Stop Guessing: How to Actually Manage Running Injuries | Paddy Lally

In this episode of the Maximum Mileage Running Podcast, we’re joined by team physio Paddy Lally to break down what runners actually need to know about injuries, recovery, and long-term performance.

Paddy works with everyone from everyday runners to elite athletes, and brings both clinical expertise and personal experience as a former GB age-group triathlete and a 2:57 marathoner. 

We dive into how to tell the difference between normal soreness and a real injury, why so many runners get stuck in the cycle of recurring niggles, and the key factors that often get overlooked, like stress, fueling, and lifestyle.

This episode is especially useful if you’ve ever felt frustrated by injuries that don’t seem to make sense, or if you want to train in a way that actually supports consistency and progress.

In this episode, we cover:

•  When to push through vs. when to back off 
•  The most common causes of running injuries 
•  How cadence, strength, and load impact pain 
•  The role of stress and recovery in how your body feels 
•  Practical ways to stay healthy and keep training 

If your goal is to run stronger, stay consistent, and stop second-guessing every ache, this one’s for you.

Right, that's us done. If that was useful… share it. Stick it in your club WhatsApp, send it to that mate who's always getting injured three weeks before race day. You know the one ;)

If you want to go deeper on any of this, Nick puts out videos every week on YouTube, and the entire team of coaches are sharing helpful tips on their instagram channels... links below. And if you're thinking you actually need a proper plan and someone in your corner… we've got Guided Coaching from 97 quid a month, right up to full one-to-one coaching with the coach of your choice. Either way, maximummileagecoaching.com is where you want to be.

See you on the next one.

To work with us - https://join.maximummileagecoaching.com/home-page-9835

Nick's YT - youtube.com/channel/UCgdIPeN3bF7I7-tcspyFbVg/

Faye's IG - https://www.instagram.com/fayejohnsoncoaching/

Rachael's IG - https://www.instagram.com/rachforthelongrun/

Hannah's IG - https://www.instagram.com/coach_hannah_witt/

Matt's IG - https://www.instagram.com/ultracoachmatt/

Transcript

SPEAKER_01 0:00

Hey, welcome to the Maximum Mileage Podcast. I'm Coach Hannah Witt, and this is where we talk about building strong, resilient runners without the constant cycle of injury, burnout, or guesswork. Each episode, I sit down with runners, coaches, and experts to break down training, recovery, fueling, and mindset so you can train with more confidence and actually see progress that lasts. And if you prefer to watch these conversations, you can find the full video versions on my YouTube channel, Coach Hannah Witt, under the Performance Collective series. Let's dive in. Today's guest is Patty Lolly, the Teen Physio at Maximum Mileage Coaching, someone who works with everyone from everyday runners to elite athletes, helping them stay healthy and actually keep progressing. Patty's not just on the physio side either, he's lived it. A former Great Britain age group triathlete, he still remains competitive, running 257 at the Houston Marathon, breaking the three-hour barrier with smart pacing and grit. In this episode, we get into injury management, how to tell the difference between normal soreness and something more serious, and the small changes like cadence and strength work that can make a huge difference long term. If you've ever dealt with a niggle or just want to stay consistent in your training, this one's for you. Hey, welcome back. Today we have Patty Lolly on the podcast. He is actually the team physio here at Maximum Mileage. He works with everyone, everyone from elite athletes and procycling and football, all the way through just everyday runners, just trying to stay consistent and injury free. He's also a former international triathlete, so he doesn't just understand training on paper. He has lived it. And if you've ever struggled with injury setbacks or just trying to figure out how to keep your body holding up while training hard, this episode is going to be massively helpful. Thank you so much, Catty, for being on the show today. I didn't actually know that you were an international triathlete.

SPEAKER_00 2:07

Yeah, well, it was sort of a one and done in my teenage years. It was in the uh GB age group triathlon, end up doing the European champs out in uh Dusseldorf, which was uh which was good. Took a a lot a lot of training to get there. That that's sort of where the uh early inspiration to be a physio sort of came from, seeing all of the the injuries, getting back from those. So so yeah. So a different lifestyle now.

SPEAKER_01 2:34

Help me with geography. Dussel Dusseldorf is in Germany, right?

SPEAKER_00 2:37

Correct, yeah, yeah. And I I'm based in in England here.

SPEAKER_01 2:41

Okay, so that was a bit of travel. That's crazy though. You were a teenager and you kind of catapulted to that level pretty like how did that even happen? When did you get started?

SPEAKER_00 2:52

Yeah, well, so I mean, my whole sort of like sporting career sort of started around like playing football. And I remember football, soccer. Remember playing football, and there was this like run group running around the track outside where we were training for football. And at the time I remember just thinking, it was it's only young kids, thinking that looks good fun, we'll we'll give that a go. And it turned out to be like the local triathlon squad. So just through there, and through a few years of training, building up through a few sort of national races, getting a few podiums and uh a few races there, got selected for GBH group team. So I think I was about 15, 16 racing in the under-21s, and yeah, and ended up getting the opportunity to fly out to Düsseldorf in Germany to compete in the European Champs, which was uh good fun, great experience. And uh yeah, it was uh a big, big learning cave, but it certainly helps with everything where I'm at today.

