REWIND // You're Not Running Wrong: Running Myths Debunked | RICH WILLY, PT, PhD

Okay, so this one is a Summer Rewind, and I'll be honest with you, I went back and forth on which episodes to bring back. This one wasn't a hard call.

The original aired in September 2022. I re-listened before we re-ran it and quite honestly? I'm still hearing every single one of these myths in clinic. Every one. A couple of years later.

Rich Willy has spent 20+ years treating injured runners and publishing the research the rest of us end up citing. And the thing I love about him is that he opens by admitting he used to believe most of these myths himself. That's the whole reason it holds up.

So I asked him to name the running myths he most wishes would just disappear. Stretch more. Strengthen your glutes. Land softer. You're running wrong.

Here's what we get into:

🔹 Why stretching isn't the thing standing between you and an injury, and what to do with that warm-up time instead
 🔹 The calf, not the glute. Running is a plantar flexor sport, and Rich tells you exactly where to spend your strength minutes if you only have a few
 🔹 The bone force number that flips "just land soft" completely on its head (this one genuinely changed how I talk to runners)
 🔹 Why your single biggest injury risk factor is the injury you already had, back in your 20s, in high school, in a body you don't have anymore
 🔹 REDs, energy availability, and why a normal body weight tells you almost nothing
 🔹 Return to participation, return to sport, return to performance. The three-stage model most of us skip right past
 🔹 What actually happens when you tell a runner to change the way she runs

And I promise you, this is a pelvic health episode. If the calf and the quad and the hip aren't holding up their end of the bargain, the pelvic floor is left holding the ball. You can hyperfocus on the pelvic floor and still completely miss the boat.

So if you're a mom who's five or ten years out and still hasn't gotten back to running, this is for you. And if you're a clinician who's been quietly wondering whether the thing you've taught for a decade is actually still true... this one's for you too. No judgment. I've been there.

Come find Rich on Instagram: @montanarunninglab

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Transcript

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SPEAKER_00 0:00

Welcome back to the Active Mom Podcast and our summer rewine series. Our next rewine episode is with Dr. Rich Willie. I pride myself in trying to stay as up to date as possible, not only in the Pelpic Health, Women's Health Pregnancy Postpartum Perimenaspa space, but also in running space as well. Rich is one of the most respected voices in running injury research. And we talk about some of the myths that runners keep getting told. And I'm telling you, they it's a couple years after this episode, and I still hear some of these myths rolling around. So you're going to want to listen to this episode. You're going to expect a few assumptions to get challenged. This is evidence-based. I think it's timeless. And this is a great one, whether you are a clinician new to running, or if you're a runner and you just want some good evidence-based advice and a little bit of myth bisting, which you know I always love. So make sure you check out this next episode of the Summer Rewind series with Rich Willie. You're listening to the Active Mom podcast with host Dr. Carrie Pagliano. I'm a mom physical therapist and your go-to guide for staying active with public health issues in pregnancy, postpartum, perimenopause, and beyond. Whether you're a fellow mom, physical therapist, or women's health professional, join me where I'll share expert insights, real life stories, and the latest research to help you approach running, CrossFit, yoga, Pilates, hit, or whatever activity you love with confidence and evidence-informed guidance. Let's start the show. All right, so believe it or not, I don't always just follow postpartum professionals and public health people. Sometimes I dabble a little bit in kind of sports and orthopedics. And that's how I found Rich Willie. And he's known as Mountain End Sports. Did I get that right on Montana Running Lab. Oh my God, I'm so sorry.

SPEAKER_02 1:49

Oh that's okay.

SPEAKER_00 1:50

I screwed it right off the bat. Or off to it's right in front of me too. So I found Rich on Instagram and I've been following his stuff and love it. And so I'm so glad to have Rich on the podcast to chat about myth in running, just period. So thanks. Um thanks for coming on, even though I totally messed up your IG.

SPEAKER_02 2:10

Oh, that's okay. Thanks, Carrie. Thanks for it, it's really, really awesome to be here. So I appreciate it. And uh yeah, I really enjoy your feed as well. It's super helpful to me. And uh I don't I don't treat a lot of individuals who are postpartum. So it's it's it's really helpful for me to to see that feed.

SPEAKER_00 2:24

Cool. Yeah, there's there's a lot of crossover. It's it's funny. Um with with my background in orthopedics and pelvic health for so long, they kind of ran in two parallel kind of universes. And at some point, it just made more sense for them to collide. And because there's not great research in pelvic health and return to sport, um it it really we've had to look at um research like yours and you know others in the sports ortho space because you guys are looking at like return to sport, um, you know, stress injuries, patello femoral sorts of things. There's impact involved, which obviously with pelvic health, we need to kind of take a peek at that too. So um I wanted you to kind of just dive into just basic running myths because so many of our moms and even our professionals maybe don't know that there's been some updates. So maybe you could just dive into the top three running myths that you kind of just wish would disappear.

SPEAKER_02 3:24

Oh yeah, this is a yeah, it's really uh yeah, for me, I find this to be a really fun area and and um in particular because I used to believe a lot of these myths as well. Yeah. You know, and and and so much has changed in the last decade. Uh I came out with my PhD in 2011 in biomechanics. And at the time I thought, you know, biomechanics really was the big cause of many injuries. And you know, of course, that was my my bias, but you know, I've been a clinician for for for 20 plus years, and so um, you know, and I still treat. And so, you know, you start to see, and look, you look at the literature and you're starting to see that some of these kind of strongly held beliefs that that even I had maybe don't necessarily pan out. So um, so yeah, I think I think a couple of them would be, you know, um, I think stretching is a good one. And so I think that, you know, we as as PTs, um, if something hurts, we're taught, or maybe our biases to stretch it. And um and when you when you look at the literature, uh people who um fail to stretch uh are not at greater risk for running related injuries. And um also, too, that stretching doesn't seem to have a major role in recovering from most, if not all, running related injuries as well. So I think stretching is one of those things that is probably over-emphasized. I think people spend uh maybe perhaps too much time on it. And I'm not saying that there's anything wrong with stretching, I wouldn't be one of those that would say that you know stretching is bad for you and you're you're harming yourself. I would just say that if you're doing stretching, understand that you're probably doing it for perhaps reasons such as relaxation or stress relief, but it's probably not doing anything to uh, I would say, like reduce your risk of of experiencing a running related injury. So um, so I would say that that was probably number one.

