Paul Hobrough

Episode 73 – How To Avoid Fitness Injuries With Paul Hobrough

 

Episode Highlights

00:02:07 Common Injuries people experience
00:07:59 Avoiding shin splints injury
00:10:10 Strengthening and stretching is very necessary
00:16:53 Why  we need to condition our strength first
00:17:55 Type of injuries most middle aged men experience
00:22:29 What is patellofemoral pain syndrome
00:28:10 What causes of inflexibility
00:37:26 Things to be aware when we are deskbound
00:43:47 Determining  if your glutes are activated
00:47:03 Main causes of lower back problems

Links

Transcript

Welcome to the Fitter Healthier Dad Podcast, where you can learn how to improve your diet, lose fat and get fitter in a sustainable and fun way without spending hours in the gym is your host Darren Kirby.

Darren: Welcome back to the podcast, guys. This is the number one podcast for dads in their 40s who want to improve their health and fitness. This is episode 73. And we welcome back on today’s show, Paul Hobrough, we’re going to be discussing injuries and how we can overcome them and also what we can do to prevent them from happening in the first place. Hi, Paul. Thanks very much for coming back on to the podcast today. How are you?

Paul: Yeah, really good. Thank you. And you?

Darren: Yeah, very well. Thank you. Very well. Back into lockdown 2.0 is that everyone’s calling it, which is this madness. But it is what it is, unfortunately, isn’t it.

Paul: Well, they’ve got to put a number on it. Makes you wonder whether we’re going to have three point zero and so on. But the point is, nobody knows that. Not even the people at the very top of the tree, everyone’s flying blind. And so we just have to do what we can to follow the rules and keep going.

Darren: Yeah, absolutely. But obviously, that’s not the topic of conversation today. I’ve done that to death on this podcast. So we’re going about it. But today is really and for us to talk about injuries, really. And I also see you come back on your own in some earlier episodes and it’s become a common theme that I’m seeing with people in our community, people that are buying the programs now that loads of people or like you guys Forty’s, are struggling so much with injuries, long term injuries, whether or not that’s prevented them exercising or they’ve picked it up since they started to exercise. So what I really want to get into today is the common things that you see in your practice and the stuff that you do and why you think that is and what we can do to kind of mitigate against it. Really?

Paul: Sure. Well, the first completely unscientific fact that I’m going to give you is that in the first two years of somebody’s running journey, they stopped for the first time or in fact, they returned to running after a layoff and took this for your podcast. A lot of that seems to happen. You’re running well. You have kids that keep you awake all night. And then two or three years down the line, you finally feel ready to get back to running. And those first two years as your body is adapting and adjusting, which it will do, you tend to pick up the majority of these overuse injuries. So in answer to your question, the most common is the knee or what is a very closely linked time. 

That is the Achilles tendon in the back of the heel, namely that with other things like plantar fasciitis, plantar fasciitis is it’s more commonly known, which is the heel pain, shin splints, and then really run to various muscle pulls like calf or hamstring or or things like that. And just across the whole population, not just for runners, low back pain is a significant one. And another stat which is backed up by science actually is that 80 percent of the world’s population will have a significant back complaint. 

And by significant, I mean it will keep you off work or your hobbies at least once in their lifetime. But 98 percent of low back pain is not serious at all. So that although 80 percent of us will suffer from it, there’s a Monu percentage where something is really serious. So in terms of what we say, it’s heel shin may be the most common and then everybody is low back.

Darren: Ok, so the first thing that I want to pick up on then Paul is something which I believe to be quite simple and straightforward, but it’s quite common and that’s shin splints. The reason I say it’s quite simple is the general remedy that I’ve learned is that it could be your running shoe. So what’s your answer to that?

Paul: So I would probably put running shoes as as low down as I possibly could on the fact that set to injury, however, you make a really valid point with with shin splints in the what people are doing to wind up the inside of their shin is they tend to have a very fast heel, pronation. Now, pronation isn’t a bad thing. It’s a natural movement of the foot. And we need … Otherwise we run like ducks, it’s one of the good things about the foot movement. And it was really vilified in the 90s and early 2000s. But we need to get away from pronation being a bad thing. But it’s to do with the speed of movement of the river and that major longitudinal art for everybody to catch in the foot. 

But the long archila in the middle of the major longitudinal march and how that is affected by that movement of the rear foot. And so. You find some really, really good runners that have got a lot of rear foot and the made along with two large pronation, and it’s not a problem because their bodies adapted to it. However, if let’s say, we take an individual who has come back from becoming a new parent, maybe he’s got a bit more with that burden and is getting into running to maybe address that, then there’s extra force going through that role of the foot.

And that can create an issue with a muscle that’s deep in behind the shin bone called tibialis posterior tibial posterior does it runs just tucked in behind the shin bone on the inside and then takes a journey under the foot and on the outside of the leg there’s the peroneal muscle carrying the longest. And that kind of does the same thing but goes under the foot on the other side and they cross over before they attach and they act a bit like stirrups on a horse in terms of how you manage the foot. Now, if you end up with this increased stress on the one on the inside, the tibia is posterior that can be very unhappy. 

I won’t stop talking about inflammation or other different terms, which can have misleading consequences, but it becomes very, very unhappy and not through a process of different biological factors can lead to intense pain in that lower one third of the shin. So if you look to reduce down some of that moment, the rear foot with a particular type of shoe that’s got just a fraction more built up on the inside, or there are some great inserts you can get and that can change the fortunes of that person that’s suffering with shin splints quite dramatically and quite quickly.

Now, I’m really keen to point out that isn’t the fix. That’s Band-Aid. Yeah, that’s the fix is to start to help to strengthen that muscle tibialis posterior and start to think about the mobility around the ankle, the knee, the hit, the core strength, everything that links into your body’s ability to naturally control your foot strike. And as a course of running, many people will find they start to gain the necessary strength in these areas and people may well start to lose a little bit of the dad bod and then there’s less strain going through it. 