SPEAKER_01 3:49

Great. So you were playing football originally. Did you have any experience with swim bike run prior to that, or did you just see those people running and kind of just jump into things?

SPEAKER_00 4:00

No, uh I exactly that. I was just playing football and then seeing the swim bike run, got involved in in triathlon from there, and then that sort of spouted a bit of a more of an interest in the more endurance sport. So from there took up running track, running cross country, doing cyclocross, mountain biking, track cycling, so everything apart from swimming, hated swimming, but everything else was was good for them.

SPEAKER_01 4:27

Yeah, I I feel like swimming is the thing that people are either expert level or they're like, that's the worst. I hate that's my worst discipline. But I'm sure you were talented and continue to be talented in all of them. And so now you are you're not only the physio for maximum mileage, but you're also coached by Nick, right?

SPEAKER_00 4:48

Correct, yeah. So got in contact with Nick about a year ago, maybe, with a few various goals. Wanted to train up to an ultra, wanted to break that sub three in the marathon. So ended up finally breaking sub three in Houston this year in January, which was a a really big goal. And then unfortunately after that, I ended up getting injured myself, so I had to miss out on um miss out on the ultra, but we'll certainly be back at that soon.

SPEAKER_01 5:16

Yeah, I know. Didn't Nick help pace you for Houston to get you to that sub three?

SPEAKER_00 5:22

So we we spoke about beforehand, but Nick was also suffering a little bit with his uh hip at the time, so he wasn't sure whether he was gonna do the half or the full. So he was and I I didn't have a good qualifying time going into it. So he was in the front pen, I was in the second pen. So consistently looking for him up the road, see if I could see his hat and uh try catch up, but it it just never never ended up uh coming to.

SPEAKER_01 5:44

Well, that's still have your coach there in the same race with you and seeing him up ahead, that's gotta be pretty motivating.

SPEAKER_00 5:50

Oh, it's it was it's fantastic, and we were all in um in the same like Airbnb, like leading up to it as well. So it's just good having that few days before and after, picking his brains on what I should or shouldn't be doing, or like the like we did the shakeout run together. So it was all really good experience, and uh as you said, just fantastically motivating for actually going on and getting the sub through.

SPEAKER_01 6:12

Well, congratulations. That's very late in me saying, but you know, because that was back in January. But how did you find Houston? Did you like it?

SPEAKER_00 6:21

Uh well, to be to be fair, uh if we take this as two two things, Houston in itself as a city. So it was my my first time in America, and I absolutely loved it. Big cars, big barbecue. We had a fantastic host of Jose when we were over there. It was an absolutely fantastic time. In terms of the actual race, honestly, I felt so focused on just running. I felt like I could have been running anywhere. I I almost missed out on taking in any of the sights or anything around me. It was just focused on one foot in front of the other and making sure I didn't uh didn't start slipping back.

SPEAKER_01 6:56

Right. Well, what did what was the race like? Were you kind of yeah, just walk us through it? Did you start in a pack? Did you did you have a race strategy in mind that you wanted to get to a certain position and find a certain pace pack? And then were you picking people off beyond a certain point, or what did that strategy look like for you?

SPEAKER_00 7:15

So initially I I wanted to find like the three-hour paces for for the for the marathon, obviously, but because I was in the second pen that was like your 320, 330 mark. Because I had I I my previous PV going into it was 308, I think. So I couldn't get into the sub-three pen to go with the paces. So I was sort of on my own for the full, like the full thing, really. Like the whole time is just picking off the next person in front. I knew I wanted to stay sort of in like your 410 to 415 per kilometer. So just made sure sticking to pace. The big thing with me is set setting off too quick and blowing up. So I knew I just needed to stay that first half, just try stay just under sort of 130 for the first half. Managed to do it, and then I ended up catching up with the three-hour paces from the pen in front. So I stayed with them for a while, but then I felt fresh coming in to about 30, 35k. So from there, decided just kick on, push on, and uh think I ended up with 257 on the dot. So it was there, it was good.

SPEAKER_01 8:21

Yeah, you not only broke three, you you obliterated it. That's amazing. Good for you.

SPEAKER_02 8:27

I appreciate it, appreciate it.

SPEAKER_01 8:29

Yeah, so for you were basically, like you said, by yourself and just kind of keeping track of your own splits and making sure that you were, you know, not blowing up too early on. I wonder if you were in a race that, well, now that you have that time, if you could, you know, tuck into a pack, conserve energy, and do even you know a faster time, you know?

SPEAKER_00 8:52

Yeah, well, I I I hope so. I had a little discussion with Nick the other day and obviously iron up all of the good for age qualifying times as everyone does for all of the world majors. So I I think the quickest ones maybe Berlin. I think I I'd need 245 for that. So I think now that I have a decent sub-three time, getting a good pen at the start, sort of hoping we can target that for come Valencia at the uh in December, just try and get myself in a in a pack, conserve a bit of energy, as you said, and hopefully go for 245, 245 to 250, we'll say.

SPEAKER_01 9:27

Right. Well, quick shout out to Jose for hosting you guys because he's he's a riot. He's always posting so much on our group chat, and he's seen you know, like an amazing person. I'm sure he was a great host, also.

