to the first time i did a high rocks and i thought it was unbelievable that me as a very average person the world's elite and someone doing i've got her pictured in my head running around um doing it in over two hours we're all on there but to her and to that person the motivation for doing it might have been to push her boundaries and see what she's capable of and in which case you've got to understand what your motivation is to do it because you could never train worst case scenario that's that's very fair and i think this goes back to the kill because i think we've got to take what we're saying with a pinch of salt because many people could train in four weeks having no training before four higher what's completed and have no injury but i think if you're someone that continues to have that mindset towards the way you train and show up and prepare you are someone that is it's a ticking time bomb and you know many people can get through a whole rugby career without getting injured and very lucky so there isn't enough luck towards this um but i suppose we're just saying you know and i say this from a place of of experience there is nothing worse if you're someone that likes to live a very healthy active lifestyle you love training it's the you know the the part of your day that is the most enjoyable and for yourself if you can't train to the capability that you either used to or you want to it's just like being ill it's like being bed bound it's horrendous and injuries that are arguably slightly longer in period than than than illness um they're crippling for people's both physical and and psychological kind of well-being um and so i think some of these things are just like it's just about being aware and mindful of it and start to maybe reassess to how you approach you know your own your own kind of fitness and training um so let's come back to that one then so what are the most common injuries obviously i'm sure there are you know we spoke about acl but i think that's more towards you know sporting context and trauma what are the most common injuries you're coming up against now with the increase of running high rocks half marathons etc um whether this is a byproduct of our marketing and the content that i put out there but we see a lot of knees in particularly if I just go lower limb overuse injuries and again it comes back to the physical preparedness are you physically prepared to tolerate the demands of the training program that you're trying to partake in and complete but also the factors outside of the training is how well are you recovering, what's your sleep like what's your nutrition like, I know personally I've tried I've put a lot more effort into my nutrition over the last eight weeks and I feel significantly better both when I train and outside of training I'm more present at home my energy is better with my family I'm more I'm more present and my energy is better at work it carries over into everything and actually nailing those basics is going to go a long way to preventing injuries in general but especially overuse injuries and allowing appropriate levels of recovery um we see a lot of tendon-based injuries again it falls into that overuse category and i think one of the things that's that's important to talk about is what people think an overuse injury is just solely a result of too much load in too short a period of time and not enough recovery but let's say you have a patella tendinopathy on your right knee so the tendon that sits at the front of your kneecap attaches to your shin bone let's say that that's irritated if it was just solely down to load why aren't all tendons irritated why isn't the left knee why isn't the achilles on both sides and that again is where we come back to a detailed assessment of understanding your specific story your specific testing results and go you might have had an old right ankle injury which you never properly rehabbed and actually when we test some of your power like single leg hopping type um metrics you have a 20 deficit in power versus the the non-affected side and i think it's really really important to have a well-rounded program that takes care of lots of those things a lot of people skip the prep which is usually where the the bits that all supplement the actual training is your plios your movement work and they're just like right whether it's time or whether it's actually not understanding the intent of it um but i just think people could just do a lot better by just doing the basics really really well let's pick up on that because i think if people don't want to invest in the cost of testing and a coach etc let's just give people the basics right and you reference it there like the prep work and this is we see it in our gyms and we know it's going to be on the program you put a warm-up in there uh people overlook it and i think the the key here especially coming from you and hopefully people can listen to it because it's coming from a credible or authoritative voice it's like the prep work is the training as well like view it as the training view it as the accessory viewers whatever but just put some importance on it um for running let's just try and keep it quite clearly defined so that you can actually answer it without needing to say it depends, but for running, whether that's a high rock space session, whether there's running intervals in it, or whether that's a train for your half marathon, what are the keys that we want to try and be preparing the body for?