And usually shin splints is something that’s relatively easy to cut off and stop people having to worry about it so much. But it does require strength, conditioning, and it’s normally because the lack of running that precedes this has meant that muscle is not continued on strengthening. You don’t need as much when you’re walking one to one and a half times your body weight, when you’re walking two and a half to three times your body weight when you’re running, so that the increasing strain on these muscles, it becomes a lot more significant.

Darren: And I think that’s an important point to make. And it’s something that I’ve learned over the period of years, and it’s the strengthening and the maintenance, which I think it is very key, because what tends to happen more for my experience anyway, is if you get injured, you have an injury. And it’s in an area, as I said before, we start recording. I hurt my back just by doing a body squat. But what I then subsequently learned is my right knee. That’s the problem that’s causing the issue. And so the reason I mention that is because I now obviously need to go through a period of getting that knee stronger, whether it’s mobilizations, whether it’s, you know, kind of mobility, that kind of stuff. 

But that’s saying what if someone’s listening to this thinking, well, I’ve got shin splints I just need to fix? That’s what I’m trying to say, is that I think you have to do some investigation work to find out where that’s coming from and what stuff you need to do once you believe … So it’s not just a case of what muscle the shin splints are now. Fine. I can just carry on. I think it’s very important to make sure that you’re doing that strengthening so you don’t have other issues.

Paul: Yeah, I mean, strengthening and stretching to me is vitally important with strengthening work, just having the edge on the level of important stretching things had an interesting scientific path over the recent years. And I did a lot of research for my most recent book, which is The Runner’s Expert Guide Stretching. And we looked at the science that surrounds stretching. And it’s pretty equivocal actually, around science’s ability to prove that it is necessary. And and most of that looks around performance, which is difficult when you’re a physio, you’re looking at the biomechanics of the body and you’re doing functional assessments of people that come in all the time.

Frankly, if someone doesn’t have the correct range of movement to be able to use their strength or their explosive power, then flexibility becomes a massive hindrance. And almost therefore, if they’ve got strength, they don’t have the range of movement to use it effectively stretching because the more powerful tool, yeah, they’re very, very flexible and lack strength everywhere. Then put the stretch into one side and let’s concentrate on strength. And I refer to the human body. I talk about it being like a bicycle wheel, a 32 spoke bicycle wheel. And if somebody brought the bicycle wheel in because it was buckled and you found that there was one loose spoke and another spoke with really, really tight, you would need to loosen all the spokes or tighten all the spokes to tighten the looser one. 

And you’d take a bit of tension out of the really, really tight one of the human body. You’re getting a really good assessment to understand where you need a little bit of tension and strength and where you need to alleviate tension, frankly, for me is the only way to take that person forward. And the assessment can take rather a long time. And the person comes in if they just want a quick fix. And so she’ll wedge in the shoe. We can tell you to do some toe raises, for instance, and whatnot.

But ultimately, you need to sort of deconstruct the person a little bit. If you don’t want that person to become a frequent flier coming in for the next injury, the next injury, because you didn’t address the fact the right max wasn’t firing. And that’s the OR in your case, the knee isn’t functioning as well as it should. Do you get some back pain, which I find difficult to compute? But, just think of your house. If the foundations are slipping on one side, you notice it because the roof tiles slide off, not because you notice the foundation and it stands up in all elements of engineering. So why would the human body be any different to that?

Darren: Yeah, I mean, I used the car analogy a lot around, you know, how a lot of the elements of a car all work together. And so therefore, you know, that’s the same thing in the human body, isn’t it? Probably more so, I would say. But yeah, no, I think it’s good. And I think it’s having that realization and understanding because I think that what I believe is, is the downside to running Paul is because it is so easily accessible and I’m not knocking anybody for running, but you just go out and do so. Well, I can run. Anyone can run. Well, that’s like saying anyone can paint a house where anyone could paint a house.

But what quality paint is going to get on your house if anyone does it. So it’s kind of about quality over quantity, I think. But like I said, because it is. So you got a pair of running shoes on in shorts and a T-shirt and you go out running. But, you know, it’s kind of really stepping back before you do it and thinking about, well, you know, when was the last time I ran? How was I running before? And really, should I just go out and just talk to a five k run? The answer I would give is probably not. You need to start gradual. And that’s that’s what I think. That doesn’t necessarily create injuries. It just shows up, I believe, imbalances in the body in your movement and your functional movement or rest of it.

Paul: Yeah, I mean, if I were to have my own way with every individual that came in and said, I want to tell you running, if if anybody was going to follow my laboriously long program, then then they would start off doing 95 percent of their time, would be spent doing strength conditioning work. Yeah. And the time would be running and then they would move that to a nine to ten ratio, then maybe 80, 20. And gradually they would bring in the running out of having a chance to sort out all of the musculoskeletal and biomechanical. Insufficiencies that their body is created and, you know, if I were to pick on a small collection of people that take to running from other sports people that played a lot of football or if this goes to international soccer and then you find a very, very right footed player because they plant their left for when they go to kick the ball, they’ve got a lot of of control strength when they’re running with that left foot right there.

Right. There’s been a huge increase in mobility because you really pull back the trigger of that foot and then fire it right through, which the left leg just doesn’t do. And you repeat the action over and over again and you’ve got two sides to your body that are now trying to do exactly the same action every single step. Yeah. And yet they’re not trained that way for their whole life. Dancers and gymnasts have what we call a fairly large dose curve in the lower back, the back half curves in which makes it really easy for them to activate the glute muscles. But it doesn’t necessarily mean that their anterior core is working as well as it should do and running. And it tends to give them almost the posterior stride. They don’t tend to put their foot anywhere near the front of where we might consider the stride to. And you can almost when somebody comes into the clinic and you just look at their posture, you could almost in many cases sound like Yoda because you start saying, oh, you’ve done some ballet in your time. Or I can see you’ve been an avid rugby player or football player and they haven’t told you that looked quite shocked.

But yeah, we all know what the archetypal body shapes are, these different people. So it’s not because I’m particularly looking at these things. If you actually took time to watch, people can’t do it so much in lockdown. They watch people walking around. I bet that most people listening to this could become a fairly good judge of what that person’s sporting ambitions have been in the past, because it changes your body shape and the way you walk and the way you stand and adapting that someone that wants to do two very simple moves are left stride the right stride and repeat that many, many times over. 