SPEAKER_00 9:40

Oh, he's absolutely fantastic, absolutely love the man. He's uh so supportive for everything. And when we were over in Houston, he was he was he was there all the time. He was absolutely fantastic for just helping out, shown as the city, shown as a site. It was uh absolutely fantastic to have him there. Yeah, can't cannot thank him enough.

SPEAKER_01 9:58

I love that you said something about the barbecue, the big cars, the big barbecue. And yeah, in Texas, everything is just basically pretty big. So your first US experience being in Texas, that's probably the most robust, we'll say, American experience that you could have had. Um, but I'm glad that you enjoyed it. And hopefully you can come back and maybe do that race again, maybe do some other races in the United States. But what was the um the ultra that you had on your race calendar, but you had to kind of sideline due to injury?

SPEAKER_00 10:30

Yeah, so so I live in a a city called Chester, which is like near like Liverpool and Manchester in um in the UK, and there's the GB Ultras, which is like the big ultra race community setup organizers like in the in the UK. So one of their races is the Chester 50 and the mile six or seven, maybe goes past like the bottom of my house. So I see I see it last year, seen it the year before, and I just thought that that looks like a good bit of fun. So I had signed up for the Chester 50. But yeah, unfortunately, following Houston, I'd prior to Houston, I'd done two or three marathons quite back to back and just overloaded ITB. So following Houston had to take a bit of a break from running and just focus purely on rehab, but yeah, definitely back on the up now.

SPEAKER_01 11:23

With the rehab that you do, obviously you you know what to do since you're a physiotherapist, but have you been able to kind of tap and do that triathlon swim bike those disciplines to cross-train through it, or has it the IT been pretty flared up that you don't even want to do loads?

SPEAKER_00 11:41

Yeah, it's a good question. So a lot of my sort of cardio the past two, three months really has been on the bike, been getting out on some some pretty long bike rides, getting on the static bike in the gym, being for a few swims, as I said, I still can't really stand the swimming. So it's yeah, mainly being on the bike, being on the elliptical as well. I find a big thing with ITB pain is obviously you need to well maybe touch touch on that later, but you can do a lot of you can do what you want cardio-wise, as long as it's not irritating that that that ITB. So try try restrict on the run-in, restrict on any sort of up or downhills for for the time being, and um just try keep cardio taken away from the sure.

SPEAKER_01 12:25

You know, I had ITB stuff back in college, and I tell you, like I took time off, I did stretches, I did single leg squats, I tried to get it as strong as I could, and then I just you know went for it and went for a run. And tell you what, even though it had been all this time, it's just the fascia and everything was like so not ready to I don't know. I feel like I could have taken off a year to give it time to completely feel, but it still felt pretty tricky when I started. And it's almost like you just when you do start running, you have to really become aware of pain versus discomfort. And you know, as a physio, I I'm sure that you have to educate people too on you know, it's not going to feel a hundred percent, and you know, there's a pain scale, and what you know, what number on that pain scale should it be at? And things like that for yourself. Have you have you started to try to run again? Or are you still cross-training?

SPEAKER_00 13:31

Yeah, no, so for the past maybe like three, four weeks, start to try try try to get back into running. I'm still still using like what well, usually I would do like my long run on a Saturday or Sunday. I'm still using like a get out on the bike for that instead, just to try avoid any sort of longer stuff at the moment. But yeah, definitely get back into running now. I actually did my first first proper speed session last last night, which was uh just felt amazing to get back into it was good, but it there's always uh always a battle between my physio brain and my running brain. Running brain just wants to get out and go and ignore the physio side, telling it it just needs to calm down, ease back into it. So it's uh it's a it's it's always a battle, but yeah, it looks like we're coming out the other side of it now.

SPEAKER_01 14:18

That's great to hear. Have you kind of looked at your running form and thought, you know, did this lend to the injury, or have you tried to fix anything there?

SPEAKER_00 14:28

Absolutely. So I I had look at my data for the past year, and I think the big thing for me was my cadence. So I'm I'm quite like a tall person anyway, and it's predominantly leg. I could still fit into small or medium t-shirts, but I'm 6'1, so it's all all leg. So I I I thought that was the reason for my cadence being sort of like around the 150 mark, which I know is low. But what you find is when your cadence is lower, you're then more prone to over striding. When you are over striding, when your hips when the when your legs on the the back end coming into that hip extension, you put a lot of tension through the ITB. And obviously, over a period of time, a lot of tension through the ITB can create that sort of friction on the outside of your leg where the ITB inserts, and then obviously friction causes inflammation, causes that that ITP ITB syndrome that I was dealing with. So a big part of my training now is just trying to up that up that cadence. So I think the session last night was sort of averaging around 160 to 165. So just slow slowly trying to build that up, but it does feel a bit a bit shuffly for the time being.

SPEAKER_01 15:43

Yeah, I know the the whole trying to adjust cadence is it's struggle. But yeah, what you were saying about ITB kind of being caused by leg extension and the friction. Are you you're saying like your when your leg is literally extended behind you during kind of your feet back?

SPEAKER_00 16:03

Yeah, so so when when when when your legs uh obviously ITB can come on through an a number of different different ways, but for for me and myself, it came from that friction and that that over, like an overload basically. From because I was striding out, I was putting more tension through the ITB from when my hip was in that sort of kickback position. So you find that the ITB like flip flicks over the the head of the fibula when you're in that like coming close to straightening your your knee. So obviously, when you're striding out and your leg's out the back, you're it's in that straightening out period. So it was just it was it was just too much at there over a short bit short period of time, basically.

