Ready to Run

Dr. David Hryvniak is a physical medicine and rehabilitation sports medicine physician based out of Charlottesville, Virginia at the University of Virginia. He is an expert in several areas of sports medicine including sports ultrasound, running medicine, and Orthobiologics. In this episode, he shares his expertise on platelet rich plasma (PRP). PRP is a tool used by many sports medicine physicians. The goal of today's episode is to discuss the state of the science and to discuss some of the myths and facts, common clinical applications, and ways we can optimize our outcomes for patients with use of ultrasounds to guide our injections, and formulating a post PRP rehabilitation strategy.

This is an exciting topic that generates a lot of attention in our sports medicine practice and we are excited to have a leading expert in this arena share his knowledge on PRP! So let's get ready to run with Dr. David Hryvniak.

What we talked about:

4:10- Introduction to Dr. David Hryvniak 

12:25- What PRP is and how it works

17:45- Common applications of PRP for runners

20:35- Timing in the rehab process to utilize PRP

24:05- Patients that have the most success with PRP

29:15- PRP procedure

38:20- Return to run protocol after PRP

43:55- Tendons that have the highest success rate

50:05- Increase in proximal hamstring tendinopathy

53:00- Ultrasound guided PRP

55:15- Summary of PRP for clinicians and patients

59:20- The Running Medicine conference

Sponsors:

Previnex

Use the code "ReadytoRun" for 15% off your first order

Guest info:

Dr. David Hryvniak: https://uvahealth.com/provider/David-Hryvniak-1316238934 

UVA Runner's clinic: https://www.uvarunnersclinic.com/ 

Instagram: @uvarundoc

PRP references: 

-Malanga G, Ibrahim V. Scientific evidence of platelet-rich plasma for orthopedic conditions: basic science to clinical research and applications. Regenerative Treatments in Sports Medicine and Orthopedics. 2018. Chapter 7. 89-117.

-Mautner K, Malanga G, Colberg R. Optimization of ingredients, procedures, and rehabilitation for platelet-rich plasma injections for chronic tendinopathy. Pain Manag. 2011. 1(6):523-532.

-Dai WL, Zhou AG, Zhang H, Zhang J. Efficacy of platelet-rich plasma in the treatment of knee osteoarthritis: a meta-analysis of randomized controlled trials. Arthroscopy. 2017 33(3): 659-670.

In today's episode of The Ready to Run Podcast, we are joined by professional runner, Joe Klecker. Joe competed at the University of Colorado in Boulder, Colorado where he was a 9-time All-American and is currently the school record holder in the 5000m. He turned pro in 2020 with the On Athletics Club in Boulder and became an Olympian in 2020 in the 10,000m. 

Joe is originally from Minneapolis and both of his parents were professional marathoners and US National record holders in the ultramarathon.

He won his first national championship in 2020 where he edged out Grant Fisher in the 10,000m. He went on to finish 9th at the World Championships in Eugene, Oregon later that year.

In this episode, we discuss some highlights from last season and some factors that have led to his success and his ability to overcome past injuries including a foot injury that happened prior to some of his breakout performances last year. Joe also shares some of his goals for the upcoming season and beyond. Hearing his take on how to maintain Achilles strength provided a unique perspective in our conversation and ties in nicely to a previous recording where Kurt and I discussed Achilles tendon exercise strategies.

This episode was recorded just before his 2023 season opener at the BU Invitational where he achieved his goal of breaking the 13-minute barrier in the 5k by going 12:54 which is now the third-fastest indoor 5k for American men! 

What we talked about:

3:40- Introduction to Joe Klecker and how training has been going

6:40- 2022 highlights

11:55- Preparing for racing the best in the world

16:20- Racing strategy

19:05- Other factors in training

23:20- Achilles injuries

37:40 - Imaging of his Achilles

47:20- Takeaways from his first two years running professionally

Sponsors:

Previnex

Use the code "ReadytoRun" for 15% off your first order

Our goal in this week's Down Week episode of the Ready to Run Podcast is to sort through the literature on Achilles tendinopathy and provide practical rehabilitation strategies for the athlete with acute reactive tendinopathy and chronic recurring degenerative tendinopathy.

We'll also highlight some of the key articles on Achilles tendinopathy rehabilitation as well as a few other considerations including the role of the forefoot and load management strategies for the runner returning from Achilles injury.