39:41And it's something that, you know, when you first assessed me, having been someone that trains a lot at the time, it would be two, three years ago, five, six, seven days a week, puts a lot of effort into training. But you sort of said to me, you've just lost movement variance or variability. my body just wasn't moving in certain ways and you'd expect someone that looks at me and performs at me to be able to have all the movement in the world but I'd lost it because I wasn't training it now then it comes down to how do I prioritise the key things so is it as simple as something far so a plier what is the best plier is it something sagittal plane frontal plane transverse plane in your warm up give me the really simply a couple of tests that I believe everyone should do that runs get a metronome app set it at 50 beats per minute on beep one you go down on beep two you go up we're going to do three different tests we're going to do a single leg sit to stand uh to 90 degrees knee bend where you just tap down and come back up you're not stopping on the bench you're going to do a single leg hamstring bridge where your knees bent about 20 degrees your heels on a bench or a chair and you bridge up on beep one bridge down on beep two and a single leg calf raise from the floor straight leg fingertips on the wall you're not gripping the wall and pulling yourself up i want a minimum of 25 reps on each side with really good quality that's what the research says is like normative data but that's in a population from 18 to 60 to 70 i don't know the exact age we push to 30 for a more athletic population so just so 30 reps on each of those exercises so single leg sit to stand to 90 degrees single leg hamstring bridge near 90 degrees sorry 20 degrees heel into the floor and single leg heel onto a bench heel onto a bench and single leg straight leg calf raise 30 reps with a metronome at 50 beats per minute up on beat 1 down on beat 2 that's just to standardise the test on the single leg sit to stand I allow one failure that failure would be tapping down the opposite or the non-working foot, just to account for balance on one rep.

41:55After that, if there's another touchdown, we stop. Beyond that, some more sort of very easy-to-complete tests. A split squat isometric, front knee and hip at 90 degrees, back knee and hip at 90 degrees, but obviously an extension. Off the floor by 2 to 3 inches, holding for a minimum of 90 seconds on each side. and then a long lever side plank, minimum 90 seconds on each side. You'll take care of a lot of big rocks there. They're our capacity sort of testing markers and that will give you a really nice stable or strong base to work from. Beyond that, I believe everybody should have at least two doses of plyometrics in a week.

42:42Hide them in a running warm-up. you can do them in five to six minutes, just a little bit of movement work into a couple of rounds of plyometrics, something like a double leg pogo, something like a lunge jump where you're switching the legs. It sounds old school, but there's a lot of really good things that carry over into running mechanics like switching the hips, absorbing force in deep knee flexion, deep hip flexion positions, which people just don't do. And actually training an increased rate of force development through the muscular tenderness system. People just don't do it in traditional gym training.

43:18It's, right, let's make a strong and stable stiff base as possible and push as much weight as possible. There's not those other physical qualities that are trained. And then we can add in a lateral variation. We can do a lateral bound, a skater bound. You can YouTube all of these or message me, and I'll send you a video for it. But it's just an element of ankle stiffness, an element of a deep-tier plyometric, and then some multi-directional plyometrics. Beyond that, a really solid training program, which is progressive in nature, doesn't need to be the most complex. It doesn't need to have loads of different nuance to it.