SPEAKER_00 5:08

Um we can stop the guilt trip that we didn't stretch today. We're okay.

SPEAKER_02 5:11

Yeah, exactly. Exactly. Yeah, exactly.

SPEAKER_00 5:14

One last thing to take up my list.

SPEAKER_02 5:16

Yeah, right. And I you know, I think that, you know, too. I mean, you know, if stretching's part of your warm-up routine, that that's great. And I think that, you know, along those lines, I would ex I would encourage individuals to explore other ways uh to warm up as well. And you never know. I mean, maybe something that you've been practicing all along, there might be other alternatives out there that might be better. And so um, maybe as part of your warm-up routine, perhaps um doing some jumping jacks or some sort of like plymetric type activity, because really running is basically a planetric, it's it's just basically repetitive hopping. And so um, if you're doing a lot of like long stretching before you do that, and then you ask yourself then to do something totally opposite of that, which would be kind of like this this bouncing type activity, it makes sense maybe perhaps to do some bouncing to warm up for that. So that would be one thing I would I would encourage people to think about too. And I think the other part along those lines too is you know, maybe maybe perhaps the the time that you spend um stretching each week, if you think about replacing some of that time with some some heavy strength training, um, I think would also do a lot of us a lot of good um as well. And understand too that, you know, again, while you know you might enjoy stretching and all those things, you know, I think it's a it's important to think about that you might be taking time away from doing things that might be more beneficial for you. And so strength training is I that's my bias. I'm a I I do a lot of strength training. I didn't used to. Um, you know, I personally I you know I personally had a muscle skeletal injury that I was having a lot of trouble recovering from. I had I had hip FAI surgery and oh me too. Oh, did you? Oh yeah, good yeah, good time. Hopefully you did better than I did. I I really struggled with that injury.

SPEAKER_00 6:51

At first, not good. Like mine was um 15 years ago.

SPEAKER_02 6:55

Oh, yeah. Uh huh. Yeah, and so nobody knew that first wave of the city. Yes, exactly.

SPEAKER_00 6:59

Exactly. Like nobody knew the rehab, and so it was really frustrating to think, oh yeah, this is gonna make you great. And then I think I finally found somebody that with an hour of prep, I could go run, and that was before kids. And I'm like, I don't have this time before kids, I sure as hell don't have time after. And that's actually how I found CrossFit was because of the load and made a big difference in how my hip felt and my running.

SPEAKER_02 7:23

So yeah, and that's very similar to me. You know, when I the program I went through, the the rehab protocol, I mean, I had my PhD at the time and I was treating a lot of muscoskeletal injuries. Uh, I knew a little bit about hip FAI, um, and that's not really saying a lot because people didn't really know very much about it at all. And um, you know, I was working in Colorado and in the mid-2000s when Mark Philippon.

SPEAKER_00 7:45

I was gonna say, did Philippon do your surgery?

SPEAKER_02 7:46

No, no, he didn't. I had it done at Ohio State. And so we started getting a lot of these hip arthroscopies in the mid-2000s, and um, we were kind of like, well, I I think I know what to do rehab-wise. And and at the time, you know, I guess maybe this is another good kind of myth would be that well, we're like, well, it's a hip and they're a runner, or they're some sort of other lower limb athlete. So we need to do a lot of glute strengthening with this person. And so when I had my hip surgery done in 2012, that was basically the program that I was given. And the rehab I was doing was a lot of gluteus medius, gluteus maximus type type strength training. And, you know, and really what I found was that it wasn't really helping me very much at all. Um, and so I was like, well, let's flip this on its end and do something exactly opposite. So rather than doing a lot of hip extensor and hip abductor strengthening, I started doing a lot of hip flexor and hip adductor strengthening. And I started rather than doing a lot of body weight stuff, I shifted to doing a lot of heavy strengthening exercises. And so the more that I did that, the more, the better I felt. And in fact, um, I started doing that as my warm-up. I would do some heavy strength training and then I would go for a run, and and that seemed to be very helpful. And I I did have a really hard time coming back from that injury. It took me over two years to get back to you know, to get back to running. And so um, so I think that um I think we have an overemphasis on uh the role of of the glutes um with running. And I think that if you pick up uh Runner's World or Tri Athlete Magazine or something like that, you still see that there's still that heavy emphasis on that. I would say that Runner's World started getting is starting to get a lot better about that. They're starting to say, well, this is maybe running is not such a gluteal activity. But and and in fact, running is very much a a planner flexor or a calf uh type activity. And so if you're pinched for time, I would say that your uh your your your best bet is to probably spend a lot of time doing a lot of planner flexor strengthening, so a lot of heavy weighted um or heavy calf raises. Um I think one of the best places to do those is in a Smith machine.

SPEAKER_00 9:47

Yeah.