What we talked about:

1:15- Outlining achilles tendon injuries

3:05- Initial examinations of a patient with achilles pain

7:05- Load management

15:45- Rehab strategies

32:50- Restoring stability

35:00- Mobility, stability, and strength

37:30- Degenerative changes in the tendon

References:

In today's episode of the Ready to Run podcast we'll meet with professional long distance runner, Bria Wetsch. Bria lives in Colorado and has been passionate about competitive running since she was 11 years old. Following a successful high school career, Bria went on to compete at a collegiate level at the University of Oregon. After college, she began her career as a pro runner in Mammoth Lakes, CA where she met her - now husband and coach - Aaron Lange. We'll discuss her journey from Haglund's surgery in 2017 to Olympic trials qualifying time just 13 months later. Bria ultimately finished 27th at the 2020 Olympic marathon trials in Atlanta. More recently, Bria ran a marathon PR of 2:28:35 to finish in 4th place at the California International Marathon earlier this month. We'll recap her incredible performance as well as some of the mental health challenges she overcame during her build up. For Bria, CIM was about more than a marathon PR. She shares a very open conversation on her struggles with depression, anxiety, and panic attacks at the beginning of her marathon training cycle. She also discusses how the trajectory to finding groundedness was not linear. We hope this episode encourages everyone in the running community to better understand the influence of mental health in sports so that we can support those in need and help others achieve their goals. Let's get ready to run with professional long distance runner Bria Wetsch! 

What we talked about: 

4:15- Introduction to Bria 

5:25- How Bria is feeling coming off of her race at CIM 

9:50- Her racing mentality 

14:15- Her mentality during her race at CIM 

15:10- Her buildup to CIM 

20:25- Her Achilles injury she sustained post-college and her Haglund's surgery 

26:10- Bria's husband and coach, Aaron 

28:55- Return to running post Haglund's surgery 

29:45- Moving to Boulder 

31:05- What has kept her in the sport through all of the injuries 

38:05- What she is looking forward to in the coming years 

41:20- Her battle with her mental health this summer and how she treated that 

Show notes: 

Bria on Instagram 

Sponsors: 

Green Growers Farm Elderberry Syrup 

Use the code “Sandyboy” for free shipping 

Previnex 

Use the code "ReadytoRun" for 15% off your first order

What we talked about: 

1:10- Case presentation of anterior knee pain 

2:50- Terminology surrounding anterior knee pain 

4:20- The various myths surrounding anterior knee pain 

9:55- Primary reasons patients develop these symptoms 

11:30- Imaging to order with this injury and how to interpret it 

16:20- Where swelling occurs 

17:40- Ability to run through this injury 

21:05- Passive interventions 

26:35- Active rehab programs 

37:35- Knees over toes 

42:00- Treating someone with anterior knee pain that is still training at a high level 

45:15- Topical and oral anti-inflammatory

In our last episode, Olympic marathoner Jake Riley and registered dietician and professional runner Maddie Alm shared a lens into the personal journey and athlete’s perspective on Relative Energy Deficiency in Sport (RED-S).

Today, we’ll expand on the topic of RED-S with Sports Medicine Physician - Dr. Aubrey Armento and Registered Dietician - Amanda McCarthy of Children’s Hospital Colorado. They will share their expertise and provide insight into screening, diagnosis, treatment, and recovery considerations for return to sport.

Dr. Aubrey Armento is a pediatric sports medicine physician at Children’s Hospital Colorado and Assistant Professor in the Department of Orthopedics at the University of Colorado. She is the founder and medical director of The Running Athlete Clinic (TRAC) at Children’s Hospital Colorado and is passionate about caring for runners, in addition to care of the female athlete, the athlete triad, and RED-S.

Amanda McCarthy is the Sports Nutrition Program Coordinator and Certified Specialist in Sports Dietetics at Children’s Hospital Colorado Sports Medicine Center. Amanda enjoys working with the young, competitive athlete to help them understand nutrition's role in their wellness and performance.

Let’s get ready to run with sports medicine experts - Aubrey Armento and Amanda McCarthy!

What we talked about:

4:20- Introduction to Dr. Aubrey Armento and Amanda McCarthy

9:55- Defining RED-S

12:50- Health and performance consequences from RED-S

16:40- Micronutrients and macronutrients

20:00- Considerations for lab work while training at altitude

22:50- Assessing an athlete's diet

25:10- Screening for iron deficiencies 

27:40- Considerations for iron supplementation

34:25- Labs and tests for RED-S

37:50- Calculating an athlete’s energy availability

40:15- Treatment plans for athletes with RED-S

45:35- Assessing younger athletes for RED-S

54:10- DEXA scans

1:02:20- Treatments for low bone density

1:11:45- Return to sport considerations

1:17:15- Wrap-up message about RED-S

Sponsors:

Green Growers Farm Elderberry Syrup

Use the code “Sandyboy” for free shipping

Previnex

Use the code "ReadytoRun" for 15% off your first order

In today's episode, we have a discussion on relative energy deficient in sport, otherwise known as RED-S with Jake Riley and Maddie Alm. 