That can be a difficult transition. So that’s why we start to give them strength. I’d like people to do strength conditioning first and foremost, to prepare themselves. Whatever one does, they run five K first sessions. It feels good. The second time they go out, they run seven or eight K in the third time’s ten K and then they wonder why the knee hurts.

Darren: Yeah, exactly. Yeah. I think we touched on that previously in the previous podcast around, you know, the importance of strength and conditioning. Pre- pretty kind of run it. But you mentioned that, which is obviously a big area and I think particularly as an effort is around knees and knee injuries. Now, you said then when you start running, you put two to three times your normal body weight through the knees. And so I guess really in a summary, just how impactful is running on the knees and what type of injuries do you see with kind of middle aged men and their knees?

Paul: Yeah. So, yeah, two and a half to three times your body weight goes through the whole body. But of course that means that you get that through the knee, ankle, hip. But the knee in particular is it’s a fairly basic hinge joint. There’s a lot of working inside the knee. You’ve got various ligaments …. Which these little fluid filled sacs. You’ve got tendons, muscles running over so that the knee is simple, but it’s got a very mobile for an ankle at one end and a slightly more mobile hip and very mobile pelvis and lower back above it. So in order for it to do its job, it needs to try and keep that knee flexion and extension bend and straightening on an even keel. And it’s actually really difficult to do so. 

The most common injury we see is ITB Friction Syndrome. The Tibia Band or IGB runs down the outside of the leg. It originates from your group Maximus, your big glut, and one of the hip flexors, tenso vacillator, and it becomes their tendon attached just below the knee and onto the tibia. And its job is to help the gluteus Maximus and this hip flexor to control the major lateral, the inside and outside movement of the knee. So you think about the foot strikes, the knee will bend a little bit more. You want it to end with a knee directly over the middle toe, in most places, it goes to the second tower, even over the big toe or worse still, to the midline of the body.

So if we have this happen, then we’ve got a different moment happening around the knee, which causes that IT band to become tight. And then it starts to cause some friction on the outside of the knee. And that’s where people were first noticing. The telltale signs are that when you run this pain on the outside, your knee starts to build up. But when you stop running, it seems to go immediately because you stopped the friction. And where I fall back to every single time when I’m trying to keep this simple, because you’re spreading knowledge to lots of people. Yeah. And if so, if it was one on one, then then it would be going into much more depth. But spreading knowledge. Lots of people, the single leg squat done well, real help with this more than anything else, which is a strengthening exercise. 

And you need to do it in front of a full length mirror and you start with a straight leg and the other leg is kicked up the back like just back heel to football. And you bend the knee only as far as you can before it deviates from lying over the middle toe of the foot. Yeah. So you start coming more into the in line the medial aspect of the leg, then you stop and come back up again. And for a lot of runners I experience knee pain, they might get to a maximum of dropping 10 centimeters. Yeah, they really would. And you think of a single leg squat as your bum going to level with the knee or close to it. When we run, we need a knee bend of about sixty five degrees. So what people need to do is to build up the single leg squat until they get to about sixty five degrees. I see a saying about six, five degrees because I’m expecting people to get their kids protractor out their pencil case in know of me.

I know that runners like stats and they like to be exact about six five F and and IGB Friction Syndrome makes up part of Runner’s Knee. So the other side of runner’s knee is actually what we call Patellofemoral pain syndrome. So the patella we know is the kneecap. That’s a fairly commonly used word. The femur is the thigh bone. And when the patella and the femur, the thigh bone come into contact and they can also create some impact in between those two bones. And that can then start a process of causing Patellofemoral pain syndrome. And, you know, both of these are called syndromes. It’s because nobody is 100 percent sure to give it a more accurate diagnosis and send back. 

We know something’s going on, but we can’t give it a really technical diagnosis. And really, the rehab or prefab is the same for both of those. Well, one and one can lead to the other. So when you’re when you’re dealing with the knee. A lot of people have very, very tight hamstrings, some people have tight quadriceps, a great many people will have a loss of movement around the ankle, which in with the loss of mobility around the calf muscles. And so when you put all of this together, if we do the single leg squat, we strengthen the quads, we can strengthen the hamstrings, we can work on the alignment of the knee by working to facilitate this hip flexor, our gluteus Maximus, ankle mobility and stability, they’re all being worked. So as a first port of call, if you’re suffering with knee pain when you go for a run, essentially you’re doing lots and lots of single leg squats, but with impact, not of single leg hops or jumps.

Yeah, so. So it stands to reason. You want to train this mechanism quite heavily. But I don’t. Don’t sit there and think you’ve got tight hamstrings and I’ve read some, it says stretching doesn’t work or or whatever actually goes through a process of seeing what your hamstrings are like. Now, this isn’t a process of standing with straight legs and seeing if you can touch the floor for a test of your pelvic position. What kind of introverted or retrograde hips were you born with? And more about your spinal flexibility. The majority. This is about how much your sciatic nerve wants to put up with. If you want to test your hamstring flexibility, do it with a bent. If you stretch your hamstring on a straight leg, you might feel burning behind the kneecap. 

I can tell you there’s no hamstring muscle behind the kneecap is tendons, but not muscle. So that burning pain is a sciatic nerve. So you want to stretch your hamstrings with a Bent knee. So you got a low stool, you put your heel on a low stool, you have a little bit of a bend in your knee and you see with a straight back how close you can get your chest, your thigh, and you’ll feel the stretch build up in the back of the leg where the hamstring is. And that would be a more helpful gauge as to how flexible your hamstrings guess what’s left against right.