43:55It just needs to be progressive in nature and you need to apply appropriate effort to it to progress. And within that, I would always want, depending on how many times you train a week, but an element of frontal plane and transverse plane lower body movement, whether that's a lateral lunge not a cossack so one thing that is is probably hard to describe over a podcast is if you think if you lunge laterally and you're i'm lunging to my left i want to get my center of mass so my chest and my belly button over my left big toe so that tells me i'm shifting in the frontal plane whereas if i did that movement with my left foot outside of my left hip i haven't actually loaded in the frontal plane into my hip i haven't adducted or internally rotated my hip does that make sense yeah yeah um and then something like a curtsy a curtsy lunge a curtsy reach curtsy reach curtsy that's hard to say quickly a curtsy step up um perfect bring back the lunge jumps um the test that you you mentioned at the top of that so if someone doesn't have 30 reps for example they've got 20 then what you've identified an area of opportunity fine so that's then something you're going to prioritize then into your strength work yeah so i would we're talking about someone who isn't injured here yeah i would never stop someone doing what they are doing because they haven't met x criteria i would just encourage them to keep the main thing the main thing and it might be that if we're talking about a more hybrid approach to training running and lifting you're currently running 15k a week okay for the next four weeks let's stay within 15 to 18k we don't need to make massive jumps in volume but let's rather than that progressive effort being placed there let's place it on the strength training and that's our main focus until we get to where we need to get to um i think it's important to to know i wouldn't i wouldn't recommend someone doing plyometrics until they've hit a minimum of 10 um single leg calf raises single leg squats i've never really found anyone that hasn't hit single leg hamstring bridge bridges above 10 other than if they've cramped which is more of a neuromuscular issue and actually just doing spending more time in those positions with isometric type exercises is going to be really beneficial can we just pick up on that cramp thing because that's something that's very prevalent in me um why does someone get cramp um liam would be better talking about the hydration side of it yeah i think uh definitely that's often the one that people lean to right it could be a hydration thing but if it wasn't a hydration hydration thing which it's not going to be if you're doing a hamstring bridge lying on the floor yeah i think if if you're concerned about hydration if you go to to the loo and it's anything but really dark you're absolutely fine um beyond that from a cramped perspective the the easy way of explaining it is like neuromuscular confusion your brain and nervous system again can't doesn't understand the tasks that you're trying to complete so as a protective mechanism it creates this spasm or this cramp to stop you doing what you're doing because you haven't earned the right to hold that position in in the way that you're trying to do it so for a hamstring bridge from a hamstring bridge perspective if you're completing it well and we can get a decent control of your pelvis so the proximal hamstring is pulling the pelvis slightly posteriorly and uh the hamstrings behind the knee so the distal hamstrings are creating a bit of knee flexion and we're shortening the hamstring at both ends quite often that can cause someone to cramp because they just the brain doesn't know how to complete the task that you're asking it to do and rather than be put in a stress position where there's potential for trauma it'll go stop what you're doing which is actually really interesting because a lot of my assessment and the assessment we use as a company starts on the floor and a lot of people fall short of those sort of tier one tests through cramp when when you think about everything playing into the same bucket on the floor your nervous system doesn't even have to fear falling over it it doesn't have to balance itself your vestibular system is very very relaxed so it isolates the test even more and then if you think if you can't use your hamstring in that way because it does relate to gate quite specifically in terms of mid stance and different pits like that um imagine what's happening when you're stood upright you're increasing the force demands because your foot's hitting the floor i think the research i think it's about three and a half times body weight they class it as slow running speed but it's 430 per kilometer so it's pretty quick but they They looked at sprinting and stuff like that.