SPEAKER_01 16:46

You know, I always thought, and it I learned something new today, ITB stuff was almost caused by over striding in front of you, you know, and kind of extending your leg too far in front of you, almost heel striking so that that tissue was elongated, stretched too much in front of you. So that is really interesting, though.

SPEAKER_00 17:07

It can come from that over striding. So obviously, the the ITB is a band of fascia, and its main job is basically holding everything in. So you think you've got your quads holding everything in. So in theory, when you are striding out, you're asking a lot of your quads to sort of take a lot of the brunt of the load of that. So if you are striding out, you are going to find that that's take gonna put a lot of load through the ITB as well. So it can come from a new numerous things. The other big thing with ITB is that like lateral hip strength. So that's what a lot of my like rehab has been as well, is obviously focused on the cadence, but also building up that lateral hip strength because the ITB attaches to one of the one of the glutes, like the TFL. So building up that lateral, lateral strength just to make sure that again you're not putting as much tension through it is is really, really important for the rehab for that.

SPEAKER_01 18:01

So lateral hip strength. So you're doing what side planks, maybe kind of bent knee side braces. I don't know what those are called, but that's reasoning, maybe like monster walks with a band around your knees, that kind of thing.

SPEAKER_00 18:14

Yeah, perfect. I I the amount amount of monster walks I've done walk walking up and down my kitchen cabinets is outrageous. But yeah, so loads of things like that in the early stage. And a big thing as well is just working on that hip stability. So a lot of sort of proprioception work, a lot of like balance work, just making sure that that hip's as as stable as possible. So I think that that's a big thing seeing runners in general is can they can be as strong as they like, but they really lack, well, a few I've seen recently really lack that proprioception, that stability to an area, and it can just lead to a whole host of problems further down the line.

SPEAKER_01 18:55

Yeah, of course. And I'm thinking about is the the ultra that you're hoping to do, is that a trail or is that on the road?

SPEAKER_00 19:01

Uh on the trail, on the trail.

SPEAKER_01 19:03

So you definitely need to have that lateral strength and stability in your hips that you're gonna be absolutely dogging about.

unknown 19:12

Yeah.

SPEAKER_00 19:12

Yeah, absolutely.

SPEAKER_01 19:14

How did you really get into physiotherapy?

SPEAKER_00 19:17

So it's it's a bit of a long-winded story, but to make a long, long story short, I I just enjoy I enjoy helping people. I think I would I'd really struggle in like an office-based work. I need to be talking to someone, I need to be seeing someone. And I think part of who I am and just trying to help people be better, get back to their goals is such an important part for me. I feel like being through my fair, fair amount of injury injuries over the years and just knowing the effects physically and also mentally that that had on myself, potentially when I've not had the best advice in the past and it's taken a bit longer to get back to doing what I loved, triathlon, football, whatever, and just the impact that that had on myself, I found that that that could be an avenue where I I can make a difference in someone's life. And whether that's they get back to being able to go do a park run or whether that's them getting back to competing in professional cycling, it's uh it's all part of the same.

SPEAKER_01 20:19

Yeah, and that's that's so much empathy, right? That's a quality that you have. I think people who want to help other people, be them coaches or they're in the healthcare industry, having that desire to really see people well and you know, to get them out of their pain state as quickly as possible. I think that's an amazing attribute to have. So great for you. I I honestly you've helped me personally. I've had issues that we've had calls in the consult, you've helped my athletes to name a couple. You helped one of my female athletes who did an ultra race, it was a 50k, and it was a lot of rocky terrain where it was steep descents into and out of like kind of river beds. And yeah, and you know I'm talking about. I I won't name drop, but she really had such a time with her knee, and you got her so that she was able to do a 25k just a couple months later. And that I mean, I was checking in with her like every day, like, did you do Patty's exercise? And she's like, Yes, I did them, and you know, it was on the plan, and so it was imperative to her healing, and just it helped so much to have you on the team maximum mileage so that I can message you quickly and just be like, Is this person's protocol to start running in a week or should we hold off and things like that? And I've done that with another athlete who he had right before his marathon. Unfortunately, he twisted his ankle and I think he had twist here TB Alice. Um I don't tend would be tendonitis to tendinopathy. I always get confused. Over the two. But anyway, you helped him, and he had such a time. He was so disheartened by not being able to do his marathon. But he's back to running again. He's gearing up for a marathon long run, marathon pace within his long run this weekend. And he's got another marathon actually in two weeks. So you've been very pivotal in the longevity and health of my athletes. And I thank you for that.

SPEAKER_00 22:28

This is exactly why we do it.

SPEAKER_01 22:29

Right.

SPEAKER_00 22:30

So no, I mean, just touching on there as well. So obviously, like working in physio and working in sport, I've had my fair share of butting heads with coaches, with managers. I think particularly in the professional, semi-professional football area, there's such a demand on or such a sort of disjointed communication between the physios, the players, and the managers. Countless times I've had issues with players returning to play too soon because the manager's forcing them into them. And I think it's the sort of coach to physio relationship partnership that we have going at Maximum Mileage is fantastic. I think the communication that me, yourself, Nick have is such a key part in how these how these runners are getting back to doing marathons within a few weeks, few months of coming back from an injury. So I think the the the praise certainly goes both ways in uh in this conversation.