Maddie is a Registered Dietitian and the founder of Fueling Forward Sports Nutrition. Maddie has Masters in Nutritional Science from San Diego State. She completed her training and a registered dietitian at Lipscomb University in Nashville, Tennessee. She also competed at the University of Colorado in Boulder and currently runs professionally for Team Boss. 

Jake is an American professional long distance runner and 2020 Olympic marathoner. He currently lives and trains in Boulder, Colorado and is coached by 3-time Olympic marathoner, Lee Troop. Jake grew up in Washington and was an 8-time All-American at Stanford. He previously ran with the Hanson's Distance Project. Jake had one of the most memorable performances and comeback stories at the 2020 Olympic Marathon Trials in Atlanta where he grabbed an American flag with about 400m to go and ran to a sprint finish where he finished 2nd. In June 2022, Jake shared his story about being diagnosed with RED-S in Runner's World. His story helped to open the door to discussing RED-S in the context of male athletes.

The term RED-S evolved from what was previously described as the female athlete triad. In 2014, the IOC published a description of RED-S to include a broader definition of the health and performance consequences as well as both inclusion of both male and female athletes. 

Identifying an athlete with RED-S is not always straight forward. By sharing an athlete and expert perspective, we hope that this episode can provide a unique lens into the challenges, both physical and mental, that go into diagnosing and managing RED-S.

We also get an update on where Jake is at several months after sharing his diagnosis as well as Maddie's advice on how athletes can make positive changes that can be long lasting. 

What we talked about:

3:55- Introduction to Maddie

4:25- Introduction to Jake

7:25- RED-S and low energy availability

9:55- Early signs and symptoms of RED-S

12:35- Jake’s diagnosis with RED-S and working with Maddie

20:50- What prompted him to seek help

26:30- Warning signs and symptoms to pay attention to as an athlete

32:35- Questions to ask male athletes to diagnose RED-S

34:10- Treatment approach

41:50- Timeline of recovery

45:20- Differentiating between being tired in training and symptoms of RED-S

51:30- Jake’s recovery from achilles surgery and where he is at in training

1:01:15- Fueling during the marathon

1:05:35- Take home messages about RED-S for athletes and clinicians

Show notes:

Jake on Instagram

Maddie on Instagram

Fueling Forward

Nathan Carlson is a physical therapist, coach, and business owner based out of Kansas City. He specializes in the management of bone stress injuries, managing the high school and collegiate runner, and implementing resistance training with endurance athletes. Nathan teaches nationally and internationally on these topics. Nathan has two digital resources - A Guidebook to Running After a Stress Fracture and A Guidebook to Navigating High School Running.

In this episode, we focus on how to approach bone stress injuries once we have established our diagnosis. We open our discussion with the physiology of bone healing and what the current research says about how long it actually takes for a bone to heal and how that may differ based on the location of the injury. We also discuss the factors that influence treatment, how to test when an athlete is ready to return to running, and how to progress training load for a successful recovery. 

Bone stress injuries are one of the most complex and frustrating injuries for runners. After our discussion with Nathan, we hope that you will have a better understanding of the training, nutrition, and metabolic factors that need to be considered with diagnosing and treating these injuries.

What we talked about:

3:05- The physiology of bone healing and the expectations to set for patients

17:40- Modalities for recovery

22:20- Focus for the return to run program

31:00- Being flexible with the protocol

Show notes:

Nathan's website

Nathan on Instagram

References:

Nathan Carlson is a physical therapist, coach, and business owner based out of Kansas City. He specializes in the management of bone stress injuries, managing the high school and collegiate runner, and implementing resistance training with endurance athletes. Nathan teaches nationally and internationally on these topics. Nathan has two digital resources - A Guidebook to Running After a Stress Fracture and A Guidebook to Navigating High School Running.

In this episode, we have an in-depth conversation on bone stress injuries. Our conversation was packed with so much valuable information that we broke it down into two episodes. In part one, we discuss bone physiology, factors that contribute to bone stress injuries, clinical perils, and radiographic tools for diagnosis. 

Bone stress injuries are one of the most complex and frustrating injuries for runners. After our discussion with Nathan, we hope that you will have a better understanding of the training, nutrition, and metabolic factors that need to be considered with diagnosing and treating these injuries. 

What we talked about:

3:10- Introduction to Nathan

6:40- Weight lifting for high school athletes

8:25- Defining a bone stress injury

11:00- Differences between a stress reaction and stress fracture and what causes them

22:05- Obtaining a more in-depth background of an athlete to learn more about the injury

25:45- Diagnosis and prognosis of bone stress injuries

38:05- Testing and imaging for bone stress injuries

Show notes:

Nathan's website

Nathan on Instagram

References: