Latest / The Steep Stuff Podcast / The PT Hour EP. 1| Dr. Sean Rimmer, Conquering Injuries, Insights on Achilles Tendinopathies

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The PT Hour EP. 1| Dr. Sean Rimmer, Conquering Injuries, Insights on Achilles Tendinopathies · The Steep Stuff Podcast

• 0:00
  Speaker 1: What's up, fam?
• 0:01
  Speaker 1: Welcome back to the Steep Stuff Podcast.
• 0:02
  Speaker 1: I'm your host, james Lauriello, and today we've got a very special episode for you guys.
• 0:06
  Speaker 1: None other than Sean Rimmer, my good buddy and PT from a run potential PT, joins the podcast.
• 0:14
  Speaker 1: Sean is coming on to talk about something special, really interesting.
• 0:18
  Speaker 1: We've got something fun for you guys.
• 0:20
  Speaker 1: We're going to be doing a fun little mini series.
• 0:23
  Speaker 1: This is the first of several where we talk about common injuries that are very common in runners and, yeah, I think this is going to provide a lot of value, a lot of insight, and it's something a little bit different, something we haven't really done in the past.
• 0:37
  Speaker 1: This episode is all about Achilles tendinopathies.
• 0:41
  Speaker 1: Yeah, it's kind of wild, kind of fun those pesky Achilles tendons that I know a lot of you guys suffer from from running and all of that steep stuff pun intended.
• 0:52
  Speaker 1: So, without further ado, I'm going to hand it off to Sean and we'll get moving on this.
• 0:57
  Speaker 1: Hope you guys enjoyed this podcast, this episode, and, yeah, enjoy it's time.
• 1:13
  Speaker 1: We'll see you next time.
• 1:19
  Speaker 1: Ladies and gentlemen, we are live watching autumn autumn run no seriously though.
• 2:07
  Speaker 1: It's the color changes, you know being out in Colorado.
• 2:27
  Speaker 2: it's not quite like the East coast with all the dramatic colors, but it's still really nice when you find a good area, like we hit today, and to see some different colors, not just the yellows it was.
• 2:37
  Speaker 2: It was a treat, yeah no, absolutely beautiful.
• 2:40
  Speaker 1: It's so warm for October too, man, what the hell yeah yeah, that's that needs to move on, yeah so what's new, dude?
• 2:46
  Speaker 1: Since I said last time, I saw you've run a couple races.
• 2:48
  Speaker 1: You've been busy.
• 2:49
  Speaker 1: Yeah, what's going on these days?
• 2:51
  Speaker 2: um racing season coming to an end right now had a lot of mountain stuff this summer at the cirque series.
• 2:58
  Speaker 2: I did pikes peak, I did leadville heavy half, some good, some not so good.
• 3:04
  Speaker 2: You know we talked about that, some gi issues and stuff.
• 3:06
  Speaker 2: But you know, live and you learn and try to figure it out for next time.
• 3:10
  Speaker 2: But yeah, had a good time this summer, that's all we can ask for and stayed healthy hell, yeah, that's right.
• 3:14
  Speaker 1: That's what it's all about, man yeah, just moving from block to block.
• 3:17
  Speaker 1: You know keeping the health going and you know building, building from here.
• 3:20
  Speaker 1: What do you think you're gonna do in the off to like?
• 3:22
  Speaker 1: Are you going to got like plans to do like more trail stuff or like what do you think?
• 3:26
  Speaker 2: Yeah, I, I've started already doing getting back to the, doing some flatter stuff, like a little less volume, maybe more quality work, just speed, power output, um, and then get back to the gym more.
• 3:38
  Speaker 2: I think I'm like always craving that this time of the year to like load my body, just I don't know, I feel like I start to lose a little bit from the summer.
• 3:48
  Speaker 2: Um, so it just feels good to like get in the gym, you know, a few more days a week, um, working out of a gym.
• 3:53
  Speaker 2: Basically I have no excuse.
• 3:54
  Speaker 1: So that's true.
• 3:55
  Speaker 2: Your office is kind of yeah, so it's like if I'm not getting at least a few days in on me, that's, that's pretty bad.
• 4:10
  Speaker 2: So trying to get that in.
• 4:11
  Speaker 2: And then you know Nordic skiing, you know maybe a little bit of um cycling here and there.
• 4:13
  Speaker 1: And then, you know, maybe the roller skis.
• 4:14
  Speaker 1: Oh, dude, we did so for the audience that I know I've talked about this in the last few episodes like I just picked up a set of roller skis two weeks ago and this was like my first week playing on them and and my hips are so sore.
• 4:25
  Speaker 1: But other than that, oh my god is that?
• 4:28
  Speaker 1: it so for those of you who are in the colorado springs or front range, I'm probably going to be starting a roller ski club to have people to roller ski with.
• 4:34
  Speaker 1: My wife thinks I'm a dumb ass, but like it's, I think it's going to be really fun.
• 4:38
  Speaker 1: I can't wait to get everybody out there to uh to do more roller skiing.
• 4:42
  Speaker 1: It would be a lot of fun.
• 4:43
  Speaker 1: We just built serious fitness.
• 4:44
  Speaker 2: I'll tell you.
• 4:45
  Speaker 2: I'll tell you what like doing skate skiing now for I don't know, four or five years, get out for a few times, just not as accessible in the front range.
• 4:53
  Speaker 2: So having that option is huge, it's, and it feels very similar to it, which is exciting.
• 4:59
  Speaker 2: And I, like I said, I grew up playing ice hockey and so having that too, and rollerblading, I was like this is this brings me back, I forgot you played hockey.
• 5:06
  Speaker 1: Oh, the reason I say that is because, like dude, you picked up the roller skis and got it like that, Like it was very quick.
• 5:11
  Speaker 1: I was like I'm going to be a little sensitive if you if you pick this up much faster than me't figured out going downhill yet and there was like a lady like asked me like is everything okay?
• 5:28
  Speaker 1: Like the neighbor was like concerned for me.
• 5:31
  Speaker 2: I was like no, just trying to figure it out, like I'm just an idiot like you know, and to be honest, that is a legitimate fear, like, yeah, fall because I'll fall.
• 5:40
  Speaker 2: You know, going nordic skiing and it's like you're on snow and it doesn't hurt quite as bad as asphalt.
• 5:46
  Speaker 2: So that is a definitely a fear factor to adding those in it hurts bad.
• 5:51
  Speaker 1: I um, I will say though and I don't know if you agree with this or not, I know you said it was like a sensitive or sensitive.
• 5:57
  Speaker 1: I think you said it was like a similar feeling Um, dude, I think it's easier on snow than it is on the asphalt.
• 6:03
  Speaker 1: I really do.
• 6:04
  Speaker 1: I don't know, maybe it's because my uh shout out to Leckie Thanks so much, sven, for the poles.
• 6:09
  Speaker 1: Um, but I got to like change the bottom tips on them so they catch the asphalt better.
• 6:12
  Speaker 2: Yeah.
• 6:13
  Speaker 1: So, like mine, I'm always slipping with that, so I can't bring in as much of the upper body, um, but yeah they, it should be a much easier go around.
• 6:24
  Speaker 2: Yeah, I would agree, even just noticing that you kind of slip with just the metal end.
• 6:28
  Speaker 2: You need to put the rubber piece on or whatever it comes with.
• 6:31
  Speaker 1: Yeah, that'll make a big difference.
• 6:32
  Speaker 2: I got them in the closet.
• 6:33
  Speaker 2: I'll show them to you when we're done.
• 6:34
  Speaker 1: I just wasn't sure if I would wear that.
• 6:35
  Speaker 1: That's a conversation for a different day.
• 6:39
  Speaker 1: There's a lot, but those of you interested in roller skiing check it out, because it's what's the brand the one I got, I don't really even remember.
• 6:47
  Speaker 1: I mean, I remember a brand of the poles and then I got the Salomon boots but I can't remember the name of the actual ski.
• 6:52
  Speaker 1: I got them off like rollerskicom or something like that yeah.
• 6:55
  Speaker 1: It's a good domain name and they have.
• 6:56
  Speaker 1: Well, they have skate skis and then they have classics, just like actual Nordic skiing.
• 7:02
  Speaker 1: You like actual, uh like Nordic skiing, you could do skate skis or classic.
• 7:07
  Speaker 1: So I got the skate, obviously, cause it's um, it's just like such a good zone to stimulus, like, like I said yesterday, I went and did like an easy five miles, like after, uh, after my run, um, just as like a second stimulus, and, dude, it was like my heart rate was like one 30 to one 50 the entire time.
• 7:21
  Speaker 1: Well, and you get that, you know wind pushing at you which makes it a little harder.
• 7:25
  Speaker 1: Or if you're going uphill it's hard, uh, like there's just like no other than going like on a steep downhill, like there's, you can't get away with much, um, you gotta actually work.
• 7:34
  Speaker 1: So, yeah, it's, it's like.
• 7:36
  Speaker 1: You know, it's a great stimulus to running and something I really I think I'm going to do like a lot in the off season Once I figure out not to have sore hips.
• 7:43
  Speaker 2: And, like I said, the nice thing on that is you can do like a higher volume of that too at that zone too, or even, you know, going more intense, but it doesn't.
• 7:52
  Speaker 2: You don't get all the eccentric loading of like running and it's a little more similar to running than cycling, being truly kind of a single leg thing.
• 8:00
  Speaker 2: And so great cross training too.
• 8:03
  Speaker 2: I'm excited to see you know how you respond from that.
• 8:05
  Speaker 1: Yeah, uh, dude, I'm going to keep staying in your ear the entire off season to get you to go, we might order a pair of these after the podcast.
• 8:11
  Speaker 2: I'm tempted Seriously Like I said.
• 8:13
  Speaker 1: I think I said something to you on the lines of, like you know, whenever you and the wife exchange Christmas presents, this might be one to you know, to allude to Um yeah, no.
• 8:26
  Speaker 1: To allude to um yeah, no, definitely, uh, a cool thing.
• 8:27
  Speaker 1: And you know, dude, the one thing not to continue on this too much, but like when I'm like cross training on the bike, it's hard for me to get my heart rate super high, like I don't know how like people like tata pagacha and like some of these like stud cyclists, can get their heart rate into like the 150s, 160s and just let it stay there for like four hours.
• 8:41
  Speaker 1: That is, I can't do that.
• 8:43
  Speaker 1: Yeah, I don't know if I'm just like super inefficient or like what that is, but it's hard for me with cycling.
• 8:47
  Speaker 1: Um, you know, just get my heart rate up high and kind of keep it there, or like not even high, but like keep it in that zone two, zone three Um, I don't know your, do you cycle at all or no?
• 8:58
  Speaker 2: Uh, not as much as I'd like I have.
• 9:00
  Speaker 2: I honestly use like my spin bike at home most Um, but I have like a hybrid mountain gravel bike, but it's, I'm the same way, unless I'm like doing really hard, high resistance, like putting power into and trying to get turnover, like my heart rates one teens, one, twenties, one thirties at most, um, but it's in a way it's nice Cause when I'm running it's harder to really be that low.
• 9:30
  Speaker 2: It tends to just creep up, at least when I'm trying even going easy.
• 9:31
  Speaker 2: It's like one forties low, one fifties and that feels easy.
• 9:33
  Speaker 1: But it's a nice, that's a good zone to stimulus yeah, yeah, do you train a lot with heart rate stuff at all, or I go back and forth.
• 9:38
  Speaker 2: I definitely am aware of it, I.
• 9:40
  Speaker 2: I go on field too, and I don't know if you noticed this, but my you know, for example, if I'm running like maybe a little bit harder and you know I'm in the one sixties at times that if I'm like flat, like I feel really comfortable there, like even my marathon I think I was like one sixties and to one seventies for the whole time.
• 9:59
  Speaker 2: That's perfect but I felt good.
• 10:01
  Speaker 2: It wasn't like an aerobic limitation versus if I'm like one sixties, one seventies climbing.
• 10:07
  Speaker 2: I just perceive more fatigue there and so the heart rate's a gauge for me, but I know I also the perceived effort is something more that I go off of because it differs for me and heart rate, even though it could be similar for flatter versus like uphill stuff.
• 10:24
  Speaker 1: Yep, no, I agree it's for flatter versus like uphill stuff.
• 10:27
  Speaker 1: Yep, no, I agree it's hard to nail the uphill stuff Like I can find like even going all out like it's harder, harder for me to get into that zone.
• 10:32
  Speaker 1: For if you will like 185, to see 185 on a heart rate gauge, for me I have to be yeah, I gotta be like going all out on the incline or something like that.
• 10:41
  Speaker 1: It's hard to get heart rate, that I, yeah, but like I don't know, I'm kind of like honing in more of those sessions lately to kind of like I don't know, like being very picky, and it was funny I was like last time I was chatting with mike sinceri when I had him on the podcast, we were talking about like grand teton and stuff like that and we were just talking about like picking and choosing your battles and like burning matches and training, and like it really stuck with me because I was like you know, you're so right, like I used to kind of be a little less um or a little more with like let's go balls to the wall a little more often than I probably should and maybe burnt myself up a little more in training, whereas, like I don't know, maybe it's being old and getting wisdom, you know you start to be a little more conservative and like, oh, I can just go slow and and have the day that I want to when I need to for the speed.
• 11:23
  Speaker 1: You know, just keep building it.
• 11:24
  Speaker 1: Yeah, totally yeah.
• 11:31
  Speaker 1: So, dude, my, uh, I'm glad we're uh glad we're having you on the pod.
• 11:33
  Speaker 1: I know we're kind of phasing into this really exciting uh conversation that we've been having about doing something like mini series, um, on different kind of like different injuries that runners will see very often, um, and I think this is a really important time for it too, as people kind of phase out of their maybe out of their racing season and into more of a training stimulus or more off season Um, and then we'll phase back out of that when we get into, like the spring and stuff like that.
• 11:57
  Speaker 1: So you know, this is a great time when injuries start to pop up or have occurred during the summer, um, and one of the things I know we wanted to jump into, I think first and foremost, was that that got God darn Achilles tendon dude, let's chat about that a little bit.
• 12:10
  Speaker 2: Yeah Well, first good point, and we'll talk today all about Achilles pain, achilles tendinopathy Um, I've dealt with it so common to see in a variety of runners, and it can be a really frustrating injury just because, as runners like we, have so much load going through that tissue.
• 12:28
  Speaker 2: And if it's, if it's sensitive, if it's reactive, it can be a hindrance.
• 12:33
  Speaker 2: And so to your point.
• 12:35
  Speaker 2: Before that though and I'll talk about this later on oftentimes for especially soft tissue injuries, a change in a season or a change in style of training, whether it's going from I'm going to be running flatter to now I'm doing a lot more vert, or I'm doing vert and now I'm doing flat and faster stuff those shifts, because our body's maybe not used to it, put our tissue at risk, right, and so really important.
• 13:03
  Speaker 2: And when we shift things to start gradually building up again, even though the fitness and strength may be there, that's when we're most at risk.
• 13:11
  Speaker 2: So, this time in the off season I mentioned even earlier, I'm getting more into like speed work, and though I've been running higher volume this summer relative to me going to shift to speed work, I'm doing it gradually.
• 13:24
  Speaker 2: I'm starting off with 30 seconds, one minute bouts.
• 13:26
  Speaker 2: I'm not going for these crazy high intervals just because I know I haven't done that in a while and I just need my body to adapt.
• 13:34
  Speaker 2: And so you know, achilles, specifically, that's really important to keep an eye on.
• 13:39
  Speaker 2: But any soft tissue injury, um really we you just want to gradually build into if there's anything new happening.
• 13:45
  Speaker 2: So I think that's first, most and foremost important to speak of Achilles tendon.
• 13:50
  Speaker 2: So I want to start pretty easy, just simple, like what is the Achilles tendon Right?
• 13:56
  Speaker 2: Um, so, most of it, I've heard of it, most of us probably are aware of it, but the Achilles tendon is the connective tissue that attaches your heel bone, your calcaneus, to your calf muscles, so your gastro oxoleus, and basically it acts as um like kind of a spring tissue, kind of a rubber band.
• 14:15
  Speaker 2: It's it's highly elastic, it's it's stiff, it should be stiff.
• 14:19
  Speaker 2: It stores and releases energy and allows us to be more efficient as we move and releases energy and allows us to be more efficient as we move, and so it's something that's taking a lot of load when we run.
• 14:32
  Speaker 2: Um calf in the Achilles take six to eight times body weight, which is crazy.
• 14:35
  Speaker 1: That's nuts dude.
• 14:36
  Speaker 1: Yeah Oof, yeah yeah.
• 14:37
  Speaker 2: And you know it's more than most of our other joints in our lower body or even muscles Like um, so really important to be strong in that region, but also making sure, again, we're not shifting into new things too often, um, because that puts that at more risk.
• 14:54
  Speaker 1: So it's really interesting, like so when I think of a tequilis injuries there's, there's certain things that pop up to me and you see very certain things in runners, right, where you'll see runners either very often will or can develop haglands, deformities and stuff like that.
• 15:10
  Speaker 1: Which kind of a different thing than like the, obviously the tendinopathy, um.
• 15:13
  Speaker 1: But you see, it's like how do I say this?
• 15:17
  Speaker 1: I'll see more people with maybe the tendinopathy injury than, like torn achilles when I see torn achilles.
• 15:24
  Speaker 1: I think of like much more dynamic sports where it's like your basketball players, right?
• 15:28
  Speaker 1: I don't know if you remember that very telltale video of Kevin Durant tearing his Achilles and you just see it snap in his leg and, just like recoil, shoot back up.
• 15:38
  Speaker 2: Yeah.
• 15:39
  Speaker 1: Um, I raced an athlete shout out to Alex King, I had raced him a couple years ago.
• 15:46
  Speaker 1: Broken arrow kid is nasty good from the pacific northwest.
• 15:47
  Speaker 1: Um.
• 15:47
  Speaker 1: And unfortunately he was playing basketball and, like this, kid's a stud runner.
• 15:52
  Speaker 1: Uh, phenomenal sub-ultra athlete and you would think that, like you know, you would get injured doing all the crazy shit that we do.
• 15:59
  Speaker 1: And now he was just playing basketball one day on the basketball court, had a funny movement and ripped his achilles and had to go to surgery.
• 16:05
  Speaker 1: So it's just like what movements will kind of um, what specific movements can I guess can contribute to more of the tendinopathy and things like that.
• 16:13
  Speaker 2: Yeah, so, yeah, good question off that you don't see many true Achilles ruptures and distance running.
• 16:19
  Speaker 2: Um, for a few reasons, and really the one main reason is it's it's a fairly sub maximal sport.
• 16:26
  Speaker 2: Even people who are at the top of the sport running, you know, pretty fast times 5k mile, what have you.
• 16:32
  Speaker 2: That's still not even close to the amount of force that goes through for an athlete like a field sport athlete or a sprinter Right.
• 16:40
  Speaker 2: And so oftentimes you'll see it in fields like football, basketball, where there's a high rate of loading under high load Right.
• 16:47
  Speaker 2: And so oftentimes you'll see it in fields like football, basketball, where there's a high rate of loading under high load Right.
• 16:50
  Speaker 2: So, like you're jumping and coming down from a, you're landing from a dunk right or someone's changing direction.
• 16:56
  Speaker 2: And football, to decelerate and start sprinting, they have to put a lot of force through that tissue.
• 17:02
  Speaker 2: Sprinting, they have to put a lot of force through that tissue and for some, for some people like that can cause it to rupture.
• 17:08
  Speaker 2: Typically you'll see it in the field sport athletes more early on in a season If, like again, they're not fully conditioned to it.
• 17:15
  Speaker 2: Um, because, again, if, if something's going to give, if there's a that we have a certain capacity to it, then you know when you put that load that goes past that point, then there's risk there, right?
• 17:26
  Speaker 1: Now, what do you see more in runners then?
• 17:28
  Speaker 1: So let's say, like I'm having an issue with my Achilles tendon when I'm running uphill, like I'm just getting like pain in that area, is it just generally?
• 17:36
  Speaker 1: Can you explain what a tendinopathy is, cause I'm a chimp.
• 17:47
  Speaker 2: So specifically, there's two types of Achilles tendinopathy.
• 17:48
  Speaker 2: So today I want to focus more on the mid portion.
• 17:50
  Speaker 2: So think, two to six centimeters above the insertion point, which is, um, at the calcaneus, at the bone, that site that people tend to get achilles tendinopathy to is, you know, insertional base, we call it right at the insertion of the bone.
• 18:02
  Speaker 2: Both of these are different types of injuries.
• 18:05
  Speaker 2: They come on for different reasons typically and they should be rehabbed differently.
• 18:09
  Speaker 2: Typically, the mid portion you know what we'll see as well, what you're kind of speaking of we'll see a more of like a tension intolerance versus the insertion is more of a compression intolerance, um, and so we talk about the mid portion.
• 18:26
  Speaker 2: Typically, again, there's some risk factors for it.
• 18:30
  Speaker 2: Like I said, there's training error, again, changing up what you're doing.
• 18:35
  Speaker 2: If you're coming from, I'm running flat, now I'm just going to do all this vert and then also doing vert with more speed or more force, like that's putting the tissue at risk, um, footwear, right.
• 18:45
  Speaker 2: So for where going from, if you're having a higher heel to toe, um or something, a more of a rocker shoe, a little less risk of overloading that tissue, versus a more minimal zero drop shoe, it's going to put a little more load through that tissue, oh dude, that's like a very Anton thing, cause I know he has problems with that, with like sorry, I didn't, that's crazy Minimal, yeah, but like it doesn't have to be too.
• 19:09
  Speaker 2: So it's not like you do this, you get this.
• 19:11
  Speaker 2: It's, it's a risk factor.
• 19:13
  Speaker 2: So there's a lot more that goes into it.
• 19:15
  Speaker 2: But you know, these are things we talk about for intervention strategies too.
• 19:18
  Speaker 2: It's like maybe we need to modify the footwear temporarily, or maybe we need to put a put a a heel lift in the shoe temporarily until we can get the tissue to calm down, to get you back Right.
• 19:30
  Speaker 2: So all these things we can modify and play with um to help reduce the symptoms in the tendon.
• 19:35
  Speaker 2: Interesting yeah, yeah.
• 19:37
  Speaker 1: Shout out to our boy, mr Ace Brown.
• 19:39
  Speaker 1: I know he's been dealing with uh, this for a while, with like and he.
• 19:42
  Speaker 1: He and I have talked about this many times.
• 19:43
  Speaker 1: Um, it's just sad to see like in a lot of sub.
• 19:47
  Speaker 1: I just find it a very common injury in some ultra athletes.
• 19:49
  Speaker 1: Yeah, ryan Becker, quite a few big name studs out there have struggled with Achilles tendon.
• 19:55
  Speaker 1: I don't know if it's tendonitis or tendinopathies or just like having that Achilles pain that shows up in in you know on in these efforts for some reason, where people can either only run flat or only run uphill or only run this because that's the only thing that won't hurt.
• 20:09
  Speaker 2: Yeah, you know, speaking of the terminology you mentioned, tendonitis, tendinopathy tend to think of.
• 20:14
  Speaker 2: Tendinopathy is more of the global term of tendon pain, tendon dysfunction, tendonitis, like the itis piece in any medical term, that is to describe more of an inflammatory process.
• 20:26
  Speaker 2: We've kind of shifted gears a little bit from that terminology as of recently, just because it's not always truly an inflammatory process even though maybe there was pain going on, and so tendinopathy has become more of the term to use when speaking about pain in the tendon.
• 20:45
  Speaker 2: That's not like a rupture or anything like that, and so that's kind of how we describe it.
• 20:49
  Speaker 2: But thinking about the tendon itself, you know, and seeing in different runners, there's there's kind of two categories I'll typically see there's like a reactive tendinopathy where the tendon's really sensitive, um, it's maybe like a newer injury.
• 21:07
  Speaker 2: Typically I'll see this in like younger athletes.
• 21:11
  Speaker 2: So think you know, teens, um, young adults, twenties, early thirties, um, and sometimes we'll also see in the more of like the chronic degenerative of, like masters athletes, specifically male more than female.
• 21:24
  Speaker 2: Um, same with calf strains as well, like that type of tissue injuries of like way more common in men and shows us in the research.
• 21:33
  Speaker 2: I even see that in my practice all the calf strains and most of the Achilles stuff I see are male.
• 21:38
  Speaker 2: Why do you think that is?
• 21:39
  Speaker 2: Oh, there's, there's a lot of reasons.
• 21:42
  Speaker 1: Are we just dumb and go really hard?
• 21:44
  Speaker 1: Is that?
• 21:44
  Speaker 1: Is that what it?
• 21:45
  Speaker 2: is Well, and I see more like hip stuff in general for women, yeah, and so it's just an interesting thing.
• 21:53
  Speaker 2: Could be the footwear too Footwear like our anatomy.
• 21:58
  Speaker 2: There's a lot of factors, hormonal changes, a lot of factors, hormonal changes like, um, you'll see a lot of like lateral hip discomfort.
• 22:10
  Speaker 2: That it's taught thought as like gluteal tendinopathy in post-menopausal women.
• 22:12
  Speaker 2: So it's like there's age, there's how you're moving, there's your training history, like there's a lot of factors, and then it's just putting those pieces together.
• 22:20
  Speaker 1: yeah um, sorry, no, go ahead.
• 22:23
  Speaker 1: I'm sorry.
• 22:23
  Speaker 1: No, no, go ahead.
• 22:24
  Speaker 1: No, I was just going to ask you are like certain runners more like?
• 22:28
  Speaker 1: Are there certain types of runners that are more at risk for some of these tendinopathy injuries?
• 22:34
  Speaker 2: Certain types, like I said, the, the male in general or the master's athlete, more common.
• 22:39
  Speaker 2: But what I will say is track athletes, someone who's running fast a lot, um, someone who's doing a lot of climbing a little bit more at risk, steeper stuff, of course, um, no pun intended, but again, it doesn't mean that has to be.
• 22:57
  Speaker 2: If you're going to go run steep a lot or run fast, it doesn't mean that you're going to get it.
• 23:01
  Speaker 2: It's just, it is more of a risk factor, especially if you're not allowing the adequate recovery between those bouts, Like if you're going hard all the time doing speed work and hills.
• 23:12
  Speaker 2: You know, it's somewhat of a ticking time bomb of some irritation, some discomfort there.
• 23:17
  Speaker 2: Um, so, keeping that in mind and that's why it's always important to just understand the athlete as a whole, right, Not just, oh, they're coming in with this pain and how are they moving and what's going on?
• 23:28
  Speaker 2: But what's going on with their training, what's going on with their life?
• 23:31
  Speaker 2: Otherwise cause, all those factors contribute.
• 23:34
  Speaker 1: Yeah, yeah, interesting.
• 23:36
  Speaker 1: Yeah, I don't know, man, it's kind of funny, like the only time I don't.
• 23:39
  Speaker 1: I never really deal with a lot of achilles, injury or pain at all.
• 23:42
  Speaker 1: The only time I'll feel it is like if I'm going.
• 23:45
  Speaker 1: It's funny because we were on rampart today and if I bomb rampart like like, like in that like low, I don't know if I'm running fast.
• 23:54
  Speaker 1: So let's just say, if I'm running fast on rampart, the next day I will feel my achilles will be completely blown up and really it'll feel horrible and it'll take me like a day or two to like.
• 24:01
  Speaker 1: I guess, like for the swelling to go down or for like that, like whatever bothers it to go down, and I'm totally fine after that, but I never feel it going uphill, which is weird.
• 24:10
  Speaker 2: I mean there is in, there is low, a decent amount of load going through there, on the downhill too.
• 24:14
  Speaker 2: It just it also depends on what's happening mechanically, um, where there could be a little more eccentric load going through downhill Um, but in general up I'll see it more, just because there has to be more force through the calf and then a little bit more doors, deflection, and so I'll see that.
• 24:32
  Speaker 2: But again, you can get it downhill too, right?
• 24:34
  Speaker 1: I've got a crazy question for you.
• 24:36
  Speaker 1: So this is and this is out there partially related to Achilles, but more like like potential and and kinetic energy based Um.
• 24:44
  Speaker 1: So one of the things we talk about as runners, especially at a high level, it's I loved it.
• 24:51
  Speaker 1: Now I've kind of transitioned a lot of my training from really steep stuff to less really steep stuff, but like very purposeful steep stuff, not all the time, and a lot of very flat running with speed and intention and a lot of easy to, but a lot more flat stuff.
• 25:07
  Speaker 1: If you will, and what I've heard from so many people non-professional um is that like you just get this more and I feel better when I'm running flat and then I do go to hammer.
• 25:17
  Speaker 1: Let's say I'm going to go hammer a hill, um, or a big climb later in the week, right, and I go hit that climb and I'm able to PR it and I'm not really working anywhere near as hard as I was before.
• 25:27
  Speaker 1: Um is there like like do you get like a certain better elasticity in your tendons or something like that?
• 25:35
  Speaker 1: Like they almost get like tighter or something like that?
• 25:38
  Speaker 1: Is that it's kind of an out there question, but it's something I've experienced personally, where I just feel lighter and I feel like things are more snappy or poppy.
• 25:45
  Speaker 1: Good to go.
• 25:46
  Speaker 1: Um, if I'm just like doing a lot of flat stuff and then go do the climb, if you will.
• 25:51
  Speaker 2: Yes, I think you know, speaking from personal experience too, what I'd say is, in climbing because it is more power output, more work it often tends to be we lose a little bit of like that turnover, the cadence, the ground contact time, versus when you're flat, you don't have to overcome as much of gravity and so typically we can spend a little less time on the ground, get a little more out of our uh Achilles tendon, our like the stretch shortening cycle.
• 26:20
  Speaker 2: So our foot hits the ground, we load, but then we're getting out of that quick and that's that sense of that snappy, that poppiness, which is really nice and efficient as a runner, and so I would agree that I think that can help significantly for trail running too.
• 26:37
  Speaker 2: It's a training thing that it's much more than just the tendon, it's the neuromuscular coordination of driving the leg down to the ground and reacting off of the ground faster.
• 26:50
  Speaker 2: And it's, it's the calf, it's our nervous system, it's it's how our foot is sensing the ground.
• 26:56
  Speaker 2: And so timing of that, that's why that the speed works important because it just trains you to get off the ground quicker, but in a way where you're getting force out of the ground too, and then that's where, like that really good flow of that turnover comes and you feel very springy.
• 27:12
  Speaker 1: Yeah.
• 27:12
  Speaker 1: So, dude, if I'm dealing with, like an Achilles issue, what type of pain am I feeling?
• 27:17
  Speaker 1: Is it dull, is it sharp?
• 27:18
  Speaker 1: Is it like, how do I know?
• 27:20
  Speaker 1: Like, like what I'm dealing with here?
• 27:23
  Speaker 2: You know when.
• 27:23
  Speaker 1: I'm having this issue.
• 27:31
  Speaker 2: So definitely think about it.
• 27:32
  Speaker 2: Like, the nice thing about the Achilles is it's a very superficial tissue, right?
• 27:33
  Speaker 2: So if pain is coming from the Achilles, it's probably going to be pretty tender to the touch or local to the area.
• 27:38
  Speaker 2: Now there are some other tissues around the Achilles tendon that we have to consider in differential diagnosis a few neural tissues, um.
• 27:46
  Speaker 2: We have obviously some vasculature and things.
• 27:50
  Speaker 2: So if you're ever having like numbness, tingling, things like that, we need to contribute.
• 27:54
  Speaker 2: You know other factors, um.
• 27:56
  Speaker 2: And then there's another muscle tendon unit called the plantarus, just on the inside of the Achilles tendon.
• 28:03
  Speaker 2: So knowing again what we're dealing with is important before we rehab it.
• 28:08
  Speaker 2: But a test that's very helpful in diagnosing Achilles tendon is it's called the Royal London Hospital test.
• 28:17
  Speaker 2: I like that.
• 28:19
  Speaker 2: When we look at tests and treatment, especially in the literature, what's effective, we have something called specificity and sensitivity.
• 28:28
  Speaker 2: A high specificity allows us to rule in a test if it's positive.
• 28:33
  Speaker 2: If a test is highly sensitive, it allows us to rule it out if it's negative, and so the Royal Hospital test has a very high specificity.
• 28:43
  Speaker 2: So if we do that test and it's positive, the likelihood is very high that we're dealing with Achilles tendinopathy.
• 28:51
  Speaker 2: So what the test is is typically done in lying.
• 28:54
  Speaker 2: Um, when you have the ankle relaxed, the foot relaxed, I'll squeeze someone's tendon, starting lower and moving up and wherever it's the most sensitive to you, that's where I kind of hold my pincer grip.
• 29:09
  Speaker 2: Holding that position, I then dorsiflex your foot, which is basically moving your toes towards you, creating tension in the Achilles tendon.
• 29:19
  Speaker 2: And if I squeeze there and it's not as painful, that's a positive sign.
• 29:20
  Speaker 2: And if I squeeze there and it's not as painful, that's a positive sign.
• 29:25
  Speaker 2: The reason why that happens, I think is important to note as well the tendon itself.
• 29:30
  Speaker 2: When it's slack, when the ankles relax, when you squeeze it, you can get more into the interior of the tendon.
• 29:36
  Speaker 2: That's actually the part of the tendon, the central tendon, that's usually tendinopathic.
• 29:40
  Speaker 2: When I dorsiflex it, that creates tension on the outside.
• 29:44
  Speaker 2: So when I squeeze it I can't get deeper internal to the central core and therefore it's typically less sensitive.
• 29:52
  Speaker 2: So if we do that test, it's a really good indicator that it's truly Achilles tendinopathy.
• 29:58
  Speaker 2: The other thing that can mimic Achilles tendinopathy is something called peritonitis.
• 30:03
  Speaker 2: Mimic Achilles tendinopathy is something called peritonitis and that's think of like a sausage sheath, um, like the outer coating put around the tendon.
• 30:11
  Speaker 1: Just give analogy.
• 30:12
  Speaker 2: It's basically like the sheath around the tendon that kind of keeps it together, um, and that the periton.
• 30:20
  Speaker 2: Periton basically can get irritated from friction.
• 30:23
  Speaker 2: So big ranges of motion under load so think of like uh, calf raise fully through the range under load that can be sensitive there.
• 30:33
  Speaker 2: But oftentimes this test is negative, um, so that also will be treated differently, basically just reducing how much motion you're going through with running or other activities.
• 30:44
  Speaker 2: Versus if this test is positive.
• 30:47
  Speaker 2: I'll usually see people with a true Achilles tendinopathy not only have maybe pain with you know, heel raises variations, but also with hopping, and so again, it's the same area.
• 31:00
  Speaker 2: But we need to know what we're dealing with, to know what to treat it with.
• 31:04
  Speaker 2: Right, that makes sense.
• 31:05
  Speaker 2: So really understanding the different differential diagnosis is important.
• 31:08
  Speaker 1: Now can we talk about?
• 31:10
  Speaker 1: Let's talk about all right.
• 31:13
  Speaker 1: So like let's say, I have Achilles and Achilles tendinopathy, right, what is the quickest path, or like one of the paths to like, what does that recovery look like?
• 31:22
  Speaker 1: I'm trying to understand.
• 31:23
  Speaker 2: Yeah.
• 31:23
  Speaker 2: Depending on like how severe Great question, To be honest, that's with the Achilles tendon.
• 31:30
  Speaker 2: It's so variable, Like I'll.
• 31:32
  Speaker 2: I'll see a few weeks to up to a year which is crazy, and when I say a year it may not be like, oh, this is so painful for the full year, but you may have some consistency with some discomfort through that whole year.
• 31:45
  Speaker 2: I've been there.
• 31:46
  Speaker 2: I've dealt with it for like a five month stretch Now.
• 31:49
  Speaker 2: I was still able to run but I just had to reduce how much I was running, like uphill and some faster stuff, and I even went from a ultra shoe to a higher drop shoe and those pieces helped at the time Interesting.
• 32:02
  Speaker 2: So the prognosis can vary.
• 32:06
  Speaker 2: That's where it's also an important to consider two things.
• 32:09
  Speaker 2: So if we would think about, like, the recovery of that, we want to one, improve capacity in the tissue and to adjust biomechanical loads.
• 32:20
  Speaker 2: So adjusting biomechanical loads, that could be again changing footwear temporarily, that could be adopting a little bit more of a midfoot to heel to rear foot strike instead of a forefoot strike.
• 32:33
  Speaker 2: That could be again reducing volume, reducing speed, work right.
• 32:36
  Speaker 2: All those things we can modify but still keep you running.
• 32:39
  Speaker 2: I think that's the most important piece.
• 32:42
  Speaker 2: With the Achilles tendinopathy we don't have to stop running and, to be honest, tendon does not do well with just pure rest.
• 32:49
  Speaker 2: You may feel better because you're not running temporarily, but as soon as you go back to it it's going to rear its head again because we didn't really change much.
• 32:57
  Speaker 2: Right?
• 32:58
  Speaker 2: It needs to be loaded.
• 32:59
  Speaker 2: It just needs to be loaded to a point that's optimal for it and the condition it's in.
• 33:10
  Speaker 1: And what type of movements do you are you having your your patients do like for to load that if you will like, if you're in a gym and you're, you're in that setting trying to slowly get this thing better.
• 33:16
  Speaker 2: Yeah, so let's say, if someone's a little more reactive in the tendon where you know maybe they're having some discomfort walking and running is not feeling so good right away, you know maybe they're having some discomfort walking and running is not feeling so good right away.
• 33:25
  Speaker 2: You know, maybe initially we're doing more of a walking program, um, and on the load side we're doing more isometric.
• 33:34
  Speaker 2: So isometrics are load through the muscle and tendon but they're in one position.
• 33:39
  Speaker 2: So think of like a, a hole, like you do a calf raise and then you hold in a specific position and so tendons seem to like that um, especially early on it can be a nice way to get pain to calm down.
• 33:52
  Speaker 2: Um, the really nice thing about isometrics, especially holding for around that 45 second plus mark, it allows something called stress relaxation to occur.
• 34:03
  Speaker 2: And this leads back into what I talked earlier about the central part of the tendon being more of the tendinopathic tendon versus the outer part of the tendon.
• 34:13
  Speaker 2: If you think about a rubber band, if you were to stretch out a rubber band, it becomes more tensile on the outside and it gets more compression on the inside.
• 34:24
  Speaker 2: And our tendon does very well with tension.
• 34:27
  Speaker 2: That's what it's really designed for with how the collagen is aligned.
• 34:31
  Speaker 2: But on the inside part of the tendon it gets more actually compressive loading to it, which doesn't love as much, and so the central part of the tendon doesn't get the change in buildup of tendon like the outside does, and so it's more predisposed to pain injury.
• 34:52
  Speaker 2: And so back to the stress relaxation.
• 34:56
  Speaker 2: If we're holding in an isometric position long enough, the outside actually relaxes and we get a little more tensile load into the interior which allows it to start recovering.
• 35:07
  Speaker 2: So isometrics are really nice early place to start.
• 35:12
  Speaker 2: Typically I'll do have people do two to three by 45 second holds, and this could be bilateral, this could be single leg, this could be from the ground, from a slam board.
• 35:24
  Speaker 2: It really just depends on what's tolerable for them.
• 35:27
  Speaker 2: And from there, you know, going through different phases, we'll progress to eccentric, concentric.
• 35:33
  Speaker 2: So think about basically, like a calf, raise, going up is the concentric, down as the eccentric and then ultimately plyometrics.
• 35:40
  Speaker 2: Throughout that We'll also get back to running too.
• 35:43
  Speaker 2: You know, I want people to be able to run is basically, if they can, still right.
• 35:48
  Speaker 2: I don't want to take that away from them.
• 35:49
  Speaker 2: We just need to, may need to modify what the dosage of the running is yeah, dude, it's so funny.
• 35:56
  Speaker 1: The first thing the thing I keep thinking back to is, like on instagram, do you follow your boy scott jorick?
• 36:02
  Speaker 2: I may.
• 36:03
  Speaker 1: there's I know what you're talking there's a lot of really good memes and jokes that just like completely shit on ultra for the Achilles tendon problems that it gives people.
• 36:12
  Speaker 1: Do you have an example?
• 36:12
  Speaker 1: Uh, yeah, actually, hold on, let me get on Instagram really quick.
• 36:17
  Speaker 1: It might be too hard to find, but if there's like constant uh memes, where is it your?
• 36:26
  Speaker 2: boy, here we go every now and then I'll see someone post a story about something about that.
• 36:31
  Speaker 1: oh dude, they just shit on ultra all the time, and I think it's kind of funny wait.
• 36:35
  Speaker 2: An ultra, the running brand or ultra, here we go.
• 36:38
  Speaker 2: Here's one day three of wearing ultras every day, until my achilles tendon ruptures update.
• 36:43
  Speaker 1: So I don't know.
• 36:45
  Speaker 1: I just find it kind of funny that, like I don't know, that it's like very synonymous where I don't.
• 36:50
  Speaker 1: Can you help me understand this a little bit more?
• 36:52
  Speaker 1: On, like how a drop will help, like relieve some of that versus like like a non-drop shoe?
• 36:58
  Speaker 2: yeah, so, even though it's not a huge difference, right Going from again ultra zero drop, where there's no difference from forefoot to rear foot versus, let's say, a 10 millimeter drop, which there's plenty of shoes out there like that.
• 37:14
  Speaker 1: Yeah.
• 37:15
  Speaker 2: That just basically just makes a subtle difference in how much the heel moves through dorsiflexion right when we're loading on the ground.
• 37:24
  Speaker 2: In that subtle change, if we don't go quite as much, it can also reduce the strain within the calf and the Achilles to not be as intense right Now.
• 37:36
  Speaker 2: Again, if you're prepared for it, right, if you've been gradually running in ultras and you're doing things right, you're less likely for this to happen.
• 37:45
  Speaker 2: But there is a risk because it's just going to add that much more load and you, if you've been running in something higher for a while and then switch like your body's just not prepared for that subtle change that over thousands of steps with force, like that adds up, yeah.
• 38:02
  Speaker 2: And so that's where the risk is.
• 38:04
  Speaker 2: There's just a slight bigger range there, and if we're not ready for it, we can cause problems.
• 38:09
  Speaker 1: Yeah, now I find it interesting too, because alter was like when I first discovered the trails it was the first shoe I actually started wearing and I was pretty like it's a good shoe it's.
• 38:16
  Speaker 1: I was brand loyal to alter for a very long time and like, I don't know, I just found like super shoes and they kind of like you, you know, the hook of fat boys and stuff like that, and I was like, oh, dude, you know, I don't know, they just had more pop to them and more stuff.
• 38:30
  Speaker 1: Um, but no, I I know you wear ultras and you've had a lot of success with them, so well, take that with a grain of salt.
• 38:37
  Speaker 2: I've had.
• 38:37
  Speaker 2: I like them.
• 38:38
  Speaker 2: I've realized that I'm starting to vary things a lot more.
• 38:42
  Speaker 2: Um, I've tried a bunch of different shoes in the past that I was on an ultra kick for I don't know probably three years, where that's all I wore, um, but now I'll mix it up with some other shoes.
• 38:53
  Speaker 2: But I I did have Achilles and foot problems.
• 38:57
  Speaker 2: I I would get some outside foot peroneal insertion pain.
• 39:07
  Speaker 2: I've had Achilles pain and I was wearing those when they came on, and so there's something to be said.
• 39:09
  Speaker 2: Like it does put more load through there, like we talked about.
• 39:10
  Speaker 2: So there is risk, um, so I think it's healthier to vary things, and even the research supports that actually having more variance in footwear um can make a difference.
• 39:22
  Speaker 2: But also, you want the shoes to feel good too, and I'll just feel good.
• 39:26
  Speaker 1: They do.
• 39:26
  Speaker 1: So yeah, I mean, dude, it's crazy where shoe technology has gone now and like just I wonder if that's going to just help eliminate some some stuff or make things worse and people that just you know if.
• 39:37
  Speaker 1: I feel like form I know we talked about this very recently Cause like I, I have horrible downhill form and like that I've been working on and correcting and stuff like that Um, but just like I don't know if it's going to make bad, bad things, worse for people or just, uh, you know, help things if in a lot of ways with shoe technology.
• 39:58
  Speaker 2: Yeah, so that's, that's the thing too, and people ask me this all the time, like what shoe should I get?
• 40:02
  Speaker 2: What do you recommend?
• 40:04
  Speaker 2: It's like that is way too much of a loaded questions.
• 40:07
  Speaker 2: You got to figure out what feels good for you.
• 40:10
  Speaker 2: Um, I think for a more novice and runner, footwear can affect how they move to a greater degree versus a more experienced runner.
• 40:21
  Speaker 2: Like they can probably move around different shoes and still run similarly.
• 40:23
  Speaker 2: But what I've noticed and thinking about this, even if people take their shoes off to run, if you wear something a little bit of a like a lower drop but also maybe something more minimal, it's going to potentially shift how you're landing and loading to maybe more mid forefoot in general, um, versus something with a really chunky heel with a higher drop.
• 40:46
  Speaker 2: Like it's because of that it's it's going to tend to land more mid to rear foot and so those things can shift a little bit of how we move.
• 40:54
  Speaker 2: But again, if you're been running for a while and you have a really good tune of how you're moving, the footwear shouldn't make that big of a difference to how you land and load.
• 41:05
  Speaker 1: Yeah, Let me ask you a question.
• 41:06
  Speaker 1: Uh, I'm very curious on this socks, sock choices.
• 41:09
  Speaker 1: If you have like mid to high socks, like sometimes I find them to be almost like too tight around my cause you're, I feel like my legs will swell, you know, like your calves, and that Achilles area will swell on like an uphill effort and stuff like that.
• 41:22
  Speaker 1: Um, and I've had problems with that before where like it's swelled like too much or it's been too tight, almost like compression based, and like then it'll just I'll feel just like I have too much lactate or just nonsense or junk in the legs.
• 41:38
  Speaker 1: Um, do you like recommend certain socks?
• 41:39
  Speaker 2: for people, or do you I?
• 41:40
  Speaker 1: don't know, I just find it interesting, like socks.
• 41:42
  Speaker 2: For me it's really more of like what's happening inside the shoe, more typically the toes, personally at least.
• 41:51
  Speaker 2: So like, what's the friction amount, right?
• 41:53
  Speaker 2: What's the wicking amount?
• 41:55
  Speaker 2: That's, I think, more important to like.
• 41:57
  Speaker 2: Am I going to get blisters on the ball of my feet or to my toes, ball of my feet or between my toes?
• 42:07
  Speaker 2: Um, I personally haven't seen with much with people as well as myself, stuff that happens higher up in the leg with lower, higher socks.
• 42:11
  Speaker 2: Um, so it's tough to say with that, but um, I've, if I have to say about socks, like I love the gingies cause the the toe, the toe splay.
• 42:23
  Speaker 1: Yeah, I moved on.
• 42:24
  Speaker 1: I'm all you have.
• 42:25
  Speaker 1: I'm a Cetus guy now.
• 42:26
  Speaker 2: Okay, yeah, I'm open to trying.
• 42:27
  Speaker 2: I got to send you a pair.
• 42:28
  Speaker 2: I'll get you a pair.
• 42:29
  Speaker 1: I'll hook you up.
• 42:29
  Speaker 1: Um, yeah, no, I uh, I don't know, man, like I got turned on to Cetus uh, at the Pikes Peak Ascent and marathon.
• 42:45
  Speaker 2: I like we even talked about the nutrition, the, the gadgets, the gear.
• 42:47
  Speaker 2: It's like you want to just try it all, but they just keep new stuff's flowing all the time.
• 42:49
  Speaker 2: It's cool?
• 42:49
  Speaker 2: Yeah, it is, it's really dope.
• 42:51
  Speaker 1: Um, okay, so let's get into some more questions.
• 42:53
  Speaker 1: So one of the things that I had for you was, like we kind of briefly touched on treatment strategies to work past the tenopathy.
• 42:59
  Speaker 1: Can you go maybe a little bit more in depth with what I don't know like what your treatment strategy is going to be?
• 43:04
  Speaker 1: To get get through this.
• 43:05
  Speaker 2: Yeah, so I yeah, I talked a little bit about, like the phases, thinking about maybe isometrics to start, um, concentric, eccentric loading, and then adding in plyometrics all really important for the tissue to be able to handle that.
• 43:19
  Speaker 2: To speak more specifically about the loading, especially as we get into concentric, eccentric, what's really important in tendon likes is slow loading.
• 43:29
  Speaker 2: So think about again doing a calf raise instead of just kind of going through the motion bouncing out of it.
• 43:36
  Speaker 2: Typically we'll have people do three seconds up to five seconds up and three seconds to five seconds down, so really slow loading, but also heavy loads, right, Calf and Achilles have to take a lot of loads.
• 43:50
  Speaker 2: We want to prepare it too, and so we really need to be loading as much as we can here.
• 43:54
  Speaker 2: Um, really, the thing is to consider is sensitivity, right, and this isn't something I talked about already but it's okay to have some pain with Achilles tendinopathy, whether it's doing the rehab or whether it's with running.
• 44:11
  Speaker 2: So, to give an example of that, thinking of a pain scale and I don't love a pain scale, but it does give us just an idea Zero, no pain, 10, most pain ever right, Typically in the rehab.
• 44:24
  Speaker 2: I like to keep people in a safer zone.
• 44:27
  Speaker 2: So think of no pain to a three out of 10.
• 44:30
  Speaker 2: But to be honest, if we get up to a five moderate level of discomfort, that's okay During a run and during the rehab.
• 44:38
  Speaker 2: What's most important is to know how does the tendon feel within like a 24 hour period after that.
• 44:44
  Speaker 2: So I'll want to know from people how do you feel next morning?
• 44:47
  Speaker 2: You know, how do you feel the day after?
• 44:49
  Speaker 2: That's really going to tell me.
• 44:50
  Speaker 2: Okay, we need to pull it back a little bit to change how we're loading or we're in a good spot Like it's.
• 44:57
  Speaker 2: It's better or no worse, Like we can keep continuing with the plan.
• 45:01
  Speaker 2: So that's really important to know with the plan.
• 45:08
  Speaker 2: So that's really important to know.
• 45:09
  Speaker 2: And the reason why is the tendon responds to loading in a way where it degrades initially and then it synthesizes and repairs.
• 45:13
  Speaker 2: So the first 24 to 36 hours the tendon is kind of breaking down to build back up and a lot of our tissues do that and so oftentimes I'll have people will do a heavier loading and I want at least 24 hours before we do another loading bout, depending on how they feel Right.
• 45:33
  Speaker 2: So 24, 36 hours is a really good gauge and if things respond well from there, then we're ready for our next loading bout, whether it's through rehab exercise or through, you know, running plyometrics, things to also stress the tendon.
• 45:49
  Speaker 1: Dude, that's crazy.
• 45:50
  Speaker 2: There's a lot there, but it's tendons are wild tissues Um did they break down as you get old?
• 45:55
  Speaker 1: Is that like like bone where?
• 45:58
  Speaker 2: like.
• 45:58
  Speaker 1: I know like how people I don't know, I'm not saying like like certain osteo stuff where like it'll break if you're not maintaining your muscle mass.
• 46:05
  Speaker 1: I know people have like serious like bone issues as they get older Tendons.
• 46:09
  Speaker 2: the same thing, I think to be honest, most of our tissues, to a point they're going to adapt and fail to adapt depending on what we do and how we load.
• 46:18
  Speaker 2: And I think, yes, in general, like our tissue is not the same as a 20 year old, as it is a 50 year old.
• 46:26
  Speaker 2: But, with that being said, there's people in their fifties who have tissue health and quality of some people in their twenties.
• 46:32
  Speaker 2: So if you allow the tissue to adapt, if you stay doing you know if you're staying running, if you're staying doing strength in the gym and loading the tissue, it can be fairly healthy tissue.
• 46:46
  Speaker 2: I think where people fall off is, you know and I this happens to me every now and then too is like you fall off the resistance training and you know running is one of those things like I want to run Right and you know running is one of those things like I want to run Right.
• 46:58
  Speaker 2: And it's just so important to keep that tissue strong but making sure again that it's going to not prevent injuries in the future.
• 47:13
  Speaker 2: But it can help to reduce the risk of to a point, if there's more capacity in the tissue, we're not going to meet that threshold quite as high versus if the tissue is not strong.
• 47:19
  Speaker 1: Yeah, what about preventative measures Like is there any like preventative stuff I can do?
• 47:23
  Speaker 1: So like, for instance, like now that I'm in the off season, like I told you, kind of like what I've been doing and like what I'm like starting to transition into, and like I'll probably start being transitioned like way more into speed and like a 10 K block Cause I want to build speed in the off season.
• 47:36
  Speaker 1: So less and less, but there'll be a time where, like it's like all systems ago for the steep stuff, pun intended.
• 47:44
  Speaker 1: Um, what can I do as like a preventative measure in the gym to like so I don't stress those Achilles tendons too bad yeah.
• 47:52
  Speaker 2: So super simple it can be effective.
• 47:55
  Speaker 2: Right, if you're not doing heavy bilateral or single calf raises, you know you're missing the ball as a runner.
• 48:02
  Speaker 2: That's like if I have to give three exercises, that's one of the top three as a runner, and it's so simple, you can literally do it anywhere.
• 48:10
  Speaker 2: I think the key is, though, where I see people go wrong is they don't load it enough.
• 48:14
  Speaker 2: They'll do bilateral, you know, at steps on the home, or even single leg steps on the home, but for someone like you that's not going to be enough.
• 48:23
  Speaker 2: Like you need to load it up where you're getting five to six reps and you're like that's all I got Right, not where you can get 15, 20, 30 reps and you feel in a burn, but it's not the same type of loading.
• 48:35
  Speaker 2: Interesting.
• 48:36
  Speaker 2: So loading it heavy and slowly.
• 48:39
  Speaker 2: Important tendon likes that and responds well to that.
• 48:42
  Speaker 2: Um, I like getting people in the Smith machine just cause it's stable and we can put a lot of load there, versus like holding weight by the side or holding it in like a goblet position that just the limiting factors tend to become like just holding the weight and getting the heavy enough weight.
• 48:58
  Speaker 2: So getting in the Smith machines gray, cause it's stable, you know getting with the slant board or a weighted plate to get a little bit more of the eccentric phase, that's important.
• 49:08
  Speaker 2: And the other thing to know with the heel raises you don't have to get all the way through the toes.
• 49:13
  Speaker 2: We want to get lower, to get the full range and we want to get above that, but really it doesn't need to go much higher than that.
• 49:21
  Speaker 2: And so if you're finding a weight that's heavy and you're getting just a little above parallel, that's probably perfect.
• 49:27
  Speaker 2: That means that the way it's heavy and that's the range, really that's important for runners.
• 49:32
  Speaker 2: Um, so I think that's where people go wrong, like they just don't do heavy enough variations of this and they don't do it slow enough.
• 49:39
  Speaker 2: Those would be the two big takeaways, yeah.
• 49:43
  Speaker 1: Yeah, I got to find my slant board, dude.
• 49:45
  Speaker 2: I don't know what happens.
• 49:45
  Speaker 2: It's a great tool.
• 49:46
  Speaker 1: My brother-in-law stayed here when we had our wedding and he took it and I haven't seen it since, so I don't know.
• 49:53
  Speaker 1: Yeah, it's not coming back.
• 49:54
  Speaker 1: Joey sent me my slant board.
• 49:55
  Speaker 2: It's not a very expensive tool, but I have one, obviously at the clinic.
• 50:02
  Speaker 2: You're the one who turned me on to it.
• 50:03
  Speaker 2: It's a great tool, I mean, and you can do more stuff with like I'll do step down variations on that for like knee loading things.
• 50:11
  Speaker 2: But those things almost were like designed in the past for like stretching right, that's where they were.
• 50:17
  Speaker 2: You see them in the gyms for like people to stretch their calves and it's like I don't think I've ever used that once to do that.
• 50:21
  Speaker 2: It's more of getting the foot loading but just having a little more of that range of motion yeah, that's what I mean.
• 50:27
  Speaker 1: It's so crazy, dude, like the body's so wild.
• 50:30
  Speaker 1: I mean like not to like make this about me, but I am no, your podcast, your rules that's right, that's dude.
• 50:36
  Speaker 1: I just find it so bizarre, like how I don't know, like two weeks ago I thought I had a herniated disc in my back and I'm freaking the fuck out.
• 50:42
  Speaker 1: I'm like, oh my God, sean, what did I do to myself?
• 50:45
  Speaker 1: What did I do?
• 50:46
  Speaker 1: You know, cause, like Tabor, my coach just had a herniated disc.
• 50:55
  Speaker 1: So like it's the same injury you've had forever, like got a pelvis for some reason that just like it's what like out of whack and because of that it leads to uh, I don't know, it just leads to all kinds of funky stuff.
• 51:05
  Speaker 1: Um, and I think that's just me not being on top of thing as many things as I probably should be as a runner, but yeah, the body's kind of crazy.
• 51:13
  Speaker 2: Crazy.
• 51:13
  Speaker 2: The pelvis you know I'm not going to go off too much of a tangent, but like that is such an important area of the body that contribute to so much above and below of how we move, cause like that's literally our central core Right, and so if things aren't moving well there, it it can cause so many things to start compensating, and I'm always looking there, no matter what the injury is, because sometimes that could be leading to things too.
• 51:40
  Speaker 2: So it's just wild how much that plays a role.
• 51:43
  Speaker 1: Well, it's funny, dude, and it's funny.
• 51:45
  Speaker 1: I'm like a mini you now in a lot of ways, because, like I've learned so much from you over the last few years, like I was in the car on the way up here, um, when we left, finished our run, and my brother-in-law called me.
• 51:54
  Speaker 1: He goes oh dude, I've got this funny thing going on with my knee, blah, blah, blah.
• 51:57
  Speaker 1: And the first thing I asked him was something you would have asked me can you point to like one time where you like injured, like injured it and felt it?
• 52:04
  Speaker 1: yeah and he was like no, I'm like, well then, dude, it's probably nerve related.
• 52:08
  Speaker 1: You probably have your, something you know it could be I think that's part of the story.
• 52:14
  Speaker 2: Right, there's, there's, these are one of those things too.
• 52:16
  Speaker 2: It, yeah, I've seen a lot of nerve stuff around the knee, but it's also, unless there's a true trauma there, yeah, um, or mechanism of injury there.
• 52:24
  Speaker 2: You got to look above and below, like I said, pelvis, foot and ankle Cause.
• 52:28
  Speaker 2: Think about the knee.
• 52:29
  Speaker 2: It's like stuck between those, between the femur and the tibia and the foot and the pelvis and hip direct, so much of what happens there.
• 52:37
  Speaker 2: And so if you've, if you're just looking at the knee and you're not looking at other areas, like that's a huge miss and we know potentially what's going on.
• 52:46
  Speaker 1: Yeah, yeah, it's crazy Like and it's another thing I've come to you before.
• 52:48
  Speaker 1: I'm like oh my God, dude, I tore my meniscus.
• 52:50
  Speaker 1: You're like no, no, you didn't, no, you didn't.
• 53:11
  Speaker 2: But back to the.
• 53:11
  Speaker 1: Achilles tendon, dude, like what a crazy injury too, just because I don't know, I have met so many, not just elite runners, but just so many runners that have dealt with Achilles tendinopathies.
• 53:15
  Speaker 1: Or even taking it one step further, you know, growth like haggling growths on the calcaneus.
• 53:17
  Speaker 1: I mean dude you could think of like Zach Miller was a very common name who had an Achilles growth, who had to have it cut out.
• 53:20
  Speaker 1: You know, now look at what he was able to do.
• 53:21
  Speaker 1: But it's just interesting like how that can be such a limiting factor.
• 53:24
  Speaker 1: You know that tendon is kind of everything in a lot of ways.
• 53:27
  Speaker 2: Yeah, it's, it's tough and, like I said it's, I think they're personally more challenging, um, and and potentially longer prognosis if it's insertional so Hagelin's being part of that where the tendons pulling at the bone, um, and you can have a lot of pain in that sites.
• 53:47
  Speaker 2: Those again, those happen.
• 53:50
  Speaker 2: I don't see those as much as mid portion, but those can be a longer recovery process and even again leading to potential surgery, especially for, you know, speaking of some of the elite high-level runners, because there's just there's so much load that goes through that site.
• 54:04
  Speaker 1: Can we talk about high lens a little bit, I'm just like I'm just very curious.
• 54:07
  Speaker 1: Um, like, how does that come about?
• 54:08
  Speaker 1: Is it usually like you when you have a Haglund's deformity?
• 54:11
  Speaker 1: Is that generally related to just uh, like kind of being a runner your whole life and it just like kind of it's a growth from like the shoe rubbing or like what causes that?
• 54:20
  Speaker 2: Yeah, there's probably a component of two pieces of the tensile load through the the part of the bone, so Hagelin's deformity usually come on a little more laterally to the insertion at the uh, calcaneus Um, and, if you, if you think about it, what happens is, though the tension of the Achilles tendon is, you know, we see a lot of it through, like the dorsiflexion, plantar flexion.
• 54:45
  Speaker 2: There's also movement of the rear foot at the bottom, where we go into like that pronation supination.
• 54:49
  Speaker 2: So there's pole sometimes on the medial and lateral component and someone who's like a higher level runner, you know, maybe things are going to be shifting to where they get a little bit more pull there, and if they're running a lot of volume over a lot of years and they're doing a lot of vert or they're doing a lot of faster running, like that tendon down in that side is going to be taking a lot of load.
• 55:13
  Speaker 2: What happens, though?
• 55:15
  Speaker 2: Because we all have a little bit of a bump down there, but it can become more if that tendon's constantly pulling hard on that bone, where the bone's almost like a spur, it's an adaptation where it starts to grow more right.
• 55:28
  Speaker 2: It needs to have more surface area right To handle more load.
• 55:32
  Speaker 2: So it starts to become more and more and you can have some people who don't have symptoms with those Same with a spur.
• 55:40
  Speaker 1: After this I'll show you my right ankle.
• 55:41
  Speaker 1: I have a huge one on my right.
• 55:43
  Speaker 1: Does it hurt?
• 55:43
  Speaker 2: No, that's what I'm saying.
• 55:45
  Speaker 1: It doesn't always it's so strange, I never feel anything.
• 55:47
  Speaker 2: Yeah, and that's the thing.
• 55:48
  Speaker 2: It's like it can be a problem and it doesn't have to be a problem.
• 55:51
  Speaker 2: That's the interesting thing.
• 55:52
  Speaker 2: It's not fully understood, but when it's a problem, it's, it sucks to be honest.
• 55:59
  Speaker 2: Um, so yeah, like in general, it's the bone adapting to the amount of stress through there, right, similar to like other big areas that are common, like, um, the bony growth and our, our bone, our patellar tendon below our kneecap, like the tibial tuberosity.
• 56:16
  Speaker 2: So if you go like a couple inches below your knee where the tendon attaches to the bone, that like pointy part of the bone, that's because we get so much that develops we're not born with that.
• 56:26
  Speaker 2: That develops over time from the bone adapting to the pole of the patellar tendon.
• 56:30
  Speaker 2: Oh, I'm like touching mine right now.
• 56:32
  Speaker 2: It's so weird so similar to like the insertion of the Achilles and the Haglunds.
• 56:36
  Speaker 2: Yeah, that's what's happening there.
• 56:38
  Speaker 2: Whoa Dude, the body is so crazy.
• 56:42
  Speaker 2: It's crazy, but it adapts right it does what it's supposed to do to a point, but it does have its limits, yeah, and I think that's where things go wrong.
• 56:53
  Speaker 2: And it's not always just mechanical limits too, and there's hormonal stuff that happens.
• 56:58
  Speaker 2: There's what's again?
• 57:00
  Speaker 2: Our sleep, our diet, our nutrition, like all that affects on on how we feel and how our tissue regenerates, and so there's just so many variables and you know, if we can try to keep on top of as many as possible, that's great, but it's hard to do that.
• 57:14
  Speaker 1: Yeah, dude, all right, sorry, I'm going to.
