November 2, 2020

Risky Business: Are Training Injuries Inevitable?

Why are some athletes more predisposed to injury than others? Is injury from triathlon training inevitable? On this episode, Dr. BJ Leeper, physical therapist and TriDot coach, shares his expertise and experience to answer these questions and more. Know when to train through discomfort and when to seek advice from a medical professional. Learn how to assess your likelihood of injury and take preventative action against the most common triathlon injuries.

Intro: This is the TriDot podcast. TriDot uses your training data and genetic profile, combined with predictive analytics and artificial intelligence to optimize your training, giving you better results in less time with fewer injuries. Our podcast is here to educate, inspire, and entertain. We’ll talk all things triathlon with expert coaches and special guests. Join the conversation and let’s improve together. Andrew Harley: Welcome everyone to a brand new episode of the TriDot podcast. If you could just take a quick moment wherever you are just hit the subscribe button on whatever podcast platform you’re listening through. We would really appreciate the love from our podcast audience. Hitting subscribe and leaving us a review helps our show find its way to brand new listeners. Thanks so much in advance for doing that. Brand new episode and a brand new special guest on the podcast. I love getting people on this show who are smarter than me and who know more than I do about the topics we as triathletes care about and today is one of those days. We have a brand new expert for you guys to learn from. Introducing Mr. BJ Leeper. BJ graduated from the University of Iowa Carver College of Medicine with a Doctorate in Physical Therapy and Rehabilitation Science. He’s a Board Certified Orthopedic Specialist, a Certified Strength and Conditioning Specialist, and a USAT Triathlon Level 1 coach. He specializes in comprehensive movement testing and injury prevention among athletes and has worked with numerous amateur and professional triathletes, duathletes, and track and field athletes. BJ thanks for coming on and lending your expertise to the TriDot podcast. BJ Leeper.: Hey thanks for having me Andrew. I appreciate it. Andrew: Also joining us today is coach Elizabeth James. Elizabeth came to this sport from a soccer background and quickly rose through the triathlon ranks using TriDot. From a beginner to top age grouper to a professional triathlete. She’s a Kona and Boston Marathon qualifier who has coached triathletes with TriDot since 2014. Elizabeth, thanks for joining us. Elizabeth James: It is always great to be here and I am especially excited today to be recording with BJ It’s going to be great. Andrew: I am Andrew the average triathlete, voice of the people, and captain of the middle of the pack. As always we’ll roll through our warm up question, settle in for our main set topic, and then wind things down with our cool down. Lots of good stuff. Let’s get to it. Warm up theme: Time to warm up! Let’s get moving. Andrew: Whether it’s Michael Jordan gutting it out through his famous flu game or Tiger Woods winning the U.S. Open on a broken leg, stories of battling through injury can be found through just about any sport. BJ, Elizabeth, to kind of warm us up today, tell us about a time in your athletic career where you fought through an injury during a competition, game, or race. BJ it’s your first time on this show so I will let you share your story first. BJ: So my wife is actually a great runner. Boston qualifier back in the day before I met her. I was not into running at all really prior to meeting her. Of course we start running together and actually the paces she would maintain training for a marathon were really challenging for me. We decided we were going to race the Twin Cities Marathon together. This would have been 2006, the fall. To try to make a long story short, we’d train leading up to that race. I’d never been running before and I start getting this knee pain. Just sharp pain on the outside of my left knee. And I had gone through Physical Therapy school, knew a lot of X’s and O’s, nuts and bolts of orthopedic injuries, but I literally thought I had a torn meniscus on the outside of my knee in my lateral meniscus. And as we’re training… Andrew: So you’re trying to self diagnose yourself as you’re running. BJ: Yeah, I figured I should be able to know what’s happening with my body. Anyways we get to race day and it’s a little warmer race day than usual in the fall in the Twin Cities area. We had tapered, I felt great. So we head out the first 3 miles. I’m just this restrained beast. I feel so good, I’m going too slow, I just want to go. And I turn to my wife at mile 3 and I tell her, I”m just going to go for it and see how good I can go. She looks at me like, “Okay, whatever.” So I start pushing the pace way faster than what we had trained. I’m probably going a minute per mile faster pacing wise than what we had planned or what she had planned to run. Things go okay up