And you’ll find out if one is tight or not. Very good gauge of whether that bite point, if you like, comes in really, really early on. And then that’s by the way, that test is a very good stretch to do to try and alleviate the problem. The 60 seconds regularly is about the only the minimal amount you can do to try and attack that quads. Can you pull your head up to your backside? Most people find they can, but what’s the knee position like. Right. So you think your heel to your backside but your knees pointing out in front of you and not in line with the straight leg, then, then that’s, that’s a tight quad. Knees must be in line with the heel pulled up. And that’s only actually part of the picture because what you’re doing is showing the flexibility of your main rectus … Muscle that runs down the middle. It becomes more complicated and perhaps too complicated to talk about on the podcast. Look, the other two. But but there are there are various resources out there to help you test.

So rather than trying to be everything to everybody here, do a bit of reading up on how you can test flexibility of these different muscles, test yourself against a body. It’s not great to test against. You know, if you’re married and that marriage is to a female and your wife because they tend to be flexible by default. So see what your flexibility is like against a buddy. Oh, look, look at normative values. But the biggest thing is to see where the left is equal to, right? Yeah. All the muscle groups. And you can do that really easily at home without really any reading and you’ll start to see where your bicycle will be where your spokes are. Not in the best of my knowledge earlier.

Darren: Yeah, no, I think it’s a great analogy. And I think obviously by doing this testing yourself, you can then no. Prior to running what you need to do is conditioning wise to help you run because you see so many times people going out running and they it really looks painful for him not there slogging their way through it when I believe it doesn’t need to necessarily be. Obviously, there is at the side of fitness that comes into this being genuinely fit. But the thought, this imbalance, you see people with their heads tipped to one side or their, you know, their bodies twisted when they’re trying to run an arms all over the place. 

And I’m not criticizing anybody running technique, but what I’m trying to say is obviously what you’ve said is like conditioning, understanding where you have imbalances or inflexibility, which then can prevent the need for you to go and see people like Paul because you’ve created an injury off the back of that of these other things. But this the other thing I just wanted to go back to Paul, and that is the single leg squats. Now I can do a single leg squat, but only with it with a T-Rex if I try to do a single leg squat on my own. Now, I do probably in the region of 20 to 30 K a week of running. I cannot at this point. I have the mobility that I have. I cannot do a single squat. 

I can literally probably get down, I’d say three or four inches before I’m either really bending forward or stuff like that. So really what I guess what I’m asking is not for any kind of diagnosis, but what causes that inflexibility. That is my ability to not be able to carry that out.

Paul: Yeah, so you’ve got this code contraction for the muscles. So we spoke a little bit about your right band and the muscles that kind of operate that. We’ve got four quads, we got three hamstrings, we’ve got three calf muscles. If you want to say there’s a major natural gastrocnemius and the slowest and all of those have got to work synergistically together and they’ve got to do that over a range of movements. Right. And your brain has got to be able to make sense of all this and be able to change and adapt what’s going on as it starts to learn the new skill. So if I were to try and pick out what element was specifically wrong with each person, it would be a fool’s errand many times because we can start to build this up. And build it up gradually so that whichever is the weaker muscle is going to be working hardest and wherever we need more flexibility, the very nature of doing the exercise is probably going to get it. 

So for you, you found that by using the T-Rex, it is very, very useful to take some of your bodyweight away and give you a bit of extra balance. So if I were to be talking to exactly your scenario and many other people would share it, I would say do as many of the two to three inch single leg squats as you can and get to the point where you think I’m going to get close to failure here. Get a Swiss ball out, big inflatable gimbals, stick that between your mid back and the wall, right. So you’ve got some extra balance, but you’re still testing your balance and then see whether you can do some more things like squats and possibly even a little bit deeper because you’ve got that extra balance. And then you can move on to maybe using things like the TRX or even some fingertip control on a wall where you’re seeing whether you can do some more. 

And if you were to do that, you would gradually be building up the strength through the range of movement by using the ball TRX or fingertip control. And you would notice that you’re able to go not just to three inches, but to four inches, and it might take two weeks or two months to get to that point. But you’re not wasting your energy or effort, just sticking in that little space there. And when all of those different tricks come to fruition, you’re certainly at some point in the future. For some people, it might be two days. 

Other people it might be two years. We don’t know what historical things have got to unpick each athlete here, but you will get there by a process of continuing to do it and doing it regularly and consistently is the key. And then there’s other ways you can develop it. And if you’re really struggling with that, then you can use some of these stretchy elastic bands, different colored bands, and you can actually lay on your back and you can put one round your foot like a stirrup and you can be doing the single leg squat in midair. So you’re actually controlling it from there and then build up from that point.

So there’s always an earlier starting point you can use, and there’s always a more advanced spot where people are putting weights, you know, on their back or holding dumbbells and doing single leg squats. And you can develop and develop and develop into weighted single leg hopping and squat jumps and stuff that do strength conditioning. The wonderful thing about it is we can start at a very, very low level post surgery just with someone trying to lay on their back and push a balloon away right through to you, jumping off a box with weights on our back and then doing a single leg squats, which I don’t recommend anyone does because they haven’t built up to it.

Darren: Absolutely. And I think that that’s the other point as well, isn’t it? It’s about consistently carrying this out and not expecting the results to come instantly because we all live in this crazy Amazon economy. Well, when we do something and we want a result quickly. And I think that this couldn’t be further from the truth. But I think what’s important is it is consistently doing it over a period of time. And before, you know, you really start to see some big and it will be big benefits finally once you’ve built that strength up.

Paul: Yeah. So first part of that, be prepared to start your level. You must be the best runner at your club. You might be the best runner in the county country world to your level. Because everybody has different strengths and different weaknesses. So if you’re working on one of your weaknesses, don’t be too proud to lay on the floor and push a balloon away or to use the third round, you don’t need to go into a weighted score. The second thing is that the laws that relate to I mean, this is from a very, very long time ago, a runner, Frank Dick, his name was. And the laws are going to be that the exercise needs to be specific, that it needs to continually be overloaded. Right. 

And it’s reversible. So you need to single like squat is about as specific as you can get for runners. Yeah. And I’m pleased belaboring this point because I love the single leg, Scott, and I think everyone should be doing it actually. And it’ll take six to eight weeks statistically for you to get any kind of strength benefit I can do. So don’t expect it. And soon, sooner than a couple of months. But after a couple of months, if you don’t generate a great load of some sort, either by going lower into the squat or by adding some weight or taking away some of the balance that you’ve got, then you’ll get diminishing returns because your body needs constant stimulus. Yeah. 