SPEAKER_02 9:48

Where you've got good stability, you don't have to worry about balancing yourself and you can just focus on getting a lot of load on yourself. Um and so running is when you look at the when you run, about 50% of what we call our support moment comes from our planner flexors. And so we need to spend a lot of time on that. And then I think the next thing then to do is probably, you know, if you have an area that has been injured in the past, that's likely where you're gonna get injured again in the future. And so, for instance, if you've had patelephemoral pain in the past, when you go out and make some sort of training load error where you maybe run too many downhills or increase your speed work too quickly or something like that, you're if you're gonna get an overuse injury, it's probably gonna be patelephemoral pain. So you should probably pick a couple other a couple exercises that might be helpful for your for patelephemoral pain. And I would say like like quadr, like very targeted quadricep strengthening, I think would be very helpful. Um and uh yeah, so I think I think doing just you know just a few exercises several times per week that involve you know lifting some heavy weight. I really encourage people to join a gym because I think that it it's it's a small price in the grand scheme of things when it comes to improving your overall running health, but also your muscle skeletal health. And now we're starting to see that strength training, particularly heavy strength training, has a lot of cognitive benefits too, as far as the across the lifespan. And and of course, there are all the benefits when it comes to bone health as well. And so you know, so I think that those things are just really hard to replicate at home. And and um, I know from so we have a we have an eight-year-old, and and you know, my wife and I are really good about co-parenting. And we know that if we're at home, lifting in our we have a wonderful gym in our garage, and I walk right past that gym, hop on my bike, or hop in my car and go down to our gym and work out. And it's because you know, our um our eight-year-old comes out and then he's like, What's going on, guys? And he wants to hang out, hang out. And I love him to death. And but you know, I think like getting that that concentrated time, you know, alone or invest in yourself. Yeah, I think it's really important.

SPEAKER_00 11:43

But some of the things you just said, I thought I think they've resonated with with my population um and what we saw for a long time before we had, you know, running readiness screens like with Grain Donnelly and Tom Goom. Um, like just even looking at, like you're saying, planner flexion, like how many heel raises can you do? Because there's so much kind of atrophy that comes through pregnancy. You know, what does that balance look like? Can you handle impact? Um, and then the other thing that comes up a lot is moms that just go back to running without strengthening, they get recurrence of these old injuries from back in their 20s or high school running days or things like that. And that's what sidelines them. They don't even get to the point where, you know, they're having pelvic chlorations because they're not even running yet. And it's those basic kind of orthopedic things that I think just get completely missed. And then these moms are, you know, five, 10 years out, their kids in middle school, and they're still not running again. And that's not how they want to be for their kids. Um, but yeah, it's just, it's, it's unreal, you know, just the basic stuff that gets missed because we hyperfocus right to the pelvic floor. And it's like, actually, no, these other things really do still matter because, you know, if you're not running during pregnancy or you, you know, you've gotten weaker, you have these old injuries that that haven't been resolved, and you're not doing anything to strengthen, you can't just go out and just run and think that it's gonna be fine. Plus, we're getting older.

SPEAKER_02 13:03

Yeah, definitely. I mean, you know, and that's the thing is that is that the number one predictive factor on whether or not you're gonna get an injury is if you've had that injury in the past. Right. So we know that if you've had patello femoral pain, 50 to 80 percent of people will have a recurrence of that, even if they've completed rehabilitation. We see that with um patellar tendinopathy, over 50% will get that again. Achilles tendinopathy, the same thing as as well. And yeah, bone stress injuries. If you've had a bone stress injury anytime in your life, anywhere in your body, so if you've had a tibual bone stress injury, yeah, you have a six-fold increased risk of having that uh that injury again somewhere else in your body, you can get another bone stress injury. Um, if you're male, it's a little bit higher, actually. It's it's no kidding. Yeah, and males have a little bit higher risk of um of having a subsequent one. So that's interesting.

SPEAKER_00 13:48

I didn't realize that.

SPEAKER_02 13:49

Yeah, and a lot of that has to do with the fact that you know that first off, I mean, bone stress injuries are are really complicated. And I would say it's the the most complicated injury that I certainly treat. And that a lot of times that those underlying risk factors are not resolved. Um people get the bone stress injury, they're like, oh, I'll just let it heal, then I'll go back to running. They don't resolve some of the things, such as energy deficit issues, um, you know, perhaps uh some strength deficits. Um, and they continue to make a lot of the same training load errors, perhaps. So yeah, so that's the reason why a lot of these injuries tend to be very persistent. And, you know, and as we get when we're recovering from something uh such as pregnancy or what have you, and you've had a long time off from running, it's important to realize that you know, it's not just your pelvic floor that's that's lost capacity, the rest of your body has lost capacity as well. And so um, you know, again, reflecting back on my own experience with that hip FAI um surgery that I had, uh, I was just following like one of our like one of actually one of my own standard return to running programs that starts off with like a minute of running and you know, five cycles of that rotating with like two minutes of walking. And um, I was getting really frustrated with that. And then I realized that that was actually just too much running for me. And so I started off with 15 seconds of running, and and it took me, it took me six months to get back because I I'd had two years off without any running, and it takes you know, you adapt you adapt very slowly, and I think you know, different tissues adapt at different rates, and so muscle adapts very quickly, bone adapts very slowly, yeah. And you have to give it all a chance to catch up with yourself, yeah, as you're as you're going forward.

SPEAKER_00 15:28

That makes a lot of sense. Um, we see that more in the context of like Red S, where you know, you've got depleted, you know, you're you're fatigued, your nutrition isn't great, you've got all these other factors hormonally. Um, and I just don't think you know moms are necessarily aware that this can result in bone stress injuries. And then also, too, like looking at getting back to running, I think we we go to what's easy, we Google and couch to five case come up and we think, oh, five minutes on, five minutes off, that's enough. But to your point, sometimes that's way too much. Um, and starting back slowly, I I have a modified program that I'll do with with moms where I'm like, look, we'll find that baseline that we start at, but I'm gonna have you do that at least three different sessions. So that way you buy the confidence that you know that it's okay. It can be in the morning, it can be at night, because obviously, you know, prolapse leakage that can change depending on time of day and fatigue and all of that. But like to buy them the confidence, but I think we also get some underlying physiological benefits from just time under that task, too. Um, and to go slowly so we're not, you know, because it's too hard when I think this is any athlete, when you overshoot and then you have to deal with that mental, you know, fallout from oh my gosh, is am I ever gonna get there? Am I ever gonna finish? And I'd rather undersh undershoot all day long.

