Fix My Running

So you love to run, but now you've got the news that you have knee osteoarthritis. You thought it was the end of your running career but you stumbled across a wonderful podcast that convinced you otherwise. After listening to episode 19 with Dr. Greg Lehman you are now feeling much more optimistic about your knee osteoarthritis. You're feeling that perhaps the diagnosis isn't a death sentence for your running career. Even more than that, after listening to episode 15 with Dr. Merv Travers, you're feeling so anti-fragile that you're convinced your knees can even become stronger and more resilient than they used to be! You're ready to hit the gym and strengthen the hell out of those quads, glutes, hams, and calves. But, I hear you ask...

So how exactly do I do that?

Well, if you're anything like most of the runners I've ever met, you'd rather go on a 3 hour run up a hill in sweltering heat than spend 15 minutes in a gym. Alas, you want to get stronger and you're ready to take your medicine. You've signed up for a gym membership and you are committed to actually using it this time! You're going to need to know what to do. What's the point of going to the gym if you don't know how to get stronger? 

Fortunately, my guest today is an expert in Strength and Conditioning and she's going to break it all down for you. Dr. Claire Minshull is one of the most highly respected rehabilitation and conditioning specialists in the UK. She has worked in the field of sports medicine and health for over 20 years as a Senior Lecturer, Researcher, Consultant, and Practitioner. She has designed, led, and managed major clinical and non-clinical research trials, supervised several Ph.D. students, and has published over 30 research papers in peer-reviewed journals.

Claire’s area of expertise means that she uniquely spans the gap between the physiology of conditioning and physiotherapeutic rehabilitation. She founded Get Back To Sport, an international education and training company, to translate scientific research findings into enhancing clinical practice.

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A few years back my cousin, Adrian, invited me to do a Park Run. Park Runs are a popular event in the UK. Each weekend runners line up for a 5k race in parks all over the UK. It’s free to join in and a wonderful initiative that I hope finds its way to Red Deer someday.

At the start line, Adrian said something like “I’m going to push it today, so I’ll just find you afterwards”. The clear implication being that I wouldn’t be able to keep up and he’d just have to leave me behind.

Huh, we’ll see about that!

What follows is an epic tale of cellular heroism. We’ll be exploring the physiological activity taking place within the muscle cells during this Battle of Titans. In order to understand performance in the 5k, we’ll need to examine the energy systems involved.

We're also going to learn about the physiological mechanisms of fatigue and adaptation.

The blog that goes with this episode goes into far more depth and you can see all the diagrams that accompany the information. Just click here to check it out:

The 5k: A Tale of Three Energy Systems

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As runners, we don't think about the brain much. Running is really hard sometimes, but not in the way that quadratic equations are hard. So who the hell cares about the brain? Just keep the heart beating and the lungs breathing and let me get on with my race!

Well, my guest today thinks that runners should be paying more attention to their brains. If they did, they may be able to enhance performance and avoid injury. Muscle coordination, timing, balance, visual coordination, hormone regulation, motivation, circulation ... the list goes on. We might think we're just running, but the brain is very busy. Performing and coordinating all of these different tasks is a very complicated job. A job that can be performed extremely well, extremely poorly, or anything in between.

Functional Neurology seeks to "hack the brain" and find ways to help it perform these tasks more optimally. It is being applied in the Health Sector towards concussion and other brain injury rehabilitation. It can also be applied to the otherwise healthy runner in an effort to improve their performance. My guest today is Dr. Dave Hardy, he is going to be helping us understand Functional Neurology and why runners might want to consider it as a way to get an edge.

Dr. Hardy graduated Cum Laude in his Chiropractic class and has received his Diplomate in Functional Neurology through the American Chiropractic Neurology Board. He has practiced in North Carolina and Ohio before returning home to Alberta. During his time in the U.S., his primary focus was working with patients struggling with concussions and brain injuries, as well as neurodegenerative, neurodevelopmental, and metabolic conditions. Dr. Hardy also has a passion for pushing himself athletically, he has completed both the full and half-Ironman distances, and played Rugby at a high level.

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Osteitis Pubis is a relatively uncommon cause of pubic bone pain in runners. However, when it occurs it can be a real nightmare to get rid of it. A few months back I received a question about it from a listener...