And it can stop doing it. You will lose all of those benefits much faster than it took to gain them. So if you spend six months doing it and you get all the benefits, then you stop because you think I’ve made it in less than six months, you’d have lost all that benefit. So you need to keep going with it, but if you’re building, building, building, and you get to a point where I’ve been doing this five times a week and I’ve now got to where I want to be, if you’re no longer building it up two or three times a week of doing something far more basic will be enough to continue and keep that plateau.

Darren: Yeah, which yeah, it kind of sounds a lot, but they’re also at the same time make sense. Again, it comes back to consistency doesn’t it, consistently doing it over a period of time, you know, gradually build up the strength in that muscle group or that area for you to continue to progress. But it’s important that you don’t just stop, like he said, because I think it reverses quicker than it took to to build it up in the first place, which I think is quite, quite important to recognize really. And so moving up from there Paul, when we when we’re thinking about like the glutes and we obviously we’ve talked about hamstrings in the hips. You know, there’s a lot of people listening to this who are deskbound.

And therefore, you know, there’s this whole kind of movement now around, pardon the pun, around, you know, standing up while you just standing up there sitting down is the new smoking and all this kind of stuff around that whole area. What are the things to be aware of when we are deskbound, i.e. sitting down all day and then we are going to go out running in the evening.

Paul: Yeah, so first of all, your body’s going to adapt to the thing that you do the most, right? Yeah, and so you’ve got eight, nine hours at a desk and then you want to combat that with a 40 minute, 60 minute run in the evening. Yeah. You put those two things on an old fashioned scale and you know which one’s going to win. So one of the things about the muscle is if we spend a lot of time sitting, that muscle becomes a little it can become longer in a certain direction and it can become tight in another direction. Yeah. Which is the antithesis of what we want for our running glute muscle. Yeah. Which is one of the key providers of out of our strength, for our stride. For our hip extension. 

So by sitting down, a lot of bums going to get potentially a bit overstretched in some areas a bit short is going to become very stupid because it’s not being it’s not the stimulus and therefore it’s going to become underactive as part of the running gait cycle. And so people have heard of great activation and they don’t really understand what that means. Well, if you plunked on a seat for a long period of time, we need to get it activated and we need to make sure it’s working in the way that we want to use it. So it’s as much about getting the neurological stimulus into that glute as it is about getting the strength into the groove, because you need the brain to be sending the message and getting that timing correct and you need the strength to be there once that connection is made.

So three key exercises for the glutes, for people that sit down a lot and most well, all three of them, actually, you lying on your stomach or being in a plank position you could do so lay on your stomach one leg at a time for this one. Bend your knees at ninety degrees. And then you have your ankle at 90 degrees and you should be so you could rest a tray of drinks on your foot along with your great you bent and your foot is there and could accept a tray of drinks. And then what you’re going to do is you’re going to tense your muscle and you’re going to lift your foot up into the air. And the imagery we use is don’t spill any of those drinks on that train. And that’s why we’re getting the best contraction of that glute, because if we can track the hamstring, the tray falls off. Yeah. If we do anything with the calf muscles, help the tray fall off. If we start, you know, lower back, the tray falls off. So by having that imagery in your head, you can be fairly certain you’re active in the glutes. Yeah. 

And if you get five lots of five reps of lifting this imaginary tray up in the air, you would have gone a long way to activate in your glutes. You then go for your run and because your legs are activated, they will have a bigger job to do when you’re running. And that would be really specific. Remember all three levels of the strength training specificity. The next one is in the same position, but now both legs together, at this time. Bring the little toes of your feet together, The triangle between feet and knees, if you have to look at it from the back and squeeze that together and then lift your knees or thighs off the floor and you will feel a very, very strong contraction coming from your muscles. Right. Very, very strong. 

So much so that people that lack the basic strength in their glutes and question should they be running with that, with that low level of strength, will struggle to lift their thighs off not even five times, but once like. And then you take that more towards a muscle called the piriformis that lies deep in the glutes. Anyone that’s had a type pain and been told it’s piriformis syndrome, this is a good one. And this is where you create a figure four. So just so we can do the imagery of this, are you lying on your front? Both legs flat? Yep. This is lying straight out like a plank position but your flat tummy and take one leg out to the side like a windscreen. One leg is still flat. Bend the knee and fold the foot onto the back of the stretched straight leg. So you with your legs you’re creating a number for.

If you can picture that now without lifting your hips, without lifting the foot, can you lift your near the penny off the floor. Right. Yeah. And for many people it’s a bit like that trick you do with your hands where you, you bend one finger up and can you lift one of the other things off if you haven’t done that and you will find it very, very difficult to lift that knee off the floor. OK, so if you work at a desk, start working on lifting a tray of drinks, then put the real close together, create the triangle between the knees and the feet and start lifting up, you’ll feel a big contraction. You will be able to do it, but you’ll find it very difficult to do. Then go into that figure, fold position and see whether you can lift your nails. 

And if you can’t keep working at those cycles, those three events, because even if you can’t lift the knee of the very fact that you’re trying is improving the neurological link with those muscles and within a couple of short weeks will then be able to lift the knee off and start working on strength. The neurology needs to be there in order to access the strength. So keep battering away at that and you’ll have your you’ll have a bum like a nectarine. It will be full. I unit and you know what, if you do that, I’ll predict that you’ll run faster.

Darren: Yeah. Now for me around the glute activation, I found out many years ago after doing a longer distance that my glutes were not activated. And because I’d get on my twenty sixth twenty eight k into a run and my hamstrings would be on fire. And I put that down at that point to the fact that I just wasn’t flexible enough. I subsequently found out it was my glutes, one engaged and they obviously weren’t activating as far as I was running, particularly as I was getting fatigued. I was running moves from the hamstrings and I was the glue muscle. So is that would you say that’s a good way to determine how the glutes are activating or not?