SPEAKER_02 16:49

Yeah, exactly. Yeah, I think I think like um, you know, we know that uh as I mentioned, um, bone tends to lag behind muscle development. And, you know, I think a really good way to think about it is is that um muscle and bone have this or muscle exerts a synergistic dominance on bone, meaning that muscle can't do its job without without having a bone to attach to, and it needs to have the the lever arms, and there's a lot of hormonal crosstalk between muscle and bone. Um, as as a you know, and of course a bone won't get stronger unless it has a muscle that's attached to it that's pulling on it and and stretching it and twisting it, and that's how a bone will get stronger. And so we used to think too, uh, I don't want this to count as one of our myths, but it doesn't, you're good. We used to think you're cut off. We used to we used to think that that you know that impacts really related a lot to how we can um the what what results in in bone growth and and stuff and it does, yeah, but really what it is, it's the muscle that is attenuating the impact, not the impact, not the not the hit, not the force of the ground. Yeah. So so when when muscle pulls on bone, it excites the the these these bone cells, these, you know, these osteoblasts and osteoclasts to do their job and break down bone and then build new bone up. And so when you when you think about it, like anytime you have like and you think about like the soleus, which is you know your big deep calf muscle, when it contracts, it bends that tibia backward. And by by doing that, it excites all the all the bone cells, and then that's how we lay down new bone. And of course, when we jump, um, the number one contributing muscle to jumping is indeed the soleus. And so so it's a lot of times we used to think that the impact was what was really important, but really it's the muscle that gets us up off the ground and then helps attenuate that, attenuate that load. So I would say that there's probably an overemphasis and and on on impacts when it comes to perhaps improving bone health, but also there's an overemphasis on impacts when it comes to injuries as well. I think we we think too we think too much of impacts. I don't think they're really quite as important. It's it's really the muscle forces that are really important. And so that again goes back to why you need to have a really strong musculoskeletal system to basically, you know, to uh to absorb and have the capacity for those, um, for those the muscular demands of running, if you will.

SPEAKER_00 19:11

Yeah. Oh, that's really interesting. I I always kind of think, um, and again, with the readiness screening, like if everything down below, like distillate, if it's not doing its job to be able to handle that impact, then I kind of feel like the pelvic floor is sort of left holding the ball. Like, and that's where, again, if if you just hyper focus on pelvic floor, you totally miss the boat. So you have to look at these other areas and understand where something isn't you kind of holding up its end of the bargain. Um, and and I I think it's hard when you have a lot of pelvic PTs that don't have that additional background or don't have somebody in sports ortho to collaborate with that understands those concepts, that I really feel like there's a piece that ends up missing.

SPEAKER_02 19:53

Um Yeah, yeah, I I think that's I think that's that's really important. I think like, you know, I and PTs, um, I don't know, like I come from a medical family. My my father was if it was a was a physician, and okay, you know, and what one of the things that the you know, growing up, um, he he did consultations with other um with other physicians all the time and he consulted out, he sent out patients for consultation. We you know, it was just something very that physicians did. PTs are very reluctant to do that. Um, they don't we don't we don't really consult with others very well, and and I it's a it's a weird thing, and and I I I hope that we get better about that. I don't know. I for me, and I can tell you that for me, like I I know when it comes to uh a patient uh who has pelvic floor issues, I'm not the person to see for that, but I I know who to send that person to, and I know that I can do the screenings for that and can recognize, and if we've got a I've got a great person that I send all those patients um to because I know I can help them with the muscoskeletal component running, and I need to work together with someone else, and and I'm not gonna be the person who can solve this person, all this person's um, you know, challenges that they're that they're dealing with at the time. So um, but yeah, I mean back back to that impact thing. I think that one of the things, so we used to think that if you hit the ground very stiff, that your bone forces were were greater. But really, when you look at the amount of load on a bone, and we'll talk about the tibia, for instance, that the contribution to total bone force or the bone stress, um, you know, total bone force on the tibia is about eight to nine body weights when we run, which sounds like a tremendous amount. And we all know that when you run, your ground reaction, vertical ground reaction force, we often hear that you hit the ground with about two and a half times your body weight. So if you've got nine body weights of force on the tibia and you only have two and a half times your body weight coming from the ground reaction force, then you have to ask yourself, well, where's that other six and a half? Where'd it go? Right. It's coming from the muscle. So the muscles that are attached to the bone are really the biggest contributors. And so, so with that said, that if you are cueing someone to land really soft who has a bone stress injury, you're actually increasing their bone forces, their bone twist being force.

SPEAKER_00 21:57

Interesting.

SPEAKER_02 21:58

And so we used to think that people have hit The ground very hard and um all that stuff had had really high bone forces, but it's actually it's actually the opposite. So it's the opposite. It's the opposite of that. So we're starting to see us now is like new um muscle modeling techniques are coming, uh coming online, and we're we're being we're being able to see and look at different things. And so if you look at downhill running, downhill running actually has a slightly less tibial bone force, even though your impacts are higher because your muscles aren't using as much as uphill running. Uphill running actually increases load on the tibia more than downhill running. So that just goes to show you how how important the muscle is that.

SPEAKER_00 22:32

Oh, that's really interesting. That might I'm sure there's some crossover. Like I'll have clients with um leakage or prolapse issues, which obviously we're we're concerned with impact and pressure and that sort of thing. And it's funny, you'll have some that uphill is a big problem for them, and some it's it's downhill. And so maybe it's you know worth diving into that a little bit more to see what's going on down the chain.

SPEAKER_02 22:53

Yeah, yeah, I think so. I think that, and again, this always goes back to why we should always be kind of challenging some of the assumptions that we hold near and near us is that we might be wrong. And I think you know, why why is that? And if someone says something, this is I this is when I also teach in a program, and I tell our students like, look, if if you hear something and you're like, you know, you have like a little bit of an emotional recoil that going into distance, you know, you should step back and say, Well, why do I hold that belief so near and dear to myself? Write that stuff down and then go look that stuff up and make sure that you're right because you might be wrong. And it might be something that has come along since then that is telling you that, hey, maybe you need to reconsider what what you're thinking.

SPEAKER_00 23:29

So that's great advice. I I I tell a lot of people don't do that enough later on in their career. We hold on to these things for a really long time and um we don't ever reflect on why we still hold on to them.