"Hi Matthew, I’ve been watching your podcasts on YouTube they’re really good. I can’t come to see you as live in England. I’m a 51 year old ________ trying for 5 years to beat 1hr45 for trail half marathon. Not sure if you can help but had to stop due to bilateral pubic rami osteitis (diagnosed on MRI) with medial groin pains radiating down my adductors during runs and for days afterwards. Literature is confusing, rest for 3/12 and lose all my conditioning? stretch or not to stretch? Continue weight training? Run to below 4/10 or not? Try cycling or rowing machine? Please can you advise, understand if you can’t for professional reasons etc. Thanks Adam _____"

Since I had little experience dealing with this problem I took to the internet. It's very hard to find any good information about managing pubic bone pain in runners. I did know just the person to ask though.

My guest today is an expert in the management of hip and groin pain. Benoy Mathew is a Physiotherapist and Extended Scope Practitioner, specializing in the management of complex lower limb pathology. Benoy completed his Masters in advanced physiotherapy from the University of Hertfordshire in 2014. He currently works in a senior clinical role in the NHS and privately at the Life Plus Clinic in London, UK consulting on complex hip and groin pain cases that have failed rehabilitation elsewhere. Benoy teaches his hip pain and running injury management courses to Physiotherapists and other clinicians all over the world.

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Shoulder pain with swimming is often referred to as Swimmer's Shoulder. It's a fairly common problem among swimmers and even some triathletes. So what is Swimmer's Shoulder? Well, it's kind of an "umbrella" term for a bunch of different shoulder conditions that may cause pain with swimming. One person with Swimmer's Shoulder could have a painful rotator cuff tear, whereas another may have subacromial bursitis. Many swimmers with shoulder pain are diagnosed with shoulder impingement, so what the hell is that!?

My guest today will be helping us unpack this complicated topic. Jo Gibson is a Clinical Physiotherapy Specialist at the Liverpool Upper Limb Unit based at the Royal Liverpool Hospital in the UK. She is an associate lecturer at the University of Liverpool (where I did my Physio training back in the day) and lectures internationally on the subject of shoulder rehabilitation. Jo is also the Squad Physiotherapist for the Great Britain Endurance riding Team and provides consultation to many elite sports teams regarding the management of difficult shoulder pain cases. Jo co-founded the International Congress of Shoulder and Elbow Therapists and has served as Vice president and Chair of the education committee on the EUSSER board (European Society of Shoulder & Elbow Rehabilitation).

I could go on listing Jo's achievements for quite some time! However, most importantly Jo has a gift for understanding the whole picture when it comes to her clinical work. Fortunately for us, Jo is also a superb teacher, so get ready to learn a ton about shoulder pain from swimming.

Check out the full show notes here

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"Bad News Hun, the Doc says it's bone on bone..."

Have you been told you should quit running because of hip or knee osteoarthritis (OA)? That it's bone on bone. All that running has caused too much wear and tear?

Well, these aren't very optimistic sentiments, are they? So is this an accurate depiction of the future for runners who develop knee osteoarthritis? My guest today doesn't think so. In fact, he's so sure that we health professionals are giving the wrong message to runners with hip and knee osteoarthritis that he has created a program dedicated to providing a more optimistic outlook for OA. The program is called OA Optimism and Dr. Lehman joins me on the show today to discuss why runners with hip and knee osteoarthritis have good reason to be optimistic.

Click here to read the full show notes

Dr. Greg Lehman is a Physiotherapist, Chiropractor and Strength & Conditioning Specialist. He is a thought leader in the rehabilitation world, famous for his efforts to reconcile the biomechanical and pain science research. Dr. Lehman has taught his two-day course, Reconciling Biomechanics with Pain Science, to health and fitness professionals all over the world. Dr. Lehman is also a renowned Keynote Speaker and I recently had the pleasure to attend his address at the Third World Congress of Sports Physical Therapy in Vancouver. As well as being intellectually challenging, it was also quite hilarious, as Dr. Lehman is also known for his somewhat edgy sense of humor.

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Runner's knee refers to a bunch of different conditions that cause knee pain in runners. However, it is most commonly used in reference to patellofemoral pain. The patella is the kneecap and the femur is the thigh bone. The articulation (joint) between them is the patellofemoral joint. Pain coming from this joint is usually experienced as if the "back of the kneecap" is hurting or as a diffuse (general) pain around the front of the knee. For this reason, it is also sometimes referred to as anterior knee pain.