Paul: Yeah, so one of the unhappy byproducts of an active glute is that they can’t do their job and that job is to extend the hip. So think about the back part of your stride. So as you defer your body’s transition forwards and then you’re going to lift up your back. So that hip extension. Isn’t being done primarily by the glute, which it should be, so the only thing that can take over is the hamstring or the hamstring is a weak, hip extensor. But prime rib dogs, let’s be honest, are dependent. Yep. So if your glutes work properly, that will do the heavy lifting in terms of extending the hip and asking the hamstring to come in as part of a co contraction to help with that last little bit, but to make sure that we bend the knees so that we don’t trip over as a running forward. 

Yeah. So if you’re not active, the hamstrings got to do all of that and won’t be able to do it for very long before it starts complaining. You got to about twenty five K before it was really complaining. And as you will know, if it complains too much, it can be the end of your run and each time you go back into it you then go, oh I’ve got tight hamstrings. Well of course they’re tightening up. They don’t want to do that job either, but there’s no one else down that that that production line to be able to reach out to to do the job. The only thing maybe is your doctors might be able to start kicking in, but then you’ve got to have an intern toe to even think about lifting you like that creates knee problems. It’ll just sucker punches out. So, yeah. So you. 

Protect that whole change in the kinetic chain by making sure that your glutes are active and people have had long standing hamstring problems and they had the massage and they’ve been stretching them, strengthening them, if you haven’t looked to your glutes, almost guarantee they’re the problem.

Darren: Yeah, absolutely. It was definitely in my case because I can now feel when I do a long run, my glutes are either feeling the tension or and that for me now just tells me that they’re firing, which I believe to be a good thing.So moving up from there, Paul lower back problems. What do you see? The main causes of lower back problems, though, obviously coming back to the kind of desk analogy of people sitting at a desk all day. Can that be the cause? Because the people are sitting down like that. The hips are a funny shape or they’re not, the hips are not being flexed or what can cause the lower back problems.

Paul: Yeah. I mean, there’s so much that can cause the problems sitting it. So, this transition is nicely on from the glutes because also when you’re sitting down you’ve got around a 90 degree flex position at the hip. Yes… and your hip flexors originate from the lower back and they come through attached onto the hip. Their job is to flex it, bring the knee up closer to the torso. So if you’re sitting in that position all that time, those muscles can become very, very strong in that position and not overly strong when they’re stretched out and they can become a bit short. So when you go for a run, you want that glute activity, you want the leg to extend, you want to have that nice position. But if your hip flexors are really short, they’re going to start to stop that from happening. And if you’ve got tight hip flexors, guess what? It doesn’t help with the glue activation. It actually limits some of that. 

So the hip flexors originate from the back of the hip. Flex is a very, very resilient muscle when you compare it to the sensitivities of the lower back. So. The fact they originate from the lower for lumbar vertebra means that when they get tight and they start to pull, it’s not the hip flexor that’s going to be called into question. It’s the lower back. So let’s think about the anatomy of the lower back. We’ve got these. Segments of bone that make up the spine, the spinal segments, and there’s so many in the lumbar spine, so many in the thoracic spine where the ribs. 

The … and then you’ve got a few in the cyclosporine spine, the neck and each of them, although they changed the spine, these ones in the lumbar spine, they’ve got a desk in between each of the larger portions. But coming out the back, it has almost like a shark fin, which is that if you reach round your back, you can feel that knobbly bit of your spine. Yeah, that’s see the shark’s fin, if you like, that comes off the back. And on either side of that, these two little are called the facet joints. And then they rest onto the next segment below. Now the facet joints are designed to take about 20 percent of our weight through the body. 

And where the disc is is supposed to take 80 percent. Yeah. And one of the biggest things that I see when someone comes in and says I’ve got back pain is that they’ve actually transitioned on to that facet joint that’s only supposed to take 20 percent. And they’re loading that with a much, much higher percentage of their body weight. In effect, we’ve had a positional change. The spine isn’t out. It doesn’t move back in. That’s that’s really old scientific speak and really erroneous and shouldn’t be used. But they’ve just managed to load that portion of spine too much. And so what we need to do is, is to think about the strength within the deep core. We need to think about the flexibility of these muscles. But in runners, I find the underactive glutes and very, very tight hip flexors. A large part of the reason that this has been caused and what we do to treat the facet joints is great and varied and depends on the individual. But reestablishing the hip flexor glute even into hamstring sets up is the greatest way to resolve that long term.

And I have to say, I’m being very broad about this because it’s one of those things where I would spend a lot of time with somebody on in person in the clinic here in sunny Northumberland, or indeed I see a large portion of my clients online via our physio where I can actually watch what they’re doing over Zoom. And that means treating people all over the world, but being able to see this but is very difficult to give a blanket approach. But make sure your glutes are firing and strong, make sure your hip flexors are getting some stretch, and particularly if you’re sitting for a long period of time and you’ll be 70 to 80 percent of the way there.

Darren: Okay, so just to quickly summarize them, we’ve talked about the shin splints. We’ve talked about the knee, we talked about the hamstring. I’ve seen the glue and then we’ve talked about kind of hip flexors, lower back. Is there any one in one other common thing that you say it’s worth mentioning?

Paul: Yeah, I mean, the Achilles tendon, they’ll be whenever I do big talks to the patient, I say, right, who’s injured? And at 50, 60 percent of the hands will go up. But I don’t leave your hand up if you have a knee problem. And that tends to have the biggest portion. And then I say, OK, and now put your hand up. If you’ve got an Achilles problem and the numbers depend upon the group and the age group stuff, the numbers will be relatively the same. But yet. But the knee tends to transcend a wide age group. Achilles is if you go to that middle aged man and you have a room of just middle aged men, which is potentially what we’re looking at here, given the name of your podcast. And it would be like a Mexican wave of who had this problem. And and and one of the things that I say to people in this age bracket, which I’m in myself, is that the rehabilitation exercise is for the Achilles tendon. That is a life sentence. 