48:50There's huge amounts of force. There's the chaos of the environment that's going on around you. If you're just out for a run, you're watching the people in front of you. You might be crossing a road. You might be the camber on the curve, whatever it is. There's so many different layers to it, but you need to pass the T01 foundation test to then go from lying to standing. And is it just a case of then if you are cramping through one of those tests, it's just more exposure to that position over time? that is a option um obviously it depends i find myself saying that quite a lot in in my world um it might be that there's an unresolved issue or an unidentified issue pathology wise or non-pathology um it might be something in your history your injury history that we need to address further down or up the chain um but yes actually spending more time in those positions is is going to earn the right to be better at that exercise it's going to build the strength the control etc etc let's keep on this this um this idea of running i think just using that as the context here because i think that is the thing that most people are going to be uh experiencing they're increasing their running volume because of high rocks and marathons etc i think people know how to prepare and warm up for strength training i think strength training is pretty controlled um so we've mentioned there that sort of prep work the plyos etc we've mentioned the test to do first just to see where you're at is there anything you see missing from a program and i kind of i don't want to tee up the answer too much but what is missing from most people's strength training when it comes to the desire to want to run more um i don't know where you were heading it but the first thing that comes to mind for me is isometric type training um and there's some really good work by a guy called franz bosch who's strength and conditioning coach uh from the netherlands and he talks about muscle actions and things like that and far more complex than i'm going to go into but if you think about it again at a really simple level in your strength training you have an eccentric and a concentric component you move down you move up when someone runs you don't well one you'd look pretty stupid if you had a large eccentric and a large concentric but you'd also spend much more time on the floor and then you'd actually run a lot slower so the muscle actions or the muscular tenderness unit works far more isometrically and there's some company that i work with uh quite closely and have used for a long time even in sport called valve and they've got force plates and different pieces of tech that is fantastic and they're now producing normative data for everyone from elite sports to team sports to everyday person of what certain isometric movements or tests so they have something called the runner's um ankle isometric and the sorry they've got runners isos and there's a knee iso push an ankle iso push and a hip iso push uh developed by a guy called alex notaria who's a really good strength and conditioning coach from australia but they're producing normative data and they're wanting people to hit team sports four times body weight on a knee iso push and that's a lot of force but that shows the demands that healthy populations are required and need to be exposed to it's not that it's think of it as a 10 % drop from there to just the normal population but it will make you more efficient and more effective as a runner which in turn is going to reduce your chances of injury and this is where you need to look at things with this performance hat like a lot of people go i don't want to get injured i'm going to do less i'm going to rest i'm going to do my activation exercises when actually you haven't built the foundation of strength that makes you perform better and makes you more resilient it's funny isn't because i think you know it's quite typical of like someone from a strength background to cross over into this you know strength and now running and we're married to our one rm back squat numbers and you know this is probably like a you know two times body weight is that was respectable but we don't necessarily it may be because the access to the equipment just will test these things but we don't necessarily place the same importance on like that you said four times body weight on the knee isopush yeah it's i guess you don't know what you don't know and and the this tech and this kit is very new and the data is even even newer and actually it's about now educating people on other options and i guess it's there's a few barriers it's the actual educational piece but then people's willingness to go into a recreational gym and set up a runner's knee iso push people are going to be like what on earth are they doing and it's breaking down that barrier and again it wouldn't bother me in the slightest i've done some weird things in in commercial gyms over the years that are from a certain conditioning background but for the everyday person that's a it's a big hurdle and a big challenge yeah i mean something certainly something over the last couple of years went up where it's strange right coming out of rugby moved away from sort of performance-based training probably got too caught up in just lifting and looking trying to look good now given what I'm asking my body with the running etc coming back to it you do feel a little bit weird like doing a runner's knee iso push and there being no back spots in your program for example um but I'm certainly feeling the effects of it I mean this is the healthiest my body's felt for a long time having been really diligent with it um so you mentioned that isometrics in the training program I think that is something many people are going to overlook.

54:19I think there's many people holding ISOs in a gym now, given the increase in running. The other thing I was going to talk about is maybe just the isolated calf work. Sort of preface that by saying I've got the smallest, weakest calves in the world. But it's something that, again, I've noticed in the programming that it's something that is always in there. So if there was two things to take away, it's the ISOs. And someone can just go on YouTube and maybe look at the best ISOs for running for example calf work, how many times a week how many sets, is there any sort of guide rails you can give us for that?

54:53Yeah definitely, I think to give a bit of context the paper I'm talking to is by Donatown, you'll find it easily enough and they'd look at peak force demands of different muscle groups during varying running speeds and again I always come back to this slow running speed which is the 430 per kilometre and from a calf group perspective so the soleus and the gastroc is anywhere between nine to twelve times body weight that's going to go through that group at that running pace now you're never going to lift nine to ten twelve times your body weight in a calf raise whatever variation you can you can give yourself as much stability as you want on a smith machine and a single leg calf rate all this but it needs to be progressive in nature and you need to push it like you'd push your bench press and your back squat it was only last week i was um assessing a professional rubber player and i said oh so you do your calf work he's like yep diligently i do my minimum of eight sets minimum of eight sets a week um i was like okay cool on your seated calf for is what you're doing he's like i don't know like 30 35 is 105 kilo back rower professional rugby player and i was like why don't you do anymore i went i just thought that was quite heavy i was like i'm just gonna use some context I'll do 60 to 70 kilos stacking plates until it's too awkward for me to keep loading it.