through the first half. I start feeling a little twinge on the outside of my knee, but nothing major. And then I get to the proverbial mile 20 hit the wall mark. And instantly at mile 20, after the sharp pain came on, I started to just cramp up. Hamstrings both side, calves both sides. In my mind I’m thinking, “I’m just dehydrated,” so I just start walking at that point cause I can’t muster up a run. And I just start drinking any water I can find in sight. I’m just drinking as much water as I can, not taking any other type of nutrition in. Pretty soon, mile 21, the horizon starts to get wavy and I can barely see straight. I’m thinking something is seriously wrong with me and again I’m thinking it’s just a hydration issue. I just keep chugging water and in hindsight I was actually becoming hyponatremic, making my electrolyte balance even worse by just taking water. So I’m at mile 23 roughly and just like the tortoise and the hare, here comes my wife just trotting along. I see her out of the corner of my eye, you know it’s a big race, and sometimes you can’t see everybody as you’re passing. She passes me and I yell to her, “Jodie!” and she turns and looks and she had actually thought that I had finished the race and had come back to jog the rest in with her. Like some stud that’s just jogging after the marathon for a cool down cause they didn’t get enough out. Andrew: How nice of her to think that. BJ: I know. So she looks at me and she thinks I’m just running it back to finish with her. Well she gets closer and sees that I’m white as a sheet and I literally the next 2 miles I have to throw my arm around her in order to just walk straight because not only was the pain in my knee significant, but I was just getting pretty messed up at that point. And there’s this race finishing picture of both of us finishing together just like my wife had wanted. The look on her face is like this smile of pure joy. My face looked like death worn over. We finished the race. I felt bad because I totally took her off her pace and she had to just help me finish. But it was just this gut wrenching just getting through not only that knee pain, but this horrible imbalance in my system just for being foolish in how I approached it. A long story to kind of tell about my pushing through an injury but it kind of goes along hand in hand with my humble entry into the endurance sports realm. Andrew: Everyone should feel a little bit better in the fact that a doctor in Physical Therapy has also made poor decisions out on the race course at times. BJ: Oh man. The worst, the worst decision. Andrew: It also makes me wonder how many spouses out there have had to help another spouse to finish a race because Elizabeth on the podcast has shared a story of having to help her husband to the finish line of a marathon from fighting through the flu on marathon day. Elizabeth: I feel like we could have a marriage and marathon story series or something. There’s probably a lot of good ones out there. BJ: Exactly. Andrew: Well, Elizabeth, for you what was a time in your sporting career, whether it was soccer or triathlon or running that you kind of braved your way through an injury in competition. Elizabeth: Well yes goodness, I certainly have a story or two on that topic and like you said going back to a knee injury in soccer. There’s some great battle stories along the way, some of which I’d be embarrassed to admit in front of our Physical Therapist expert BJ here, as I’m sure he would not have advised racing in some of those injured states. Andrew: You get through the race and you call BJ and tell him what you did. Elizabeth: Right. Ask for forgiveness later. But for me, I think my most memorable injury was an Olympic distance triathlon I raced in 2019 where I had crashed on the bike, I broke my right hand, and yet decided to continue to finish it and actually won the event. So that was the battle through injury that had a happy ending. Andrew: Yes, when we say Elizabeth is our resident pro triathlete here at TriDot she can crash, break her hand on the bike course of an Olympic triathlon, and still win overall female for the entire thing. So when I talk about she’s faster than me, that’s what I’m talking about right there. I figured you might share that story, and you should share that story because unlike me and BJ, when you have something go wrong on the course, you still were able to have success and we love watching that and cheering for that. Main set theme: On to the main set. Going in 3…2…1… TriTats: Our main set today is brought to you by TriTats. 