You keep doing those for all the time that you want to run. This is the biggest message because many people know about doing heel raises and a few people know about shock wave therapy on the Achilles from our previous podcast. And those two things are vital. And I don’t want to just regurgitate all the stuff we did last time. But this point is really, really key. When we’re not in pain, we forget to do the exercises and it’s completely the wrong way around to do the exercises. So we never have to remember what that pain feels like if you’re doing them regularly. So when we’re rehabilitating somebody from an Achilles, they start from there due to two weeks of alternate day I symmetric exercises standing on your tiptoes. Hold it for forty five seconds. Repeat five. Times don’t do it the next day because, you know, the whole complex is still recovering from that and you will make it worse if you do it every day by day comes along, do it again, make sure there’s sufficient load a white rucksack on your back to be making that 45 seconds difficult. 

After two weeks move to heavy, slow resistance, which is stand on a step, go up slowly for six seconds, don’t pause and come down. Started six seconds. And you repeat that 15 times and you repeat those 15 repetitions three to five times every other day, making it heavy enough. So it’s challenging. When we’re completing that, we then go to a loading, which is just lowering down, but for the purpose, what I’m saying here, that heavy, slow resistance of a step 15 reps, three times, two or three times a week. Is what you should be doing. With the single leg squat and the group activation stuff as your core set of exercises each week, if you are indeed a middle aged man who wants to keep running and doesn’t want Achilles tendon, obviously doesn’t want the knee pain and doesn’t want the groups to create the whole plethora of things that they will create if they’re not looked after.

So three times a week, we’ve just given you a maximum of eight minutes worth of activity. So if you don’t have twenty four minutes available in your week to support your running, get up early. You go to bed a bit shorter on your mobile device or whatever on your lunch break. If you can’t find that twenty four minutes a week, then, then just stop now. Just stop because there is no excuse in life. Not that it leads me to believe that you’re telling the truth that you can’t shoot or not.

Darren: Yeah I know. I completely agree with that. And the other thing and you can correct me if I’m wrong, but by doing all of this, by doing the maintenance as you want to, if we want to call it that, and you actually will find running easier and I can I can relate to that because that coming back to the whole thing now, I’ve switched my glutes on a back end of a long run. I might be fatigued, but I don’t feel like it. So I’m really trying to drag the road along or drag myself along the ride. So I think it just will make it. I think that’s the word I’m looking for. It will make you more of an efficient runner by having this as a process as part of your running. So it’s not just putting your trainers on going out, running, it’s like a precursor to it.

Paul: Yes, so if you run because you want to become a faster runner or if you run because you want to lose weight or your mental health or the plethora of things. The things that will stop you running. A lack of time, lack of motivation and injury and now lack of motivation. I’ll leave that to you, Daryn, because you’ve got a great podcast and we’re doing the lack of time. Get up earlier. Stop making excuses, lack of injury. Listen to what I’m saying. Listen to what I’m saying next. Because you will not achieve your goal of going faster, helping your mental health, losing weight if you have time out through injury yet. Yet what runners think is a twenty four minute run in addition to my running week is going to help me achieve my goal for more than twenty four minutes. Strength, conditioning. And that’s a complete lie. 

Yeah, because if you do the twenty four minutes strength conditioning each week instead of that twenty four minute run, your mechanics are going to be better. You will run faster at free speed. You will have less time out, you will have less time out because of injury. Therefore you put more running sessions in per year so you will be thinner, fitter, your mental health will get all the things we’ve spoken about. If you look at it over a year, if you just want to look at it as a week, that twenty four minutes, they are all junk miles in comparison to what that twenty four minutes of strength conditioning will do for you. And I will put it in a tablet of stone if somebody were to do that. 

The brick by brick, I would eat my house if it didn’t work. And the reason I can say that with such certainty is A will work and B of work with runners in my whole life. And there is one of them out there that will go off and do exactly what I said, because they all want the buzz of the run. And so they do that and they just don’t hear you. And I sometimes feel like, you know, the vegan or the cross fitter or the atheist, he just wants to drill into everyone. This is my you know, that Ricky Gervais is going to tell you that Christianity is a mockery. You know that the Crosthwaite is going to talk about that within the first eight seconds of seeing, you know, these things. And none of those people are necessarily wrong. But I know that I’m right. But that makes me evangelical, makes … All about it all the time. Probably not the most popular person, because I want to give you an extra run in and you’ll be a better runner, which is true to a point, but it’s Click bait compared to what I’m telling you, which is real, genuine, proven advice that conditioning would do more for you than the run.

Darren: Yeah, and I know I’m saying that and I’m agreeing with you and I’m not in my head. And the only reason for that is that I found out through injury. So, you know, like you say, people don’t listen to you necessarily until they’re forced to through injury. And what we’re trying to say is there’s no need to go to that point to actually learn about it. We’re giving you information and advice you can take away. And so you don’t have to have that injury because if we talk about the whole mental health thing, when you can’t run, that does affect you. That does all the endorphins and everything that you get from running in the balls you get from running, you can’t do when you’re injured. 

So don’t get injured. Is this the message that you’re trying to put out really? And I yeah, I completely agree. But I think even from the first podcast we did, I’ve implemented now just the walking lunges before I run, and that has made the start of my run so much more pleasurable because I’m starting up in a place where I’m a lot more looser. I’m not the first couple of K I’m not trying to pound the pavement because I’m not. I feel lighter on my feet. I don’t know where that’s supposed to happen, but that’s what happens.

Paul: Yeah. If you improved the flexibility, you’d have activated your glutes in some way and you’ve got everything ready to go for the run rather than getting back from work and were trainers on. Because if I get stuck into that I won’t go and go at lunch time. You put the computer on sleep mode and you rush out of your room and your sandwich at the desk and you miss that. And sometimes that’s needed. Yeah, it runs in. I get that. We’re only asking for twenty eight minutes and make no mistake. I’m saving you money and I am expensive, so I believe in my faith because I spent a long time getting to the point where I know all the things that I know. And I believe that I get the person back better, quicker pulse economy, perhaps, to think of me as expensive. 