56:11And it was like a light bulb went off. It was like, why haven't I just kept progressing it? And it should, well, any exercise should just be trep with intent and progressive overload. You're never going to, as long as your program is well balanced, you're never going to see a negative impact of getting stronger. But I think it's important, going back to your question, minimum of eight sets per week through um different variation of bent leg and straight leg calf raises um if we can push up to 12 great there's lots of research about um the most effective amount of sets and frequency across a week and it's pushed up obviously 16 to 24 um sets but i think actually looking at it practically for people that manage running and training together and the primary thing isn't just about muscle building you'll get a really good stimulus from 8 to 12 sets done with real intent progressively overloading week on week now the thing we need to think about is and this is for me where the buy-in is to the plyometrics and the prep work whether that's in the before a session or whether that is before a run to bridge the gap from a 50 kilo seated calf raise to nine times body weight when you run is plyometrics really good so again just for take homes so 8-12 sets bent leg and straight leg variations are they single leg?

57:38always isolating one leg over the other? I prefer that obviously it doesn't really matter as long as it's progressively overloaded I prefer it because it isolates say someone hasn't had the opportunity to be assessed and identify maybe different areas for opportunity and improvement just doing the single leg work should start to close some of them gaps and it might actually identify you could use it as your own self-assessment or i can only hit i can hit 50 on my left but i can only hit 40 on my right right i need to probably do an extra couple of sets or even just an extra set on my right every single time i train until they catch up and that doesn't mean you do less on the left you still want to progressively overload that side and this is a big rehab mistake that people make is they go, I've got a 20 % deficit from left to right, so I'm going to do less on my left.

58:28So actually, yes, you meet, but because you've done less on the left, you've deconditioned. So you've met at 45 rather than coming up to 50 and beyond and returning to play better than you were. And it's a big, big mistake that people make in any rehab. It's actually we want to catch the good side and the non-affected side. We don't want to let that decondition and then kid ourselves that our limb symmetry index or our deficit from side to side is within 10 % when actually we've just got worse. That brings me nicely onto this next question, which is kind of coming back to injury because you picked up on it there.

59:07But I wanted to touch back to it. This notion of when someone is injured and you see it just in like I said, the everyday person coming into the gym is I can't train, I'm injured. one thing you know I used myself as the example ran the London Marathon four days later in Mykonos tear my hamstring at the track I've got you on speed dial and sent you know sent the distress signal out to you and said look mate I've done my hamstring I think it's quite bad when can we start and you're like here's the program for tomorrow and I think people understanding that an injury doesn't mean everything has to stop and whether that's training the uninjured side or training around it or like you said, being able to prioritize aerobic work if you can't train a limb, for example.

59:50That notion of people needing time off from the injury, obviously the injury needs to be let heal, there's maybe some swelling to account for, et cetera. But what can you give people in terms of confidence if you are injured, what should the next one to three, three to seven days look like? Depending on the injury, obviously. Absolutely, yeah. I firmly believe that every injury is an opportunity. and it's something that I instill into my team and that I encourage my team to instill into our clients because, can I swear? Yep. Getting injured is shit. It is. Like nobody wants to do rehab, but it's an opportunity to, one, focus on other things.

1:00:31Let's say hamstring tear, for example. Yes, we need to protect the injured site and we need to load the injured site appropriately, but you might have a goal associated with pull-ups you might have a goal with stacking some muscle on your upper body you can now place more energy and effort into that channel it might even be i want to focus on my business for the next four weeks it doesn't have to be a physical pursuit that is the opportunity but it's actually just going and changing the lens of this is shit i'm injured the world's ending i can't do anything it's actually right where is the opportunity where can I make improvements both personally and physically, professionally, whatever it may be, outside of that, there's always something you can do.