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Andrew: With all the training we’ve put in to succeed as triathletes, injuries have long been thought to just be part of the game. From stress fractures and muscle strains, to sore shoulders, backs, and knees and feet, there are multiple physical afflictions our beloved sport can incur upon our bodies. So, a big question of course is are there things we can do to prevent injury in the first place? Or are injuries just simply unavoidable in our sport? These are the things we will kick around with Dr. BJ Leeper. BJ, as we make our way in to talk about injury, I just want folks to understand that we just have industry leading knowledge with you on the mic for this podcast. Can you kind of give everyone the highlights of your education and your experience in this field of physical therapy and functional movement? BJ: Back when I was in undergrad, I went to college to study Biology and play basketball and that was kind of the thing. I ended up graduating with a degree in Biology and Chemistry in 2001. I got my Bachelors’ at that time and then I thought I was going to go into research honestly. I was thinking about Med school and then got into the Anatomy and Cell Biology department at the University of Iowa doing some research for them and I thought that was going to maybe be my path and I ended up deciding the world of research wasn’t for me. I actually pursued physical therapy. I wasn’t really aware of what Physical Therapists did because oddly enough I was in and out of the training room in college, I had only ever worked with athletic trainers and had never really had experience with the PT. A family friend of ours introduced me to a sports physical therapist in the area I was living and I shadowed him for one day and was instantly hooked in that field and just loved it. Outpatient orthopedic and sports was the avenue I chose and so I went to the University of Iowa and got my clinical doctorate in PT in 2005. I ended up working for a group out of Kansas City doing sports and outpatient ortho, became board certified in 2012, and then just got into the world of functional movement testing. There’s some stories behind what got me into that. But I actually began studying functional movement in 2007 when I first started working under the umbrella of Titleist Performance Institute out of Oceanside, CA. Andrew: And that’s Titleist, the golf company, correct? BJ: Yeah, so they had a performance division and I did a lot of training under them because I was going to become the world leading expert in golf fitness and correction in the Kansas City metro. That was the original path I started on. In 2007 then shortly thereafter I got hooked on the sport of triathlon and just shifted gears and I started working with TriDot training plans and programming way back in its infancy, probably back 2012. I’m kind of back with the John Mayfield era where I can remember the old Excel spreadsheets and all the stuff as we were getting into it at that point. Andrew: People that are used to the TriDot app have no idea what the original TriDot athletes went through to get their training plans. BJ: It’s like I’m starting to feel old talking about back in the day when we had Excel spreadsheet driving our training. But after doing some study in functional movements creating and testing, I have just adopted a lot of those practices into the clinic where I’m at now. I’m up here now in NW Montana. My family and I moved up here back in 2017 in outpatient ortho and sports environment here. It’s kind of my path, it’s been great. I love what I do and I’ve just really become passionate over the last 10-12 years about triathlon and screening triathletes, helping dive into how can we keep triathletes healthy and performing even better. Elizabeth: That’s awesome. Thank you for kind of giving a run down of that. As Andrew was saying, it’s great for our listeners to have a better understanding of your knowledge and expertise. That we’re not just asking somebody, “Hey, what do you think about injury?” This is somebody who has really studied this and devoted a lot of their professional career to these specific topics. Andrew: And with endurance athletes in particular. Elizabeth: So, BJ, plenty of our listeners, myself and Andrew included, have had a variety of injuries throughout the years. It seems like some athletes stay healthy no matter what they’re putting their bodies through, where there are others that just seem to be predisposed to have injuries all the time. Why does it seem that some athletes are more likely to get injured than others? BJ: That’s a great question and honestly it’s tough cause there’s so many variables. I always feel like I'm taking a page out of these guys who have gone before me, some of the smartest guys in the field of health and fitness and medicine. It seems like when they’re faced with these tough questions, their answer is always two words, “It depends.” I feel like that’s always a cop out answer. But if the smartest and the brightest are saying it, it’s got to be a thing, right? So the true answer is it depends. There’s a lot of variables that feed into injury predisposition and we always talk about and we know that the biggest predictor of future injury is previous injury. Your past history of injury, whether that’s overuse or traumatic, will obviously influence the body’s potential for increased risk in the future. That’s one of the things. There was an interesting study in early 2000’s that came out of Journal JOSPT, which is Journal