• 57:17
  Speaker 1: I'm kind of going down a rabbit hole here because I'm just really curious about all this stuff, like what is this is?
• 57:22
  Speaker 1: This is like worst case scenario, but I'm just, I'll, you know, bring it on chimp brain here.
• 57:27
  Speaker 1: Um, dude, like when you snap that achilles tendon, what does that surgery look like and how do they?
• 57:32
  Speaker 1: Okay?
• 57:34
  Speaker 2: there's multiple different surgeries is there really?
• 57:36
  Speaker 1: yeah, yeah, how do they attach that thing?
• 57:38
  Speaker 1: Got to go in there and yank it and like retie it down.
• 57:41
  Speaker 1: Yes, oh, my God, yeah.
• 57:44
  Speaker 2: Um, there's different strategies and how they do that.
• 57:48
  Speaker 2: Um, just like any surgery right, there's different ways they do ACL different.
• 57:52
  Speaker 2: You know, um, sometimes if, depending on how, if it's not like a full rupture, they won't they don't even always need to do surgery.
• 58:02
  Speaker 2: It depends on what you know.
• 58:02
  Speaker 2: If it's this is an athlete that needs to get back to sport, I think, like Aaron Rogers versus someone who's maybe a weekend warrior.
• 58:07
  Speaker 1: Yeah, aaron Rogers is a good example.
• 58:09
  Speaker 2: Yeah, yeah and like he went through surgery.
• 58:11
  Speaker 2: But like even looking at him now, yeah, um, he's not this.
• 58:15
  Speaker 2: I know he's 40, right, that doesn't help to a point, but he's not moving the way he did before.
• 58:21
  Speaker 2: Like there's that tissue has to handle so much low.
• 58:25
  Speaker 2: When you're changing direction, you're accelerating, decelerating, especially in field sport, and so if that, if there's some susceptibility still in that tendon, like it, it just the brain can kind of shut it down on how you move and change how you move where you're not pushing off as much on that foot, planting as hard on that foot.
• 58:41
  Speaker 2: So it's interesting to see that.
• 58:43
  Speaker 1: Ooh dude, he's a great cause, like Kevin Durant, I feel like came back and he's he's still pretty, pretty nasty, you know for more for less, so good.
• 58:50
  Speaker 1: Right, so like, but he took a while to come back, but like Rogers was back.
• 58:55
  Speaker 1: I mean this is two completely different sports but like, and two completely different like levels of movement.
• 58:59
  Speaker 1: But like you're right, I never even thought about that.
• 59:02
  Speaker 1: Like Rodgers really hasn't been much.
• 59:03
  Speaker 2: Kobe Ryan when he ruptured his Achilles too.
• 59:06
  Speaker 1: Oh, I forgot, that was long ago, man, yeah.
• 59:09
  Speaker 2: But I think, to be honest, basketball is especially like he's an NFL quarterback versus if you were a running back wide receiver.
• 59:17
  Speaker 2: That's going to be a little more explosive.
• 59:18
  Speaker 2: Yeah, it might be different, but basketball, you know, those guys who are sprinting down the court, jumping high with high force, that Kelly's needs to be at a higher level of preparation to get back to that full steam versus probably someone like Aaron Rogers, like he can.
• 59:34
  Speaker 2: He can get away with kind of modifying how he's moving, even though it's not optimal.
• 59:39
  Speaker 2: But it's just that tendon needs to be so resilient to really put power through, especially in those sports, and handle that.
• 59:49
  Speaker 1: I'm trying to think of examples in our sport.
• 59:51
  Speaker 1: Like I said, I mentioned an example earlier of Alex King Did he rupture it.
• 59:57
  Speaker 2: I haven't heard of many distance got.
• 59:59
  Speaker 2: I got a well he did it playing basketball I got, I have to look.
• 1:00:02
  Speaker 1: Well, that's the thing, and I don't know if he ruptured or if he tore it.
• 1:00:05
  Speaker 1: There's a difference, right or no?
• 1:00:07
  Speaker 2: well, it's the same thing, yeah I got.
• 1:00:09
  Speaker 1: I have to look on his instagram to see and.
• 1:00:11
  Speaker 1: But like he he's like one of the few people, like he's still really good runner.
• 1:00:16
  Speaker 1: I mean he's great, great athlete.
• 1:00:17
  Speaker 1: Yeah, I don know, I'd have to ask him to see like.
• 1:00:20
  Speaker 1: All right, are you at?
• 1:00:20
  Speaker 1: Like?
• 1:00:21
  Speaker 1: I don't know Like, are you at?
• 1:00:22
  Speaker 2: I'd be curious yeah.
• 1:00:23
  Speaker 1: I mean, dude, he this year he had, um, you know much to his to compliment him was right up there with, like, darren Thomas and folks like that.
• 1:00:29
  Speaker 1: That's crazy.
• 1:00:30
  Speaker 1: So if you're able to come back and still compete at that level, I think that's pretty, that's a great thing.
• 1:00:35
  Speaker 1: I just our, our movements in the sport are different, so that's why.
• 1:00:45
  Speaker 2: I find it.
• 1:00:46
  Speaker 1: I just find it interesting.
• 1:00:47
  Speaker 2: Curious, do you?
• 1:00:48
  Speaker 2: I'm sure if, if it was a rupture, that I'm curious.
• 1:00:53
  Speaker 2: How long do you know how long he was?
• 1:00:55
  Speaker 2: It's been a while From the injury to where he got back to that race, his uncle was the surgeon also who happens to be like a phenomenal surgeon.
• 1:01:03
  Speaker 1: That's part of it.
• 1:01:04
  Speaker 1: That's part of it.
• 1:01:05
  Speaker 2: But also what you're doing after.
• 1:01:07
  Speaker 2: That's just as important, if not more important.
• 1:01:09
  Speaker 1: Yeah, because you need to put the right.
• 1:01:11
  Speaker 2: You need to give it the right stimulus to get back to what you want to do too.
• 1:01:14
  Speaker 2: It's just like in my, in my repertoire of like knowing athletes, I think that's like one of that might be.
• 1:01:37
  Speaker 2: Tendon is weaker due to other processes going on, so you know there's speaking of it.
• 1:01:44
  Speaker 2: There's a.
• 1:01:44
  Speaker 2: There's a medication, um an antibiotic called fluoroquinolones, um, also known Cipro.
• 1:01:51
  Speaker 2: That's like a, the trade name.
• 1:01:53
  Speaker 2: That drug has been shown to basically degrade the collagen and tendons and cause rupture, and it could be like even you could be like walking, going out for a jog.
• 1:02:05
  Speaker 2: If and you may not even realize it, but if you're on that for a period of time it's been shown to cause Achilles to rupture.
• 1:02:12
  Speaker 2: Dude, that's fucking crazy, which is terrifying.
• 1:02:15
  Speaker 2: Um, I I, to be honest, like I don't you don't hear about that medication being used that often.
• 1:02:22
  Speaker 1: Well, dude, that's just so many antibiotics, but not to go off on a tangent here, I and I have to do my research on this before this comes out just to make sure like this is legit.
• 1:02:30
  Speaker 1: But I have heard from other podcasters before this was that like what is it?
• 1:02:37
  Speaker 1: It was epic and metformin, but mostly it was epic.
• 1:02:40
  Speaker 1: Breaks down soft or can break down like soft tissue and tendons.
• 1:02:43
  Speaker 1: Um, I don't know if there's any science written on that before.
• 1:02:48
  Speaker 2: I have to look into it.
• 1:02:49
  Speaker 2: I don't know, I don't.
• 1:02:50
  Speaker 2: I wouldn't be surprised.
• 1:02:51
  Speaker 2: I don't know as much about that.
• 1:02:53
  Speaker 2: I mean, I've heard of that medication that you see that people will do that a lot for like weight loss weight loss.
• 1:02:57
  Speaker 1: I think it's.
• 1:02:58
  Speaker 1: I believe it's a um, it's a diabetic drug metformin's diabetic.
• 1:03:03
  Speaker 2: Yeah, it's like a blood glucose regulator and I.
• 1:03:06
  Speaker 1: I want to say ozempic is the same, but I like I said before this comes out, I gotta I gotta do my research before this is coming out, but like from what I've heard, like I said joe rogan, I don't know how true this is, but like he's had experts on and they say that it like breaks down, breaks that stuff down.
• 1:03:22
  Speaker 1: I don't know.
• 1:03:22
  Speaker 1: That could be bullshit, but it wouldn't.
• 1:03:24
  Speaker 1: If you are losing weight I would imagine you're you could be losing soft tissue or whatever.
• 1:03:30
  Speaker 2: I don't know.
• 1:03:30
  Speaker 2: Collagen breakdown?
• 1:03:31
  Speaker 2: I don't know.
• 1:03:39
  Speaker 1: I don't know the full mechanism to that to say, but I'll be curious to look into it.
• 1:03:41
  Speaker 1: On the topic of collagen, though, as before we start to wind up, because we're almost at an hour now like was supplementing with collagen help that stuff at all?
• 1:03:44
  Speaker 1: Like help your soft tissues and tendons and stuff this is yeah, this is gonna be.
• 1:03:49
  Speaker 2: I can't give a great answer on that.
• 1:03:50
  Speaker 2: Um, it's like anything right, supplements, if anything, are gonna make often a very small change.
• 1:03:57
  Speaker 2: Yeah, um, potentially right.
• 1:04:01
  Speaker 2: Um, they, they've done study where I think actually I want to say gelatin and vitamin c, so those two mixed have like a collagen synthesis.
• 1:04:12
  Speaker 2: Um, that can help to help with tendinopathies, help with tendon, but I'm not sure to what point taking it, cause, like you hear about a lot, it's a very I've taken collagen supplements yeah.
• 1:04:24
  Speaker 2: A lot of people take it.
• 1:04:25
  Speaker 2: You know, I don't, I don't know to what extent how much that helps.
• 1:04:28
  Speaker 2: I think maybe in the back of your mind it gives you like a placebo to a hundred percent.
• 1:04:33
  Speaker 1: A hundred percent.
• 1:04:42
  Speaker 2: Right, right, um.
• 1:04:42
  Speaker 2: Plus, it's probably mixed in a vat that's full of other shit that you don't even know so much of the supplement.
• 1:04:45
  Speaker 2: World's like that, man.
• 1:04:45
  Speaker 2: It's like hard to know exactly what you're getting, sometimes too.
• 1:04:47
  Speaker 2: Um, but yeah, I can't speak.
• 1:04:47
  Speaker 2: Like probably an rd could speak better onto that.
• 1:04:48
  Speaker 2: I can't speak as much on.
• 1:04:50
  Speaker 1: I was just curious yeah, good question.
• 1:04:52
  Speaker 1: We were on the topic and we talk about collagen a bunch, so I was like, oh, I wonder if that actually.
• 1:04:56
  Speaker 2: I don't know, but I mean most of our Achilles tendon and tendons in general are made up of collagen.