SPEAKER_01 23:27

Oh, thank you. Uh I'm just thinking if an athlete who's listening, perhaps they're dealing with some sort of it's in the niggle stage, correct? So niggle being in America, maybe the vernacular is not as straightforward, but niggle being we'll call not full-blown injury yet, something that's a little bit tweaked, but maybe lessened volume for you know a couple days and everything should be back together. But for athletes who are in that stage where they don't think it's full-blown injury and perhaps they're fairly new to running, so kind of monitoring their body and injuries in general is new to them. What kind of key signals would you suggest athletes to? Yes, you need to go see a physio. Here we call them like a physical therapist, or maybe just like a sports doctor. What would those signals be?

SPEAKER_00 24:22

Yeah, so I I I think it's important. I think obviously every little niggle or tweak or a slight bit of vape is not a sign to go run into a physio straight away. I think some people get well, it can go one of two ways. Some people are very trigger-happy with X0 ringing up a physio whenever the slightest little thing goes wrong. And some people are the other way and they can just never speak to a physio ever, and it's the running through sort of a dangerous level of of pain. I think a big thing we try to sort of work on is like your sort of pain pain scales type of type of thing. So if you were to rate your pain 0 to 10, and I'm not a huge fan of using that because obviously everyone's got different pain thresholds, it works in different ways, but I think from a general point of view, if your pain sort of in like the three out of ten, it tends to be something that you can manage with a bit of load adjustment. You find a lot of running related injuries come from something somewhere is not pulling the weight, whether that is your you need to work on some mobility, you need to work on some strength to be able to support the amount of running that you're doing, or or you've just increased the increased the mileage, increased the load too much. So what what one of the big things I always do when I get a new patient in, because everyone uses Strava, is that right? Pull up your Strava, let me see your chart. If that chart is like an ECG and it's up and down and up and down, there that there lies the answer to why why they're getting injured. If it's nice and gradual, it's it's put probably coming from somewhere else. What I would say is the big sort of red flags to be looking for is any sort of like any sort of bony pain that you're getting, we're looking at your stress fractures, we're looking at things like that. I think like um an increased amount of fatigue, obviously, is a big thing at the moment about reds and and things like that. So, or or like an inability to wait there or anything serious like that, I'd really recommend getting in contact with a deo sooner rather than later. But then also if if you've had a niggle that's just not going away after deloading for a week or so, I think it can just be beneficial just to get a set of eyes on it, make sure we're not doing any damage, and just see if we can come up with a plan to build you back to doing what you need to be doing.

SPEAKER_01 26:40

Okay, I appreciate you going through that. And so to kind of consolidate bone injury is bad, you can't bear weight. That's kind of indicative of a bone injury, which is not good. It's not always, but it's not good. If something hasn't cleared up with load adjustment within a couple of weeks, bad. Yeah.

SPEAKER_00 27:01

So yeah, that's very, very or or or any like high levels of pain, anything over like a five out of ten is not a normal amount of pain to be in post post-run. And I I I think and this this goes back to me and talking about running brain versus physio brain. I think there's uh almost a case of too much knowledge in the area because uh me rehabbing my my ITB got got the knowledge, I've been able to rehab it, it's been fine. But then also the case of too much knowledge. I remember going for a run in the last marathon block and thinking, you know what, my my my Achilles is a bit sore. I wonder what that could be. I wonder if I've got a bit of tendonopathy coming in, wonder if I'm dealing with something. And then if you just take a step back, it's I know I've just done 35k off the back of uh 100k week. I'm tired. Like this is a very normal pain to be in. And it wasn't a high-level pain, and it was that almost like a curse of too much knowledge and uh overthinking it, basically. So so yeah, I would say any any high level of pain is also a bad sign, and you should probably get that checked out.

SPEAKER_01 28:07

I'm the same as you as being a running coach, kind of having this heightened self-awareness and being like, uh-oh, that hurts. Is that something you know? And having a biology background, I immediately assume the worst. But I've learned that if you know it's been a long session, I take a shower, get some food in, maybe have a bit of rest. Like it's amazing what those things can do to kind of reset the body. And you know, definitely, definitely make sure that you're doing those things and taking care of yourself because sometimes it can be a little psychosomatic, even.

SPEAKER_00 28:43

I absolutely I think the psychosomatic side is uh a largely underexplored area when it comes to physio and running in themselves. I think it plays such a huge factor into injuries in general. I think, particularly when you're your body, your mind, you think work stress, family stress, and all that's added in, it can have such a physical presentation of heightened pain. So, yeah, as you said, just having a having a day, taking care of yourself, making sure your head's in order can be such a valuable reset to what needs to be done.

SPEAKER_01 29:21

Yeah, that is really interesting that you mentioned that different types of life stress, work stress, family stress, maybe other health-related issues, it can all manifest its physical pain in your body. And it's so unfortunate because it's like you feel like you don't have control over it. You're like, well, I'm doing the training and and you I can't help these other stresses in my life, but the way that it can show up in your body is quite real. And just to kind of touch on psychosomatic pain a little bit more, I think about people I've had this before. If you have an injury that becomes a recurring injury, it's almost like you have this sick sense that it's coming on again, even though it might not be, but you that area for some reason, that neural pathway is still a little bit glitchy. And so any kind of sensation you immediately assume is dangerous. Have you found that happen before?