of Orthopedic and Sports Physical Therapy. It’s a great peer reviewed journal. They were looking at hundreds of triathletes out of Australia and tracking these athletes through a six month preseason phase and looking at their competition season of about ten weeks and they were actually looking at and seeing how many of these triathletes got injured in the course of training, preseason and competition. And consistent with a lot of research that’s out there on (there’s not a lot on triathletes specifically, but runners and cyclists in general) it showed that 50% of those triathletes experienced injury. Injury defined as taking them out of training or racing for at least one day. I would think that it’s even higher in a lot of certain areas. Andrew: So you said 50%, so half? BJ: Fifty. 5-0, yeah. At least half. Out of those 50% that experienced injury, what they found was that many of the main factors tied to those 50% were previous injury history. They found that increased years of triathlon experience was a correlating factor, not their age, but their age in the sport. Even if they’re younger chronologically, the number of years they’ve been in the sport, the older you are in the sport, the more high risk you are for having injury. Increased hours of volume specifically of pre season running training was actually a correlating factor. For every extra hour per week of pre-season running volume wise, it showed a 12% increased risk of injury. Some of these predisposing factors that we can see with some literature that feeds in. But a lot of it is we all have these previous experiences that sometimes set our bodies up unsuccessfully for the future. It’s just a matter of what happened, when did it happen, how long has it been going on for. Even if there’s no history of injury and none of those other factors, I think we all have different thresholds in our genetic makeup. We can all run ourselves past threshold and when we go past threshold, there’s an increased risk. Just like any car. Some cars can drive 90, no problem. Some cars can drive 140, no problem. But every car has a threshold if you drive it long enough or hard enough or fast enough it would break down. Some people are just good at staying under the threshold and some are probably pushing past their threshold on a daily basis. Elizabeth: Well I’m so glad that you brought up that genetic component too because this is something I find absolutely fascinating about the optimization that TriDot does with our training plans. There’s so many amazing things that the technology can do that drives athlete training with TriDot. We are able to leverage predictive analytics, machine learning, artificial intelligence and we have nearly two decades of athlete data to offer these unparalleled training optimization with. But specifically speaking to injury predisposition, there are these additional insights from an athletes genetic profile that can be considered within that as well. And so I would almost feel remiss if we didn't’ mention that TriDot athletes have the opportunity to have their PhysiogenomiX analysis as part of their training which can be completed by uploading their genome from Ancestry.com or 23andMe to their training plan and then that’s going to include detailed results of more than two dozen genes that are directly linked to training intensity response, aerobic potential, and then recovery rate and injury predisposition. Knowing the genetic component of your injury predisposition, how genetically prone you are to those soft tissue, tendon and ligament injuries, from training really allows for adjustments in the training plan to really help reduce that injury risk too. Andrew: So, Elizabeth, as you’re listening to BJ talk, you’re kind of honing in on the PhysiogenomiX aspect of what he’s talking about. I heard him talking and I immediately thought back to last week’s episode where we talked with TriDot founder Jeff Booher about training stress and the NTS metric we use at TriDot to measure an athlete’s training stress because, BJ just said it, your body can only take so much time at threshold or above threshold before it starts to break down before you risk getting injured. So I’m thinking back to that. If you didn’t catch last week’s episode, make sure you go back and listen because the training that we have at TriDot (shameless plug, we don’t intend for training to come up in every single episode), but it is designed to try to keep you healthier and keep you in the game and try to mitigate those junk miles that aren’t going to improve you all that much but come with such a heightened injury risk. BJ there is this huge stigma with triathletes, Ironman in particular, that we’re just kind of gluttons for punishment, right? And that we’re more injury prone than many of the athletes from other endurance sports. Is this a true stereotype associated with us or is this more of a myth that we’re more injury prone? BJ: Funny story, this is what catapulted me into really being passionate about this with triathlon. Going back to probably 2008-2009 