• 1:05:02
  Speaker 1: And so you'd think, but it doesn't always that's the case Really quick.
• 1:05:07
  Speaker 1: Is there anything that you think we have not touched on that you want to touch on for Achilles tendinopathies.
• 1:05:13
  Speaker 2: Yeah, I think, like anything you know, recovery from these injuries is kind of a balancing act, um, you know whether you're someone doing the recovery on your own, you're working with a physical therapist or someone else.
• 1:05:26
  Speaker 2: Like, communication is really important to know how you're responding.
• 1:05:30
  Speaker 2: Like I said, you know, making sure that the patient or person dealing with this knows some pain is okay.
• 1:05:36
  Speaker 2: Um, really, the bigger indicator is how.
• 1:05:39
  Speaker 2: What's the pain in that 24 hour window after window after, I should say, is it?
• 1:05:43
  Speaker 2: Is it mild, is it not there, um, or is it to a higher level?
• 1:05:47
  Speaker 2: That's going to really give us an idea if we need to take a step back, keep where we're at or or even progress more loading, um, but knowing also which is great news with these injuries, that it's okay, you, we can keep running in most cases.
• 1:06:00
  Speaker 2: Yeah, like, maybe initially, if it's really reactive, we need to take a brief step back for a few days a week, but we can keep running.
• 1:06:08
  Speaker 2: It's not like bone, where we need to often do a hard stop to a certain point of time.
• 1:06:12
  Speaker 2: We can keep running with these.
• 1:06:14
  Speaker 2: We just need to modify it to a point that's low enough level of pain.
• 1:06:19
  Speaker 2: You're feeling good for the most part, and we're not making things more reactive, and so that's the best news.
• 1:06:27
  Speaker 2: You know, if we can get loading, if we can get running and modify things, we can be on our way, and the communication piece is huge, right, that's the most important.
• 1:06:38
  Speaker 1: I love that.
• 1:06:38
  Speaker 1: And one thing I do I think we got to end on to and talk about like as we end.
• 1:06:45
  Speaker 1: It's like I meet so many runners and just athletes that like we'll be dealing with an injury or dealing with something, and rather than they'll just think that like, okay, I'm going to take, I'm going to either like peel things back or just take time off and just hope it gets better.
• 1:06:59
  Speaker 1: And a lot of times it doesn't.
• 1:07:00
  Speaker 1: So, like, if, if and this is a big shout out just to any person that like might be dealing with that or going through that now like just go see a PT, you know, go see someone and get it looked at, because what you think it might be, you know, like, for instance, like two weeks ago I'm like I think I have a herniated disc.
• 1:07:16
  Speaker 1: That couldn't be have been further from the truth.
• 1:07:18
  Speaker 1: You know, with what I was dealing with, and until I went to go see you and you're like no, you idiot, like that's not what's wrong, that's not what you said, but that was in your mind.
• 1:07:29
  Speaker 2: That was in my mind Like no dipshit, but anyway, like that's.
• 1:07:31
  Speaker 1: You know I automatically go to like, whereas I think a lot of athletes they automatically might assume the worst or think something bad.
• 1:07:40
  Speaker 1: Just go to a PT, go get it looked at, go to see a professional, because I think that will help you at any level of the game.
• 1:07:50
  Speaker 2: I think, just speaking of that, giving the person that's dealing with this an understanding of what's going on and what's okay, what's not, setting expectations and understanding the situation Like that's huge.
• 1:08:05
  Speaker 2: Right, that can go from this fear, anxiety about pain, to oh, actually this is okay and that can just, we can let the guard down a little bit, and I think that's huge for people.
• 1:08:15
  Speaker 2: It's like it's scary when you run a run and you can't, or it hurts but not knowing.
• 1:08:19
  Speaker 2: Okay, should I just stop and take time off and see what happens?
• 1:08:24
  Speaker 2: But oftentimes that's not the best answer, um, and so, yeah, just having some expertise, some guidance, can go a long way.
• 1:08:31
  Speaker 1: Yeah, and don't believe web MD yeah there's going to be.
• 1:08:36
  Speaker 2: I'm sure there's going to be some mixed things out there.
• 1:08:37
  Speaker 1: Yeah, that's for sure yeah, well, that's the thing.
• 1:08:40
  Speaker 1: Like I, I, I don't know like I'd go to you and be like dude, like when I bend my neck, like I feel that in my lower back, like it's so weird.
• 1:08:46
  Speaker 1: And that is one of the interesting things.
• 1:08:48
  Speaker 1: If you go on webmd, that's the first thing it says.
• 1:08:50
  Speaker 2: It's like oh, there could be a herniated disc, that could also be, some other could be a billion yeah, Like some uh, like even like MS or things that are going on with the, the spinal cord, like bending your head causing, like this electrical type plane pain, like all these things, and that can be scary.
• 1:09:08
  Speaker 2: You're like, oh my God, am I dying?
• 1:09:10
  Speaker 2: Like is something happening.
• 1:09:11
  Speaker 1: Seriously.
• 1:09:12
  Speaker 2: And it's like that's the scary part.
• 1:09:13
  Speaker 2: You're going to go.
• 1:09:14
  Speaker 2: You're going to go, you're going to get all these answers and some of them you may not want to hear.
• 1:09:17
  Speaker 2: Then you go and start catastrophizing.
• 1:09:19
  Speaker 2: That's what I do.
• 1:09:21
  Speaker 1: I bet I text you in panic Anxiety.
• 1:09:25
  Speaker 1: Well, dude, thanks so much for coming on.
• 1:09:28
  Speaker 1: Like I said, hopefully this is the first of many.
• 1:09:30
  Speaker 1: I like the idea of these mini series and like talking about talking through.
• 1:09:33
  Speaker 1: You know some of the more common injuries and athletes and what to do and how to deal with them, and just you know kind of the telltale signs and how to work through them.
• 1:09:41
  Speaker 2: So yeah, try to do my best to give answers that are also can be applicable to people and give some insight and you know just a little more background about these Cause.
• 1:09:51
  Speaker 2: Again, there's so much changing too in the science of, you know, soft tissue injuries, bone injuries, running related injuries, so it's nice to be able to have some perspective on these.
• 1:10:02
  Speaker 1: Yeah, and I think it provides the athletes, because you know not everybody that listens to this.
• 1:10:05
  Speaker 1: As an elite, you know that are being, have the ability to go to a PT all the time and get things looked at Like there's a lot of you know just just people you know going out there and doing it, and you know a lot of people in Colorado and a lot of Colorado Springs athletes.
• 1:10:19
  Speaker 1: So, yeah, I think there's a lot of value there for people that might be going through an injury and what to do with it.
• 1:10:24
  Speaker 2: So, yeah, well, dude, thanks, very cool.
• 1:10:26
  Speaker 1: Thanks for coming on.
• 1:10:27
  Speaker 1: Um, let's shout out run potential PT, um website the whole thing.
• 1:10:32
  Speaker 1: Give the rundown.
• 1:10:33
  Speaker 1: So if people you know, especially in Colorado Springs, the front range, are listening to this and looking for a PT, Cool man Appreciate it.
• 1:10:39
  Speaker 2: So yeah, run potential rehab and performance is my practice.
• 1:10:42
  Speaker 2: You can find me on Instagram at run potential PT, or Facebook at run potential rehab and performance, and then website run potential PTcom.
• 1:10:53
  Speaker 2: If you have any questions or anything like I'm pretty open to answering things you can shoot me a DM on Instagram.
• 1:11:00
  Speaker 2: That'd be awesome.
• 1:11:00
  Speaker 2: I'd be happy to help.
• 1:11:01
  Speaker 1: Thanks, man.
• 1:11:02
  Speaker 1: Yeah, dude, thanks for coming on.
• 1:11:03
  Speaker 1: Appreciate it until next time.
• 1:11:04
  Speaker 1: What'd you guys think?
• 1:11:06
  Speaker 1: What a fun episode.
• 1:11:07
  Speaker 1: Uh, really insightful and super interesting.
• 1:11:09
  Speaker 1: I learned all about those pesky Achilles tendons.
• 1:11:12
  Speaker 1: Uh, we talked literally about everything.
• 1:11:14
  Speaker 1: It's hard for me to stay on track when cause I'm an idiot and uh so it's hard for me to stay on track when cause I'm an idiot and uh so it's hard for me to stay on track.
• 1:11:18
  Speaker 1: So it was fun having Sean on to kind of do this mini series and talk about those pesky Achilles tendons.
• 1:11:23
  Speaker 1: Um, guys, before, uh, before you tune out, um, hop on over, um, give Sean a follow.
• 1:11:30
  Speaker 1: Like I said, sean is going to be found on Instagram, at run potential PT on Instagram.
• 1:11:35
  Speaker 1: And or, if you or a loved one are suffering from Achilles tendinopathies or are suffering from anything where you might need a PT, hop on over to Google maps and type in run potential, rehab and performance.
• 1:11:46
  Speaker 1: Give Sean a call.
• 1:11:47
  Speaker 1: Also, hop on to his website and that's going to be run potential.
• 1:11:54
  Speaker 1: Actually, let me make sure this is correct before I go and spout this out Runpotentialptcom.
• 1:11:59
  Speaker 1: And, like I said, if you are a loved one suffering and need a PT, go find Sean.
• 1:12:05
  Speaker 1: He'll help you.
• 1:12:06
  Speaker 1: He's dealt with me for many, many years, so this is if he could deal with me, he could deal with you.
• 1:12:12
  Speaker 1: Yeah, guys, I hope you guys enjoyed this episode One of my favorites.
• 1:12:16
  Speaker 1: I'm not really sure what we're going to bring you guys for the next one, but, like I said, this is the first of a mini series we're going to be doing on all kinds of pesky injuries that runners kind of face.
• 1:12:26
  Speaker 1: So pretty cool, guys.
• 1:12:28
  Speaker 1: Very last but not least, if you happen to be on Google or Spotify, or if you are on YouTube or Apple, please, please, please, please, please, hop on and give us a five star rating and review.
• 1:12:40
  Speaker 1: I would also challenge anybody to if you love this episode or any other episodes, if it's your favorite one, go ahead and share it on social media.
• 1:12:48
  Speaker 1: The whole point of this podcast is to get this out to the world so we can cover the vast world of sub ultra.
• 1:12:53
  Speaker 1: It's my passion and something I genuinely love and want to continue to do, so my goal is to get this out to as many ears as possible so we can help grow this great sport.
• 1:13:02
  Speaker 1: Guys, I hope you have a wonderful rest of your week.
• 1:13:05
  Speaker 1: Keep a lookout.
• 1:13:06
  Speaker 1: On Friday We've got a great episode dropping with Colorado Springs stud Mr Dan Metzger.
• 1:13:11
  Speaker 1: Really fun guy, really fun podcast and yeah hope really excited to bring that to you all.
• 1:13:17
  Speaker 1: So have a great rest of your week, thank you.