SPEAKER_02 23:44

Yeah, no, no, I know. I yeah, yeah, I think it's I think it's very true. So maybe maybe we'll make that one our third one because uh I do have a couple other ones, but but just because we're gonna do that.

SPEAKER_00 23:51

No, I was gonna say the you can you can have a couple extra ones there. And any any other good ones that you've got that you think are important.

SPEAKER_02 23:57

Yeah, I mean, maybe maybe maybe one last one because you mentioned it earlier in our in in this conversation, and and that goes to you know, red S. And you know, I think that you know, before, and going back to my bias of coming out of my PhD, thinking biomechanics was the reason why people got bone stress injuries. And now I actually think it's just one of, you know, probably a dozen plus reasons why people get bone stress injuries. Um, and I think of those, it's probably not as important as we used to think it is. And really, it has to do with energy availability. Can this individual's physiology support the load, a training load that this person is is exerting on themselves? And I think that when you look at some of the literature, particularly some of the female athlete triad stuff that was around before we transitioned into red S, there's a lot of emphasis on BMI. And we know too that we know that um that only a few percentage of people who are experiencing red S have a low BMI. And so it's very easy for us to think, oh well, that person has a normal body weight, and so they're not at risk for for red S, but they keep getting bone stress injuries. And um, you know, it what we're starting to really understand much more so it's not so much sure, the the the person who is in prolonged red S, uh those people are at risk. But we're now starting to understand that very kind of micro bursts of red S really are one of the big reasons why people kind of get this like, oh, I got this bone stress injury out of nowhere. And it might be that, you know, for whatever reason, you know, running is a very energy intensive sport, cycling is a very energy intensive sport, and it's not necessarily intentional, they just weren't meeting the energy demands of that activity for the maybe the last couple of weeks, particularly when they're leading up to a big event. That's when people tend to start watching their diet a little bit more closely. But then we start training at the same time, we're also training much more intensely. Um, and you know, our volume perhaps is going up too. And so those tend to be very, very risky periods. So, yeah, so I would think I would say if you're a clinician, or really anybody, if you're saying, oh, I'm not, I'm not, or this person's not at risk for for red S, and that's not really a causative factor because you know they don't fit what I think is what someone would look like who has an energy deficit. I think we should be very, very careful with that because um we see that in people who decide to adopt like a paleo diet. If you, if you want to get a bone stress injury, do a lot of exercise, a lot of endurance exercise, and start on and doing a paleo diet. We see an increase in biomarkers or bone breakdown. Uh, they accumulate very, very quickly. And the reason is is because it's not a carbohydrate intensive diet, and you know you don't have the energy to do your sport and also support your your regular physiological mechanisms that you need to live. And part of those is bone health and and supporting your endocrine system, which is what you need for healthy bones.

SPEAKER_00 26:45

Yeah, I think that comes up a ton in that postpartum population that they're trying to drop the baby weight, or you know, they they want, they have this expectation, they want to get back to racing, they want to get back to something right away, and and their body hasn't caught up to you know the the nutritional demands that you need to to breastfeed, the you know, waking up multiple times at night, like all of that. And I think we normalize it, but like, oh, it's this is just how it is. And unless you've gone through that, I don't think you necessarily, and this can be, you know, moms and dads, like you don't necessarily appreciate how depleted you can get. And if it's your first time through, you're like, oh, well, this is just how it is. You don't realize how depleted those stores really get and how important it is to have good nutrition and as much sleep as you can possibly get, and maybe kind of ramping down those, those expectations of trying to perform and get back to higher training loads, which is hard for our elite athletes that we're seeing now that are trying to get back to that level and compete and you know, meet their sponsors' demands and that sort of thing, um, but still also learning how to be a mom in their new body. So I feel like that's gonna come up more. I think it's gonna be more of an uh hopefully more research and more of a conversation now that we're seeing more voices that are in that space.

SPEAKER_02 28:00

So yeah, you know, I you know, I think like uh I don't know, my you know, my wife and she wouldn't mind me sharing this, but you know, she should it took her a good year to get back to running, yeah, you know, after the birth of our son. And you know, and I think that it it's really easy. I mean you always hear about the elite athlete who who had a kid and then was you know, ran like a great time at a marathon, you know, you know, 16 weeks later. You never you you you never hear about the elite athlete that that that takes longer to get back. Yeah, and and that's really unfortunate because I think that and I again this is you know, I I don't I don't work with this population very closely often, but that this is, you know, at least from I see and the patients that I treat is that um that I think that's more the rule than I think the the people you hear about are the exceptions, and then you start feeling like, oh, I should get back a little bit quicker and starting yourself to this other this other standard that maybe is not really I mean, we're all human, you know.

SPEAKER_00 28:53

Yeah, yeah. There was just an article, Margie Davenport um was in sports medicine journal. It just came out, I think the last week or two, looking at, you know, really where we need to provide more support and more research and stuff like that. So the good news is we're having a conversation about it. Um, but again, we just don't know a lot about how to return moms to elite level anything, and we're just kind of making it up as we go. So um cool. All right. Next question What are the biggest mistakes you see clinicians making with their return to run clients? So, this is what you you hear about in clinic, you see on social, like share the bad ones.

SPEAKER_02 29:30

Yeah, I mean, I would say probably making um not understanding the type of biomechanics that might be stressful for the injury that they're or that they're recovering from, you know, and those might be those are gonna be different. So, like uh depending on the injury. So patelephemoral pain, for instance, you know, you need to uh uphill running is typically pretty easy. So if you want to get back to running um and you're having you're having some trouble getting back from patelephemoral pain, a good thing to do is do some uphill treadmill running. And it doesn't have to be a big grade, so like a three and a half percent grade. But if you've got someone who has an Achilles who has Achilles tetanopathy or planner heel pain or planner fasciapathy, whatever you want to call it, that's gonna be the exact wrong thing you should be doing, and more level running and and and so forth. So I think like understanding the biomechanical loads that that um uh might be a little bit more stressful for that injury and know that those are gonna be the things you're gonna have to add in later on.