when I was doing some of the training under Titleist, I was out in Oceanside, CA talking with some of the greatest minds in our industry (these world renowned PTs and MDs and chiropractors) and one of the PTs in particular had just finished giving everyone a seminar. And I’m sitting there, surrounded by all these really smart guys, and one guy in the room after the session (there’s probably about 10 of us sitting around a table just shooting the breeze) and one guy piped up and asked the lead conference seminar speaker, because he knew this guy owned his own PT practice and was operating that, and he said, “Hey, 5’ o'clock on a Friday, who’s the last type of person you want to see walk through your doors?” I was sitting there thinking, “This could be interesting.” I was expecting him to say some type of chronic pain patient or some really tough PT clientele and he doesn’t even bat an eye. He just looks at us and says, “It’s easy, a triathlete or an ultrarunner.” And I felt offended. I had just gotten into triathlon and it’s such a great sport, it’s multisport training. You exercise, you’re healthy. And he just looked at us and said, “Triathlete or ultrarunner, easy. I’d hate to see them walk through my door at 5:00 on a Friday.” And so everyone’s like, “Why?” And he says, “A: because they play slave to their training. They won’t give it up no matter how much I tell them they need to.” Andrew: Guilty. Elizabeth: Yeah Andrew and I right now have guilty looks on our faces like ooh. BJ: He’s like, “I can’t get them out of that. And B: they just continue to drive their bodies in sagittal plane, which is just forward. They don’t have any complementary training for their body. And so their body just runs down this road of more and more dysfunction and they don’t change it. And not only that, but they’re putting a lot of volume into that pattern.” It was after that time where I was just like, “This can’t be. This has to be changed. What can we do?” Like that whole summit with future proofing triathlon. We’ve got to do something. So this is back in 2008 and I remember thinking this is such a motivated, healthy, and generally fit population of athletes. It shouldn’t be they have a target on their back that they’re always injured or people just know there’s this stigma associated with triathletes. They are just a ticking time bomb or train wreck. You don’t want to see them walk through your doors. We’ve got to change that. Shortly after that I started talking a lot with Jeff Booher and he and I had tons of conversations about these types of things. We then, probably 2014-2015, we were running the pro camp out of Dallas and I went down there and we started screening some of the pros he was working with. We had probably 10 pros at these camps on 2 different years. And I remember thinking I really want to get my eyes on these guys and just screen them because I know these guys are at the top of their game in the world of triathlon. I just want to see how do they move. Do they really move poorly or what does their injury predisposition truly look like? And I remember we had a questionnaire we gave all these pros and in the questionnaire we asked them what is your previous injury history. We even qualified it by saying injury had to be defined as taking you out--and I made it long because I wanted to make sure it was a true injury--two weeks or longer which took you out of training and/or racing. So two weeks was the qualifying factor. And I expected, these guys are young, they’re in their 20s, in the prime of their fitness, by making that a 2 week qualifier that each person would maybe have one in their history that would have taken them out that long. We had a laundry list from these guys. These guys are great pros and we had a laundry list of on average about 4 significant injuries per athlete that they listed that took them out of training or racing for more than 2 weeks. It was just confirmation that these guys are hurt and they’re hurt a lot and what can we do? Some of the things we tested and we screened--Jeff has alluded to this before in a podcast--some of the factors, cause the movement screens we did, they didn’t move a lot different than our amateurs. So it wasn’t a physical prowess thing as far as just functional movement that made them elite or professional level. We found with some of the tests they could literally just endure more pain and suffer more. And I just think watching videos and movies about Prefontaine, that was always the thing surrounding him. These guys can just gut it through more. They can hurt more, hurt for longer. That’s what makes some of these guys honestly the best at what they do. But having said that, you can only do that for so long before it comes back to bite you, right? So looking at that, it’s a thing. It’s a true, true thing. Everyone in our industry recognizes it. Especially with the world of endurance sports and triathlon. Again, it’s definitely true. It’s not a myth, that’s for sure. Andrew: In my previous job at a television network I worked at, there was a girl there who is an ultrarunner/marathoner. She and I were probably the two most experienced endurance athletes on staff and triathlon was my hobby, marathon and 100Ks and 100 milers were her hobby. And we would always laugh because I was faster than her at 5K/10K, but on the year Strava will give you your end of year how many miles did you run. And she would routinely, in the 4-5 years I was on staff, have about 2500-3000 miles running a year. And that was farther than I swam, biked, and run in a year on TriDot training for 70.3s. I, throughout the year, would have these little foot pains that would take me out for a week, a little knee thing would take me out for another week, and she can just keep up those miles. 