1:01:16As long as, and the context I would give around that, as long as you're protecting the injured site, if you've got a wound from surgery and things like that, you do not want to be sweating, you do not want to be risking it. Even last week, we had to pull one of our clients up. He'd gone in and done stuff and we were just like right just just just chill the worst thing you'll get is an infection just give yourself a stable base to start from but beyond that there's always something you can do right whether it's low level isometric just to slowly start loading that area whether we're training the other side there's something called the crossover effect so you you can train um a couple of times a week typically three three sets of five at really high intensity rp eight nine pushing it and the actual deconditioning on the injured limb will be reduced from anywhere between 20 to 30 percent i it will keep 20 to 30 percent of what it would have lost if you didn't do that on the other side so there's the the psychological piece around keeping moving keeping training doing the things that you enjoy doing in the environments that you enjoy doing but actually the things you do as early as as early as is appropriate are going to have a positive gain and a positive long-term impact on your injury recovery?

1:02:33The follow-on question was around the psychology around injury. What should people's mindset towards injuries be? But I think you've touched on that nicely, unless there's anything else to add. It's so hard. We spend more time talking to our clients, particularly our, so we have something called our Pro Recovery Plan, which we take over everything. And we work really closely and intimately with our clients. But we spend more time talking to them about the psychological element of it and managing expectations and feelings and thoughts and emotions than we do going, here's why you're doing this exercise and this many steps and reps because it is so challenging.

1:03:14It's your identity changes. Like you might go from training twice a day, posting it on Instagram, it's a big part of your life and things like that, to for the next two weeks you just need to chill. and it's a really tough transition for people where and whether that's you who works like works out at this high level or Sandra who does three sessions a week but loves going to the gym because she has a coffee with her friends afterwards and now she can't do that it's it's meaningful on so many different levels to different people it did um it did you know once I sort of talked to that period of like finishing rugby and I didn't really do anything in terms of my fitness in terms of really pushing myself so didn't really get injured for four or five years as I started getting a bit more competitive and and toeing the line a little bit more I sort of picked up injuries and you do kind of think particularly as a fitness professional and someone that's supposed to be super fit and super capable when you get injured you are kind of it's a bit of a dent to your ego you're a bit like fuck because you found I mean obviously you frame it as an opportunity but you found found a weakness or you've done something your body wasn't quite capable of um but certainly over recent years i've begun just to understand that you know whilst of course i don't want to get injured i'm not seeking injury i am seeking to try and toe the line and to ride the right side of the line but sometimes um you know you just you just drift the other side and and it is a it's it's a shame but it does it does become an opportunity and i think every opportunity every time i've got injured and particularly working with you i've been able to come back and focus on things to bring back a more complete well-rounded athlete so it certainly has been opportunities definitely and i think it's the whole the the point of training and the super compensation effect is you lose fitness to gain fitness and what i mean by that is is you're striving to create adaptation but as a result of that you you are toeing the line like you say and i think especially it's important for people that get frustrated with niggles and a niggle would be something that you can feel but it's not stopping you from training well it's actually like is is that just normal for someone who is really pushing their body to its hardest capability to create a positive adaptation and i would argue yes i i personally don't think there'd be anybody that never feels an ache pain or an eagle even if you did nothing you'd probably feel stiff from lying in bed all day and it's a really unique I have some really unique conversations with people around it at both ends of the spectrum really Yeah I mean I think I've said this to you before I think from 16 years old there's not a day that I haven't woke up in pain or with a niggle you kind of learn to deal with it I want to wrap up on testing it's something you're obviously very big on we've touched on it with the VALD stuff how important is it for someone to be able to get that baseline data and objectively kind of see where they're at.