SPEAKER_00 30:23

Yeah, so it's so funny you say it's I've I've had this conversation twice today with with with patients. So the the way that like pain pathways work and the way that we like to sort of describe it when you're touching into that almost like psychosomatic pain. So, say you had a big house and you've got locks on all the doors, locks on all the windows, and then one evening someone tries to break in through through one of the windows. That lock on the window, that alarm system gets set off. So all the sirens are going, and then you you fix that, sort that, whatever. But that lock's still not quite functioning the way that it should be. So there's a big gust of wind, it just rattles a window, it's nothing damaging, it's nothing, no one's trying to break in. But because that lock is not functioning in the way that it had, or it's got a bit heightened because of it, all the alarms in your house start start going off again. So it's it's it's really interesting you should say that. And uh sometimes when patients are dealing with or patients, athletes whoever are dealing with pain, that doesn't necessarily equal tissue damage. It can issue, uh it can indicate that there's other factors going on elsewhere that you maybe need to look at. And it's also, I think a big part of physio is building back that confidence into the athlete, into their hip, knee, ankle, whatever, and letting them know that it's as strong as needs to be. It can take all of the load that needs to be. They are they are fine to crack on and push on.

SPEAKER_01 31:51

I think a lot of physio physical therapy that I've done has been a lot, it's been focused about, like you said, building confidence, but almost retraining those neural pathways so that the neuromuscular connection, everything is firing synchronistically again. And it's just even though the exercises seem very minute a lot of the time, and you don't feel like it's not like going to the gym and lifting heavy weight, you don't get a surge of dopamine and endorphines from it, but you're you're really trying to reprogram your mind-body connection with these really little exercises. And yeah, that's that's what I think about when I think about physical therapy, and you know, hopefully, too, you can get to the point where you're back in the gym lifting weight correctly. But unless you start small, then you can really it's it's really hard to do heavy lifting correctly.

SPEAKER_00 32:51

Yeah, absolutely, absolutely.

SPEAKER_01 32:54

Right. So for I'm thinking about the football players that you work with, soccer players here, but and you mentioned something about how they are often pressured into returning to sport before they're ready. Maybe it's like internal pressure, and they they're like, I want to go back to playing like tomorrow, and you know, something's broken, or maybe it is a manager or some other person trying to get them back on playing field sooner than they should. Hey, those have to be really difficult conversations that you have. But I'm just interested in what kind of injuries do you typically see with football players?

SPEAKER_00 33:31

So a lot of like the butting heads and and things like that came from when I was doing like the pitch side physio. So when someone's had a nasty tackle and they've sprained an ankle, they've damaged some of the ligaments and then knee, or even like concussions and things like that to an extent. And in the the level I was working in, it was in like some of the lower leagues. So every player is, or even the manager, is looking for their break to try to get into the the higher levels of of football within within the area within the country. So there's pressures coming from them, the players themselves, pressures coming from from the footballers. And it was always like, no, no, I'm okay to carry on and I can push on. And I dealt with a shoulder dislocation once, and the guy popped it back in himself and tried to get back on the field. And it's like, you probably need to go get that x-ray, mate. I'm sooner rather than later. But he was just determined to get back on and get going. And it was a real argument as such, just to say, like, look, you need to, you need to stop, get this checked out. There's there's no point risking the playing the next 20 minutes of a game when you're gonna risk the the rest of your season, should should something else be going on.

SPEAKER_01 34:45

I actually, when I was in college, was an athletic training major for a little bit, which is you know, it's more you you know what an athletic trainer is. I don't know if there's a comparable term in the UK or if they call them athletic trainers, but a lot of it was I had to go to soccer games. I feel like I was at soccer games more than any other games, maybe volleyball too. But yeah, it's crazy the kinds of injuries that you see because soccer is such a high impact sport, and a lot of ACL, LCL, um concussions were big. We had one guy, I mean, his Achilles was basically like threads, you know, when you looked at the image and it was so torn and it's a brutal sport, and yeah, for concussions in general, even though well to a certain extent, I think concussions can be definitely applicable to endurance sports because if you're biking and you crash, you probably you know, concussion is highly likely. If you're an ultrarunner and maybe you take a stumble or something and you hit your head on a rock or something, that definitely can warrant having a concussion. But maybe explain a little bit to people who perhaps don't have like a medical background, biology background, what a concussion is and what are kind of signs that you should monitor within yourself to know what you know is this serious.