3,000 miles a year of running and she seems to never have an injury and it would just almost boggle my mind. I was happy for her that she’s that way, but why is she that way and I’m not that way? So, being a triathlete in practice with the day to day training, the 3 sports, the strength stuff, all the meters and miles, with everything that we do, can injuries actually be prevented? Are there things that we can do to make these things not happen to us? BJ: Again, a great question. I think that we could go back to “it depends.” With everybody having a different history, whether or not the girl you mentioned, it would be interesting. Who knows her previous history? Has she ever been injured before? If not, maybe that’s why. Who knows. How does she move outside of running? What’s her body fundamental movement capacity or functional movement capacity look like? What’s her fundamental movement pattern? There’s this adage that I’ve adopted at the clinic and we talk about it a lot just with honing in on your true deficits. How can we prevent? And what’s interesting in our world of medicine is just how much we react within our medicine. We’re so much reactive versus proactive. We pop a pill when things hurt, we focus on this once we’re finally hurting and it has just literally shut us down. There’s some areas of our health system that don’t do this that I think we really need to learn from and adopt. Look at dentistry, for example. How many people go in a couple times a year to their dentist because they know they should? Prophylactic care. And when there’s no issue. We don’t do that in the area of fitness and rehab. We react when it hurts. So I think the key is this adage I’ve learned lately that I’ve been using a lot that you don’t go to sniper school to learn how to shoot. You go to sniper school to learn how to aim. And I think that’s the key is what are we aiming at? How can we become a sniper within our own fitness and preventative care? Versus just shooting at a bunch of things. I think we try to be proactive in some regards and I think a lot of times we’re just shooting at things. We’re following “my magazine told me the top 10 things I should be doing” and… Andrew: Here’s the top 10 stretches all cyclists should be doing before your rides. BJ: Right yeah. And maybe you get lucky and one of those things catches you when you need it and it helps. But maybe you’re just shooting and just exercising and putting fitness on dysfunction. And maybe you’d be better off not doing any of those. That’s assuming that any of us are even taking the time to pursue something. A lot of us don’t even take that time to pursue something else. So I think the first key to prevention and really setting our bodies up right is just being a sniper and I think that starts with knowing your body, knowing your previous history, and thinking about “I know I’ve had this issue before, and maybe it’s not an issue now, but I want to make sure it doesn’t become an issue later.” What can I do to pursue something to affect that? And I think the best way to do that is to seek a professional. And obviously I’m biased, cause this is what I do. But I think seeking a professional that’s good and that becoming a sniper for you and helping you with that. Cause it’s not just about the area that you hurt either. That’s another thing that’s important to know that we work collectively as a bunch of patterns of movement and we’re collectively a bunch of parts put together to move in patterns. Your knee hurts, but it’s not always just your knee. Maybe it is and maybe it isn’t. But you need somebody to help you there and to give you some guidance. And a lot of times professionally when we seek help from someone that can help us be a sniper, it’s not someone that’s going to help us turn something on. I always find that the best professionals out there are really good at what they do, not because they help somebody turn something on like a strength training thing. But honestly they help people turn things off and they inhibit the area that might need to be turned off in order for you to then turn something on. And we could get into a whole podcast on this alone. But at the end of the day, I think a lot of times we need to be able to control the variables we can control. It’s like going to a self-help seminar: the only way you can know how