Unfortunately, many runners are very familiar with this problem. We have quite a bit of research to guide us in the rehabilitation of this condition. Most of the research focuses on load management and strength exercises. However, I recently came across a study that suggested we should also consider whether a higher BMI (body mass index) or obesity could also be a factor. The lead author of the study joins me on the podcast today to discuss her research and her other thoughts on the management of patellofemoral pain (runner's knee).

Amanda Schenatto Ferreira is a Physiotherapist and Ph.D. Candidate focusing on biomechanics and patellofemoral pain at São Paulo State University in Brazil. She recently published a paper entitled Overweight and obesity in young adults with patellofemoral pain: Impact on functional capacity and strength.

Click here to read the full show notes

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Achilles tendon pain is one of the most common and persistent running injuries. Many runners experience Achilles tendon pain after particularly long or hard runs. It usually hurts as you start running and then warms up and starts to feel better, only to feel more painful the next day. Achilles tendon pain can often persist for years and years. In response, many runners gradually reduce their running volume or switch to shorter races to “avoid damaging their tendon”.

Myles Murphy is a Sports Physiotherapist and PhD candidate at The University of Notre Dame, Australia. His PhD focus is investigating rehabilitation strategies for Achilles tendon pain (aka Achilles Tendinopathy or Achilles Tendonitis). Myles has done a lot of work reviewing the current evidence on Achilles tendon rehabilitation. He joins me on the show today to help shed some light on the current best-practice for Achilles tendon pain rehabilitation. This episode is packed full of practical advice for runners suffering from Achilles problems.

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"If I keep running, will I be causing more damage?"

I think all runners have asked themselves this question at some point. If you have knee pain, and your x-ray shows that you have arthritis, we think that makes sense right? What if your x-ray shows that you have arthritis, but you have no pain at all and you can run as much as you want?

This kind of thing happens all the time. People with scans showing "damage" or "degeneration" but have no pain. How are we to make sense of this?

The difficulty here is that we are talking about pain. While we may think that pain is a fairly straightforward subject, nothing could be further from the truth. Today on the show, Mike Stewart will be joining me to help shed some light on this very confusing and strange subject. Mike has a wonderful gift for taking immensely complicated subjects like pain neuroscience and discussing them in a way that is easy to understand and often quite entertaining. He uses metaphors and stories to explain complex biochemistry and biopsychosocial concepts. If you have not come across Mike before, you will be very glad you did.

Mike is a physiotherapist, researcher and university lecturer with over twenty years experience of helping people to overcome pain. He has an MSc in Education and Physiotherapy and is planning a PhD focusing on how people in pain make sense of their experience.

Mike teaches across a variety of clinical settings including elite sports, and is an advisor on pain management to the International Olympic Committee. Mike has taught his Know Pain courses to over 1000 clinicians in 17 countries all over the world.

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None of us want to be fragile. Especially not when it comes to running. So what's the opposite of fragile?

"If a glass is fragile, give me an example of something that is not fragile". When Dr Travers asked me I replied "a diamond". If you drop a diamond on the ground, it won't break, but it won't be any stronger for the experience. It's strong, or resilient. However, when we train, we stress our bodies and become stronger for the experience. We're not fragile, we're not even just strong or resilient, we're Anti-Fragile.

This is an important concept to grasp when it comes to training for performance, as well as rehabilitation from injury. It's also a vital concept to understand for health and longevity. On the show today, Dr Merv Travers joins me to help us understand this counter-intuitive idea, and it's far-reaching implications for performance and rehabilitation.

Dr Merv Travers is a Senior Research Scholar working in the area of low back pain, tendon pain and exercise rehabilitation at the School of Physiotherapy, The University of Notre Dame Australia. He completed his PhD at Curtin University where he also maintains an Adjunct Research Fellow role. His teaching areas include anatomy and exercise rehabilitation. He has a Masters of Manipulative Therapy and is a qualified strength & conditioning coach (Australian Strength and Conditioning Association – Level 2).

Merv’s clinical background includes working in professional rugby union and he provides clinical consultation for complex musculoskeletal conditions at Star Physio. Merv guest lectures nationally and internationally on the topics of strength and conditioning for physiotherapists and tendinopathy rehabilitation.

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