SPEAKER_00 36:12

Yeah, to be fair. So it's a lot of the work that we did with the football was like we did a lot of like pre-season testing. So there's a lot of when someone goes down with a head injury, obviously, first things first, you need to make sure nothing nasty is going on. So we'd always like check the neck and make sure nothing sort of sinister, nothing broken, and make sure they weren't getting any sort of referred pain or anything down into to arms or things like that. But a lot of like the initial signs of concussion are like the confusion. So one of the questions we always ask is do you know where you are? Do you know what you're doing? Do you know the score? You make you there's a question like, do you know who's president at the minute or prime minister at the minute? And then that can also lead into like obviously from the confusion, they get like a bit angry, they get these big like mood swings coming in, you see a lot of like vomiting as well. So if you've had like a head injury and you're experienced any of any of these symptoms, it it is worth just going and getting checked out. There's a lot of protocols that need to be go that go through a lot of investigations that are beyond the physio. So obviously, physio screens for these sort of things. Should we see see some of these things, it's get them get them referred on, get them seen by a doctor. That's that's out of a physio scope to deal with the the further on from there. But yeah, if you're experiencing any of those symptoms, it is worth just stopping the exercise you're doing. We always recommend that there's no obviously no alcohol, no like hot showers or anything like that, no driving, no, no not too much screen time. A few of the players that I were playing in were still in school or college, so making sure that they probably need a few days off of heavy concentration from from from there as well.

SPEAKER_01 37:59

That's spinal injuries and concussions. That those are pretty tricky. So I yeah, that's that's tough. For runners more specifically, what types of injuries do you typically see? And how would you suggest to to treat them? We'll say, you know, you said ITV, so we don't have to go through that again. But a lot of times I see shin splints. I feel like I've had athletes with shin splints lately. So let's start there.

SPEAKER_00 38:28

So for shin splints, obviously a medical term like the medial tibial stress syndrome, is is one that a physio is pretty good at diagnosing, but in terms of rehab for that, it's it's really you need to get some time off impact. So you shouldn't be necessarily running through pain when it's shin splints. I think it's one of the only what one of the few injuries that come with running that will result in time off feet. So they can do like cross-training, so things like the cycling, things like the swimming, provided it's not impactful, provided it's not increasing pain levels or anything like that. So like medial tibular stress syndrome should be treated as a bone stress injury. So yeah, a bit of time off feet. And there's there's a few like risk factors that could lead you to be more prone to getting like chin splints, as you say. So one of the things I did want to mention just to sort of raise a bit more sort of awareness about is is red. So the relative energy depletion syndrome syndrome. I think so, yeah. And it's it's it's basically where it used to be called like the athl the athletic female triad, and it's just to do with not getting in enough energy. So you can't your body can't go through that natural process of the bone turnover. So bone turnover is where it's like a continuous process where dead or decaying bone is shifted out, new bone brought back in, basically. And that's how things like osteoporosis happen because too much bone gets taken out, not enough bone gets put back in effectively. And that's that's what can happen when you go through reds. So when you're not fueling correctly and you're not not not giving the body the fuel it needs to rest and recover as well. So, what I would say for a shin splints rehab, it is about deloading and slowly building back into it once the pain begins to settle.

SPEAKER_01 40:28

Great. Yeah, red S is such a big issue, obviously. But to talk a little bit more about shin splints, when you say medial medial tibial stress syndrome, the tibios muscle in the medial portions, the middle portion obviously being around the tibia. And so, what's happening with shin splints? What would you say is going on? Is the muscle literally pulling away from that bone in the lower leg?

SPEAKER_00 40:54

So it it can be so when we say medial tibial, that just means like the inside of your shin bone, basically. So it's when there's an issue with like the bone density to the uh to the tibia, to the shin bone. And what you can find as well is some of the pain in and around that area is from where the muscles come and attach into into that side as well. So you can get a lot of that sort of pulling, a lot of that inflammation coming from like the attachment points in and around that area. But the main sort of like red flag that we're looking for is that bony pain to the area when it's the issue with like the bone density just from the the forces that are being put through it from maybe like someone's heavy footed and taking that load through, or maybe the Salaeus, maybe the gastroc, like the calf complex isn't doing the job correctly in supporting that for on on any sort of like striking or or push-off, really.

SPEAKER_01 41:50

Right. So well, it's not great, but I appreciate your explanation. So basically, that bone there's it's it's weak most of the time because it's not like you said, osteoplasts are not putting down enough bone in the osteoclasts, they're all taking it away. But um, so or going back, circling back to red S and I appreciate that the nomenclature for that particular condition has been changed because it is not exclusive to females, obviously, and because you know you see it in men as well. But how I guess that's an kind of awkward conversation to have, but hopefully, hopefully it's becoming more normal for physios to have their clients and say, What's your diet like? You know, you're probably asking females, are you having a regular menstrual cycle and things like that? And you know, luckily everything is shifting so that that conversation is becoming more normal. And you know, when I was in college, it was kind of like you don't tell anybody if any any kind of bone injury is happening, you don't tell anybody if your period is not regular, that kind of thing. And so I I do appreciate how times are changing that people such as yourself are cognizant of and ready to ask those kinds of difficult questions.

SPEAKER_00 43:17

Yeah, so it it it's it's one of those. I feel like it can be awkward, but it's it's for the patient or the athlete's best care at the end of the day. I think if you think about the the risks of not having those conversations, they far outweigh the awkwardness of of having the conversation. So obviously asking if like females, if if everything's normal with a cycle, if everything's happening as it should be. And then similarly with male, and similarly with males asking if if if they get an erection in the morning. And if they're not, that can be a sign of low testosterone, and and that can be a sign of of red S, of, of, of something else happening in the background that could be having uh a real impact on their their symptoms.