to start helping yourself is acknowledging there’s a problem. So I think that’s a start. We have to acknowledge that we have to be proactive, not just reactive. We need to be snipers in our corrective exercise training. Elizabeth: I love that we can learn to be snipers and be a little more proactive. And one of the things that, as you were talking about this, came to mind as a question. I know that I’ve come across this with athletes I’ve been coaching, I’ve thought it myself. BJ, I’d love to get your thoughts on this. When an athlete does feel some pain or discomfort starting to creep in, whether it’s a muscle, joint, etc., how do we know when to train through it? When to take some time off? Or when it’s time to head to a doctor or physical therapist to get some help? BJ: Again, great question. I think there’s a lot of things that I always tell my patients. Nobody knows your body better than you. So I think our own natural intuition really serves us well. You might have somebody that knows the physiology of your body better than you. But you naturally have this intuition of what’s working well, what’s maybe not working well. So I think I’m always telling guys when in doubt, don’t. When in doubt, probably not a good idea to push through something. But when is it time to actually ask for professional help? I think sometimes we can categorize our injuries into 3 different buckets. Sometimes it’s hard to know exactly. But a lot of times an injury can be due to mechanical stress. Whether it’s a joint mobility dysfunction or tissue extensibility issue, basically saying whether you’re stiff in a muscle or tight in a joint. Sometimes it can be chalked up to that. Sometimes it can be literally a chemical issue. You’re in an inflammatory state and you might need a little help to get that under control. And sometimes over-the-counter type stuff can cut it, but how do we know when to take something even over-the-counter or when to pursue help? Sometimes it’s a neurological issue. It can be, not a hardware issue, but a software issue where the computer is frozen and it just needs a reset. Again, I think guidance when in doubt can help you here. But it’s getting the correct guidance. And that’s the other big issue. I’m in the world of PT and, to be quite honest, there’s a lot of good PTs out there and there’s a lot of bad ones out there, unfortunately. And I think that when you feel that intuition to pursue help, the key is using your resources to try to get good direction. Sometimes you might know somebody that had good outcomes with somebody. But a lot of times you need to pursue and truly be an advocate of your own care. You need to go and try to sample different people that might be able to help you. Some may be better suited than others. I think a lot of times I’ll hear people tell me that they tried physical therapy and it didn’t work. And I always tell them, “Maybe you didn’t get the right therapist.” Because there is a huge difference sometimes. You don’t hear many people go to a medical doctor for something and, maybe they didn’t have a good experience say, “Well, I tried medicine, it just didn’t work.” Usually they’ll be like, “Well, I didn’t really jive with that doctor, I’m going to seek a different opinion from a different doctor.” I think the same should hold true in our world of physical therapy because this is what I do and I’m biased, but physical therapy can be hugely helpful. As can chiropractic care. There’s a lot of different professionals. Something funny I heard the other day I thought rang true in my world and how I like to look at things, too, is if you can go to a provider, whatever scope they are in general (chiropractic, PT, massage therapist), and you can tell what they are, then they might not be the right provider for you. Does that make sense? So what I usually will describe for people is if they’re holding a lot of variable tools they can use for you, you want to go to someone who has an eclectic approach. If they already know the treatment plan before they’ve even diagnosed you, you’re going to the wrong place. For example, if I go to a chiropractor and I know it’s going to be I go in, they’ll put me on a table, and they crack my back and that’s all they do. Or I go to a PT and they’re going to put me on a table and give me some bands and have me do this exercise. If you’re going to a provider and you instantly know what they are based on what they’re having you do right out of the gate, maybe have some skepticism there. I’m not telling people to buck everything. But I think the key is finding that right person that you have in your camp is a huge deal to getting you back on course and healthy. Getting back to the original question, “How do you know when it’s time?” I think your body will tell you. Again, it’s that “it depends” answer. Another layer of that is if basic movements hurt, meaning if I’m just standing and I reach to touch my toes and it hurts…or if I’m just standing and go to touch my toes and it hurts...it’s definitely not a fitness issue. It’s a health