SPEAKER_00 30:25

Yeah.

SPEAKER_02 30:26

And of course, the athlete needs to go back to those things. And so you you need to help give that um that athlete some some some some guardrails and work with them and understand where they're coming from. Uh, so you can kind of help, you know, start sprinkling those things in. And so it's not a big, a big change for the person. So yeah, I would I would think that that's one of the biggest ones. I I think too, I think like uh, and I think just taking a step back even further from that is just is just doing what I used to do, which is just hand a return to run program to an athlete and say uh happy trails. Um, I I understanding that the person got injured because they probably made some sort of training load error. And the likelihood that they're gonna make that same training load error when they're going back to running is very, very high. And that's one of the reasons why we see such a high recurrence in these running-related injuries is because we probably don't spend as much time working with athletes and um, you know, talking to them about, well, you know, these are the things you got to be really careful about, and we need to um, you know, be a little bit more judicious with these types of loads. Um, and um, yeah, and I think being a very objective. And and one of the things that that I use a lot, I I set up all of our runners with an app uh that's it's a free app on like I don't know that the the the app store or Google Play. It's called interval timer, but they can program in there their their time for that day, their rest walks, so they don't have to think about it. They can run with headphones and stuff like that, so they don't go, oh you know, you know, and I've did this too, you know, when I was recovering from the various injuries I've had, oh I feel pretty good today, rather than you know, a minute of running six times, I'm gonna go around, I'm gonna make it five minutes, you know. And then before you know it, you take a big step back and you're you're back to you know, ground zero.

SPEAKER_00 32:01

I've I found that too, like the more prescriptive and just like intentional that you can be, and for moms that works really well because we just want to shut our heads off and be told what to do and and and like don't make me think this out or work it out myself. So it works out really well. But I I do think that the more prescriptive and controlled you can be about that going back, I think there's again less chance of of overdoing. Um, and and kind of, oh, I feel great. And then they go and screw everything up and and now you're back to square one again.

SPEAKER_02 32:29

Um yeah, you feel great because you're following the program.

SPEAKER_00 32:32

Right, exactly. Imagine that.

SPEAKER_02 32:35

That's not that's not the time to say, oh, I feel great. So I'm gonna stop following the program and do what I want to do what feels impulsive to me.

SPEAKER_00 32:41

Exactly, exactly. What what are your thoughts about um I see a lot of clinicians that try and do a lot of um what's the best way to put this? They try and tell somebody that the reason why they're having injuries is not because of dosing or training or things like that, but because they're running wrong. And then they try and give them all these corrections. What are your thoughts about that?

SPEAKER_02 33:07

Yeah, so we don't, for me, um, we you know, I don't do running evaluations on people who are who are uninjured. And and I I kind of put that in the in the class of like over testing. And so it's just like anything else. Like, you know, we know that if you that a big part of overutilization of medical services because people are getting over-tested for certain things. And I would consider gate evaluations for someone who's who's who's uninjured to be part of that. So that's we'll we'll set that aside. Uh, I think that's that's not a good practice and telling people that they move wrong and you know, and and and so forth. So um, so yeah, I I think too that um, you know, so we used to think that we used to think that biomechanics was a major driver of a lot of these running-related injuries. And so, and if you know, someone maybe perhaps came to a course on mine a decade ago, they would probably hear me talk a lot about how important it is to really assess running biomechanics. And and still I I still teach how to do that and I still do gata valves on everybody, just the same as if I'm seeing someone who has had a low back strain, I'm gonna watch how they lift a box from the floor or doing whatever else they have to do. Um, but really the reality of it is that it's that it's that preparation that you're doing. It's it's how you got to that point um that that really matters. And so, like how quickly you're building up, um, you know, what are your other uh physiological risk factors? You know, we know for instance, like tendinopathies, for instance, we know that if you're taking, if you've even in the last nine to 12 months, if you took one of these big broad spectrum antibiotics such as Cipro or Lavaquin or something like that, that that sets you up for Achilles tendinopathy. And it might have that has nothing to do with your running biomechanics whatsoever. So I think that um, yeah, I I you know, I think this idea that you're you're you're getting injured because you're you're doing it wrong, you mean you're running wrong. I mean, I think like, you know, we know that some a couple of really nice papers have come out recently, and one of them was um they looked at uh they had coaches, you know, very high-level coaches, and they had them look at all these different runners. And of course, they had had the the all these runners had their physiological testing done, and so they knew their VO2 maxes and their running economy. And the coaches were asked to pick out who were the most economical runners, and they were wrong. They couldn't pick any of the they they couldn't do it at all. And so you're talking about people who have who have an eye for running economy, and and so when it when you when I see a coach monkeying with a uh particularly an adolescent athlete's running mechanics, you know, we have to understand that the way a person runs has a is this interaction between um their their anatomy, uh, their their physiology, and then their their past running injury history, you know, and so when we haven't had an injury, we are we subconsciously will shift a little bit of load. I see if you've had any injury, you tend to shift the load away from your knee. And maybe that's okay, maybe that's an okay thing to do. And we just need to kind of um, you know, get that person prepared for the loads that they're gonna experience during running through very, I guess, very smart training. And I think again, a part of that is is doing a lot of a very comprehensive and and well thought out strength program.

SPEAKER_00 36:03

Yeah, I think that makes a lot of sense. A lot of moms, when they come in after and they they they had started to run, things didn't work out, and then they find their their way to someone like myself, like they don't feel like they're running the same way. And I what comes out of their mouth is like, oh, I'm running differently, I'm running wrong, or something like that. And it's very easy, I think, for a novice clinician to be like, yes, you know, you're your your stride length, you're you're not getting enough this, you're not getting enough that. And I think it's actually probably more a reflection of like what you're saying is you don't have the strength to propel yourself like you once did it. It looks more effortful, it looks heavier, it looks plotting. Um, and it probably feels that way too. But I I do think it comes back more to having that underlying strength that really, again, over nine months, people think, oh, you know, I I'm I'm strong. Like, it's a different body. It's totally a different body.