SPEAKER_01 44:00

I I appreciate you said that you mentioned testosterone because I was speaking with someone else yesterday, Bob Siebelhar, who was actually he is a registered dietitian here in the United States. And he said that interesting interestingly enough, research, I cannot talk today, research is indicating that men in their 30s and 40s are tending to have lower testosterone that he's seeing in his clinic. And it's it's crazy to me because you know I ask first off, is it because more people are being tested and you're just more data points, or is there something really going on? But uh, you know, have you noticed that too? That males that you see well, A, do you ask for blood work? And B, have you noticed a similar trend?

SPEAKER_00 44:53

So it's it's it's interesting. I think obviously we we can ask for blood work, we we do look over it, but it's out of our scope to do anything about it. So if we notice anything's going on, we speak to like one of the advanced medical practitioners or the GP to have a look at that if we're concerned about something else. I I think it can go one of two ways. I think there's a lot more access to younger lads getting involved in anabolics, getting involved in testosterone themselves without any sort of need to because they're seeing pressures online get as big as they can in the gym. So I think it can go one of two ways. The obviously we're seeing a trend at the moment with a lot of people having quite low, but we're also seeing a lot of people take it themselves and they're the 20. They shouldn't need to be or shouldn't feel like they need to need to be doing that. So so yeah.

SPEAKER_01 45:48

With testosterone supplementation, and let me know if this is out of your scope, but if younger men who don't need to be taking extra testosterone start taking testosterone, what kind of negative side effects are there?

SPEAKER_00 46:04

So uh yeah, a little bit out of my scope as a physio. I think I know certainly from younger lads taking the anabolics, like the anabolic steroids and things like that, that it does from a physio point of view, really reduces tendon health. So we see loads of big JAP men, but they've got bicep ruptures, they've got pec ruptures, they've got Achilles ruptures, and they've just decreased that tendon quality, but continue to really heavily load it. And when you're put in a poor quality tendon over under quite a large amount of stress, it's it's it's no wonder that we're dealing with a bit of an increase in those sort of related tendon issues.

SPEAKER_01 46:44

That's so interesting because you would think testosterone would result in more muscles, yet it also causes tendons to become weaker. That's crazy. I wonder what kind of antagonistic things are going on internally to cause that. I'm gonna have to do research later, clearly.

SPEAKER_00 47:02

I think you you can just find that particularly with a lot of that sort, that sort of thing, that the muscles will develop a lot quicker and a lot faster and are ready to take that load. So I think that's where a lot of the problems lie. Also, I'm not too well researching that myself, but if if you're increasing your muscle mass too quick, but you're not allowing the tendons to catch up, it's a a recipe for some sort of tendon issue, isn't it?

SPEAKER_01 47:30

That definitely makes a lot of sense because they don't necessarily become stronger at the same rate, especially if the muscles are being enhanced in a really different, bizarre way. So yeah, that's interesting. But Patty, I really appreciate your time today. And is there anything else that you'd like, would you like to tell people if they want to work with you? Because you've been great in helping me manage my athletes in a in a virtual capacity. Are you taking on more clients virtually right now?

SPEAKER_00 48:06

Yeah, absolutely. Diaries as open as can be. So if if anyone wants to get in contact, got uh Instagram at paddy's on the run or an email of pl physio at outlook.com. If you drop me a follow, drop me a DM, or drop me an email. Happy enough to get back and we'll we'll see if we can sort something out.

SPEAKER_01 48:27

Great. And from our listeners, you can definitely learn more about Patty and his athletic endeavors via those avenues, but also your work as well is reflected on those channels, right?

SPEAKER_00 48:39

Abs absolutely, particularly on the Instagram, like to uh share a bit of my training, a bit of how that's going, but also just some nice, nice rehab exercises that have been going through myself, just some nice, nice information about did some about nutrition. As I saw Joe Wicks has put out a pretty damaging podcast today about not fueling for a marathon. So making sure we're getting the fueling across for for for that as well. So yeah, if you're if if if you're interested in any of that, give us a follow.

SPEAKER_01 49:07

Is he saying don't fuel or what what is what is the what's going on there?

SPEAKER_00 49:13

I I I I heard it this morning. He released something saying that he ran a marathon without taking any fuel, without any water, he just had a bowl of porridge beforehand and he was absolutely fine. So he doesn't know why people need to fuel during the marathon. So yeah, I think it's just a recipe for disaster.

SPEAKER_01 49:30

Well, we we just accidentally gave him a whole bunch of new follows, and people say, Well, what's we're gonna check out that? So yeah, that's wild.

SPEAKER_00 49:37

But if if if I have if I've misquoted, I hope Joe Wicks doesn't come for me, but it was it it was definitely along those lines.

SPEAKER_01 49:45

You'll have to have him on the podcast to clear things up. We'll have you on there too. Y'all can just battle it out.

SPEAKER_00 49:50

Argue against him. There we go.

SPEAKER_01 49:52

Yeah. I'll just sit back and watch. But yeah, thanks so much, Patty. And I do hope that you get back. It sounds like you've made great progress doing a speed workout yesterday. And hopefully you can be back to full strength. You can tackle an ultra, you can get even faster in the marathon. And yeah, excited to see your journey.

SPEAKER_00 50:14

No, I appreciate that. It was uh it was good fun. Enjoyed it. So thank you.