The reason I say so readily that I’m expensive is because people go and see lots and lots of other people and think they’re paying 35 pounds or fifty pounds or whatever. I’m going to see if they’re going to get a better outcome. And the majority of people that turn up see me have already spent two thousand pounds trying to get a resolution. And then they come in and I see my prices and you see a little tear come down that, but. But had they come from the first instance, still the same expensive, but have been cheaper in the long run and I don’t have enough space in my diary to hang onto people, I want you in. I want the minimal amount of input and I want you out again fixed.

And so you end up with this reputation of people coming to see you because it’s like, oh, you’re the end of the line and, you know, emptying out the piggy bank sort of thing. And it doesn’t make you feel good. But you’re like, well, I’m pretty confident that the structure I’m going to put in place is going to work. I’m literally giving the listeners to this podcast all the things they need. I’m doing myself out of a job. I’m giving them everything they need not to ever have to go to. And still, when I wrote Running Free of Injuries, my first book, I put it in the front, the only seven percent of the people that read this book will do everything contained in it. So I can sell this. And I know that 93 percent of them. So that the fact is, you know, I write by once, but you don’t even need to do that if you follow it. There’s loads of experience that follows what’s being said. And don’t ever make me.

Darren: Apart from on the podcast, obviously.

Paul: Exactly. Yeah. Yeah,

Darren: That’s fantastic. Paul, thanks very much for going into that. That was the whole reason I asked you to come back on, because I’ve had so many people that have contacted me recently because they’re injured and they can’t work out and rest of it. And then you see people out running and it’s just really like you say, please, please, please take heed of what Paul was saying and implement it and you won’t have these issues. So, yeah, fantastic. Paul, but before I let you go, is there anything that I didn’t ask you that I should have asked you?

Paul: You know, I mean, we could go on. We could still be in a week’s time. I think that doing these things and really drilling down on two or three injuries is much better than trying to give a scatter blast of everything. I when you work one on one with somebody the same virtually with physio when they come into the clinic and it is a different experience, I know it has to be personalized to that individual. And when you’re doing that, you give out, I believe, still really brilliant advice which can be implemented by everybody. But each person got that personal journey. And it’s amazing when you actually start getting stuck into it. The most common thing nobody’s ever pointed out to me. Yeah, no one’s ever tried it. They’ve looked at themselves in the mirror all the time and they don’t see it. 

And that’s one of the benefits of visually being to see someone in front of you, either by the ichat service where you were doing exactly this or on zoom in on getting used to moving around and floating around the room or when they come into the clinic. And it’s those moments, which is why I love my job, because you put that droppable in the right place.And you make that difference and then you get the person coming back to you guys. My God, I’ve never felt just think about doing the lunges and, you know, enjoy the first four minutes of your run. Yeah. That’s that’s all I need. You know, all things like that are amazing.

Darren: Yeah. Well, I find it absolutely fascinating. I’ve got to be honest. I find it the way that it works. And that way they all fit together. And if you do the simple stuff, the dramatic and I’m not underestimating and kind of trying to oversell the dramatic effects that it can have, just I know if we take running out of it just general mobility as you get older, that’s something that I realize and I respect more now than anything. And that is my mobility outside of all the fitness. And I don’t want to be getting to seventy years where I can’t move or anything like that. So if I do this stuff now, it will help, you know, in the future.

Paul: Yeah, absolutely. And use it or lose it, If you have tight hits now age 40 and you don’t do anything about it, they’re not going to get looser. Not when you’re fifty or sixty or seventy eight in those age categories. Listening will go. Yeah, I wish I could have told my fourteen year old self that because your adaptation speed at the younger age is far quicker than that when you get older. So use it or lose it. Get the hard yards done now and then you’ll just be maintaining it.

Darren: Absolutely, so Paul, you mentioned about a book if you got a new book coming out or anything like that.

Paul: I’m writing my third one. I started off in 2016, running free of injuries, came out and it was like the self diagnosed to self treatment right the way through. And then this whole mobility thing, which we’ve spoken about last year, I brought out the runners expert guide stretching, which has got all the strength conditioning it has all the glute exercise in actually which when the photo shoot, it was interesting because the models couldn’t necessarily do all the exercises.

But I don’t know. I don’t think I invented the exercise, but I can’t find a picture of it anywhere else on Google or anything. And then I’m working on a book called The Five Pillars of Running Performance, which I’d like actually to be an audio book. So I’m writing it. It’s more about me interviewing people like Steve Cram and that. What are the things that made it successful for you? Talking to an eminent sports psychologist? Explain to us what the things we could do around the sport, psychology, strength, conditioning experts. What a great one that’s joining us in the book. 

So athletes, physios, nutrition, what the five pillars of running success. Yeah, I know, because I was an elite athlete back in the day in a former life that I was looked after by all these different five pillars and it made me a better athlete. And nowadays people have become more serious about doing it. Should we set more amateur levels? Yeah, and I wanted to give people the same experience as the elite athletes by helping them with all of those five elements. And so this book is really designed for treating any runner at any level like they are Paula Radcliffe or Steve Cram and give them all of the things that they really want and need. And it’s never been done before. I’m thoroughly enjoying writing the book and I’m going to really enjoy recording it, because that’s one of the things is, as you’ve shown the audio saying, listen, this is you’re running along, I think would be very motivational, listening to it in the car or maybe checking to see if your trainers are in. So I’m really excited about it.

Darren: Yeah. Now, that’s awesome for me. Yeah. I look forward to that coming out. So definitely, definitely be in the copy. And like you say, is the kind of age group level we know now people are way more into performance and how they can get these marginal gains and all the rest of it. So yeah, that would be fascinating. But thanks again for your time today. I really appreciate it and I sincerely hope that people listening heed the advice.

Paul: Let’s see let’s try and get more than seven percent, then we’ll get the trend of science.

Darren: All right, Paul, thanks very much.

Paul: Yes Darren. Best of luck, everyone.

Darren: Thanks for listening to the Fitter Healthier Dad Podcast. If you enjoyed today’s episode, please hit subscribe. And I would really appreciate it if you could leave a review on iTunes or the things mentioned in the episode will be in the show notes. And a full transcription is over at fitterhealthierdad.com

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