SPEAKER_02 36:57

It's a it's a much different body. And so, and the other part of it too is our as we run, our running economy improves. And so a collaborator of mine, uh, Izzy Moore, she's from she's from um Wales, and she's done she's done a lot of work in this area and she's done a lot of like postpartum you know, return to running work as well, too. So um, and one of the things that she finds is that if you if someone just runs a new runner over six months, and you'll see that their running mechanics will will gradually change as we start to optimize our movement patterns and so we start to move in a more metabolically efficient way for us. And so um, and that's without anybody monkeying with it. It just happens very organically. And so I think we need to make sure that you know, we as clinicians walk a step back and say, well, maybe we don't know what's best, and just let people figure things, figure things out on their own. And so, you know, another way to look at this is so like for us, one of the so we do do some gate retraining, we've done some gate retraining studies on this and uh and and on people who have injuries and people who are uninjured as well, where we're just trying to see what's gonna work the best. And one of the things that we see with one of the big changes we make is we have runners who are you know experiencing like recovering from a bone stress injury of tibia uh in particular, we'll have them increase their um their step rate or their cadence. And so you'll you'll see a lot of clinicians be, okay, I want you land with your knee more bent, I want you to land with a slightly flatter foot, and you know, don't flex your hip so much and so forth. But what we find is if if we just give a runner like a cadence biofeedback thing, like a like a garment that'll tell you what your cadence is in real time, the runner will look a certain way on day one. And then when you look at them eight weeks later or eight days later, they're they're gonna slowly optimize and come up with the best kinematic solution to change their running cadence that's gonna be the most efficient way for them to move. And it might be different for you and it might be different for me. And I don't really, I can't sit here and tell you when someone comes in. I know that they need to flex their knee more in order to increase their running cadence. Or they only only they know that and they have to figure it out on their own.

SPEAKER_00 38:59

Yeah, no, I I love that. I I call that kind of the Spotify method where you're like, all right, find the playlist that that works, um, you know, finding that, you know, the weekend or something like that, that the the tempo's right. But I think for for again for my population too, um getting in the weeds sometimes keeps them from they're they're so worried that they're gonna do something wrong. And, you know, they're so obsessed with, oh, maybe I should keggle when I run. I'm like, you can't control it. Like you were not meant to cognitively control every single thing that happens. And chances are if you try that, you're gonna end up running actually even worse. And it's it's not gonna be, you know, kind of what the intended result is. But um, there's so much of a desire that I I want to come back and do this right. Um, but right doesn't necessarily mean like over, you know, detailed and and over-controlled and that sort of thing. But that's good to hear that you know, we we can work it out on our own. Like we we've evolved, right?

SPEAKER_02 39:54

We have evolved, yeah. Yeah, I mean, we we already have all those pathways in in place. So if you if you give there's this idea of internal cueing uh versus external cueing or or focus of attention. And so if you if you tell what someone to say squeeze your glutes more when you're running, or uh something along those lines, the it's very difficult for them to do that. The metabolic cost of running goes through the roof. Yeah, and if you want to make running more difficult, that would be one way to do it. And if you want to make sure that someone's not gonna follow through with what you're asking them to do, then then to you know tell them to do something like that, versus um, like I said, just change your cadence and we give you the feedback and you can see what your your number is, and then you try to you try to get that up a little bit, and then you'll figure out the best way and taps into more of those automatic processes that we all have. And that's gonna be much more efficient for you. And it's much more efficient from a motor learning standpoint um as well. Now, with that said, I would say that probably of the of runners that I see, I don't know, one out of five, one out of six, I might do some sort of um gate modification with them. And it's only a temporary thing. And the only reason why we do that, we we we treat it as an adjunct, um, just to get them over the hump and get them back to running. And then after a while, I don't care if they look like that six months from now. Um, we and that's what we see in the in our data is we see people start drifting back to their old way of running, but we don't see them get reinjured. So that means that that gate modification served its purpose and it's no longer needed, and they can they can move on from that. Just the same as if you're working with someone who has patellophemoral pain, you might tape their knee for a little bit. They don't need to wear tape the rest of their life. Um so you just see it as an adjunct. If you do change someone's gait, um I I see so many runners come in here who are doing dealing with uh Achilles tendinopathy, um plantar fasciopathy, or maybe even metatarsal stress fractures. Um, and I I I'm like I'm talking to them and then I get them up and start looking at them running, and then they have like a really awkward, like four foot strike pattern. And I was like, all right, timeout. Is this the way you're is this your natural way of running? And then they talk about, oh well, no, I saw a PT who told me that, or my coach told me that running with a four-foot strike was more efficient or is gonna reduce my injury risk. And I'm like, so how's that working out? Um, you know, I'm like, when you do that, it shifts all those loads down to your planner flexors and and and you can't, you just you can't you can't accommodate that. So so I I I I almost see more problems from people who have and it's not the runner's fault by any means. They're they're being told by well-intentioned individuals, yeah, and runners are very serious and they take things to heart and they're like, I'm gonna work on this and I I want to get faster and yeah, and everything, and or I want to be get injured less. And so they adopt these things and and it's just it's often not uh, you know. I think we need to again go back to some of the assumptions that we held maybe a decade ago and say, oh gosh, was that really, really a good idea?

SPEAKER_00 42:34

And yeah. No, I think that that it's it's so interesting when I kind of think back on just you know the evolution in in postpartum has actually kind of paralleled a little bit what we've seen in kind of return to sport because it complex was like the whole thing for a while, and then we realized, gosh, you know, there's actually a lot to be said for load, there's a lot to be said for simplifying, um, and and not necessarily having everything so kind of convoluted and complex. And um, that kind of brings me to my last question for you. And I'd love your thoughts on those of us that we don't really have a ton, it's getting a lot better in the postpartum space. Like, what do you think when we're kind of taking some of the stuff that you have and trying to extrapolate it and and pull it? Like, what what's the benefits of that and what are the dangers, I suppose?

SPEAKER_02 43:23

Yeah, let's see. Thoughts about barn return. Yeah, so I think um I think one of the things that has been probably most influential for me was a position paper that was published in the British Journal of Sports Medicine in 2016. Claire Ardern, who's the editor-in-chief of JOSPT, was the first author on it. And I think it's a wonderful paper. And what it talks about is that return to sport process. And um, so a lot of times we think about oh, okay, we're gonna begin the return to sport phase. Um, but what this paper did was it it was more of a like a position statement. It said, Really, your return to sport starts on day one.

SPEAKER_01 43:59

And

SPEAKER_02 44:00

And the the initial phases are of course what we typically think of as far as like you know your normal rehabilitation exercises, but then it breaks down like this this idea of um return to participation and then return to sport and then return to performance. And rather than like going, I'm gonna return to run, a lot of times people are like, okay, and they immediately go and they sign up for a half marathon. You know, return to participation is that first stage of that return to run process. And the the only goal during that is to be consistent. And that whether that consistency means running a mile every day or something like that, it's just getting consistent because once you get that consistency, that that consistency down, then you can start building on other things. And so return to um participation is just running whatever, some some like something consistent, like on a treadmill or something like that. Return to sport then would be adding in some of the more dynamic loads that we like to think about, such as running downhill or whatever is gonna be more you know stressful for that anatomical area. And then return to performance is actually doing that race, and you should be very thoughtful about all every week, like each one of those steps. And if you can do that, um, I you know, I think you're gonna have much greater success and be very deliberate about that. So I think being more incremental and understand that we the our physiology and our muscoskeletal system has a finite ability to adapt, and it also has a finite rate that we can adapt to things as well. So you can't rush that. You can't rush physiology and you need to be patient with your athlete. The athlete needs to learn to be patient with themselves. And and I think one of the big parts of that is comparing who you are today with yourself today, you know what I mean? Like not comparing yourself with perhaps your your pre-partum individual or you know, me, you know, I'm 48 now and I compare myself with my 28-year-old self. And that's not really being very, very fair to myself. I'll never run that fast um again. But I can I can at least try to get to be more consistent with my running and hopefully not not get reinjured. So I would say that those would be, I think thinking about that return to sport and return to performance uh kind of as a continuum, I think we'll do much better and and describe that for the athlete and understand that if you if you skip steps, I think that's where people go wrong, and I think that that's where they they get hurt and they get frustrated and they get stuck kind of in this like, you know, I'm injured, so I might take a little bit of time off, and then you lose capacity, then you rush back to running too quickly, and then you get reinjured and you just gets get stuck in this, like in this vortex that you can't really get out of.

SPEAKER_00 46:30

Yep. And I, you know, I it I think that makes so much sense. One to understand that as an athlete from an injury, but I think we still have a ways to go. Um, even just as a society, trying to classify the pregnancy and postpartum period in the same way that we would as an injury or after taking a time period of time off. I think there's still a huge gap there. But I think once you make that connection, then it totally makes sense to be like, yeah, okay, if we're gonna return in this, that makes, I think, a lot more sense to somebody, you know, from a concept of like ACL or, you know, uh ankle injury or something along those lines. And so I think that's a narrative that at least we're trying to establish with moms, be like, hey, did you have an injury before? What did that look like? This is gonna be very similar to that, even though bringing a small human in the world has its whole other things like sleep deprivation and you're the milk machine. And by the way, you have to learn how to raise a small human and all the other fun stuff that goes on with that.

SPEAKER_02 47:32

Yeah, yeah, I think that's a that's a good way to put it.

SPEAKER_00 47:35

Um it's return to injury plus, right? And I don't know about you, but like as they get older, it gets different. Like the time commitment's still there, as we talked about earlier. Like you still have to plan when your workout's in because when you pick them up from school, you have a grenade. You don't know if they're happy, if they're sad, you don't know how much homework you're gonna have to sit on. Like, I don't think that like the time commitment doesn't change even if they get older.

SPEAKER_02 48:02

No, no, yeah. I I used to think that I was like, oh, well, you know, our child he's two, and when he gets to be five or six or eight, it's gonna get better. We'll have more time. But I mean, we do, but I think that that's just because you know, my wife and I were we're very deliberate uh in making sure we get our own time to work out. And I think we I think that's what's gotten better as we've gotten much more skillful at planning time and and getting up early and talking about what we're gonna do for the next week and and everything.

SPEAKER_00 48:29

Better at logistics.

SPEAKER_02 48:30

Yeah, yeah, I think so. I I think for me when our son came along, boy, uh I was in a tailspin for a while. Um, I was like, oof.

SPEAKER_00 48:38

They're tough.

SPEAKER_02 48:39

They are tough.

SPEAKER_00 48:40

Yeah, they're tough. And and I'm still, you know, my oldest, he's 11, and I'm trying to still like understand boy language. And he only talks a lot about his day if he's in a vehicle and not looking at me. So we do a lot of driving around, so I know what's going on in his head. Where my daughter, who's eight as well, she's my little chatty Kathy, and I've I can see myself in her, and and we we can kind of talk through stuff, but that's a whole nother animal. A whole nother animal. So awesome. Well, thanks so much for coming on. If you want to find Rich, this is his actual Instagram, uh, Montana Running Lab. Um, Rich, thanks so much for coming on. If you have questions, go ahead and hop over um to him on Instagram. And um, yeah, we'll keep looking for all your papers that hopefully will get uh published soon. And um any more myths are over on his Instagram as well. Thanks, Rich.

SPEAKER_02 49:26

Thanks, Carrie. Appreciate it. It's been wonderful.

SPEAKER_00 49:29

If you're navigating pregnancy, postpartum, or perimenopause, whether personally or professionally, check out all our free resources and upcoming courses at carypagliano.com. This podcast reflects the opinions of Dr. Carrie Pagliano and her guests, and it is for entertainment purposes only and should not be considered medical advice. Always consult your healthcare provider with any medical questions. If you enjoyed the episode, please take a moment to leave us a five-star review on your favorite podcast platform. And thanks for listening.