issue. And at that point, you probably need to be screened. We say, “I’ll take some time off or I’ll just push through it and it gets better.” Well monitor that because sometimes it’s not a matter of if you’re going to blow up, it’s when you’re going to blow up. And you might be down a road that’s even harder to get back from. So the key is knowing your body and seeking help early on. If you can catch things early, it’s definitely a good thing. Elizabeth: And to really pay attention to those cues. Once something is not feeling right, it’s not “It’ll be okay.” But really hone in on… Andrew: Don’t ignore things for 2 weeks and then wonder why you’re out of commission for 2 months after you finally go see a PT. I’ll offer BJ a quick, concrete from my own oft injured background. There was a time, a few years ago, before I was on TriDot--I was a triathlete, but not on TriDot--and I was experiencing some discomfort and pain in my left knee. I couldn’t run farther than 2-3 miles before my left knee would just shut me down by hurting so bad. I went and saw an orthopedic specialist. He looked at it and he wasn’t a triathlete, but I could tell he seemed very knowledgeable about runners and running injuries. So after he asked a bunch of questions, poked and prodded and bent my knee in a bunch of ways, he proceeded to tell me, “I see this kind of knee issue a lot in athletes that only go straight forward and never move side to side in their sports. The kind of knee pain you’re having, I see this frequently in runners and cyclists.” He didn’t believe surgery was necessary, he gave me a list of stretches and exercises to do. He said do these two or three times a day for the foreseeable future. He said cut back to doing these semi regularly in your routine. And guess what? I did that, it went away and as long as I continue these stretches as part of my routine, I stay healthy. But I could tell from the way he was telling me that yes I’ve seen this in runners and cyclists because all you do is go straight forward and there’s no lateral movement in your sport that’s why you’re seeing xyz. I think what you’re getting at is make sure the doctor that you’re seeing isn’t just putting you through the motions he puts every athlete through. But that he’s understanding of what you do as a triathlete and your situation. Is that kind of the take away there? BJ: Right and again, along those lines, you need to find a provider that listens to you. We talk a lot in our clinic that people don’t care how much you know until they know how much you care. Obviously the background and knowledge is important. But if you’re with the smartest guy in the world and he already knows what he’s going to do and you’re telling him your story and can tell he’s not listening to you, I’d go somewhere else. You have to have a provider that listens to your story, gets information. Because one of the biggest predicting factors is previous history. So if you’ve got somebody that will listen to your history, you may have something that you might not even think is important, but if they hear it, and if they’re truly listening--it helps them become the best sniper for you and dial you in, that’s exactly what you want. A little bit of time spent with the right individual can mean a huge difference in how you perform and how you move and setting your body up for success. That’s the thing I think a lot of times in our world of endurance training we’ll say let’s just take some time off and let it recover. That might work in some situations, but if you didn’t change anything--outside of just resting--to your body...what do you think is going to happen again? It’s not a matter of if it’s going to happen, but when. It will likely cycle back up again if you start running past threshold like you were before. The key is not just rest, although that might be needed, but attack it with a purpose. Make sure your intervention is where it needs to be. A little bit of corrective work in the right area can make a world of difference. Andrew: I want to share all of our athletes in the TriDot podcast family, BJ you and I connected a few months back talking about having you on our podcast on a regular basis. At TriDot we recognize recovering from our workout sessions is important. Staying healthy and knowing how to navigate injuries and pain and discomfort. It’s all vital to being an athlete in this sport. We already talked about having some episodes where we spend 45 minutes talking about particular body parts. What are the most common knee issues? What are the most common running issues? When you see pain in the feet, what are the most typical things there? So we’re going to go body part by body part here in the future. We’re also going to hit full podcast episodes talking about compression, dry needling, cryotherapy. All the specific things and strategies we can do to help ourselves recover. So a lot of really great information coming with the TriDot team and BJ Leeper. BJ, to just leave us as we’ve talked about injury, and trying to prevent injury and navigate injury and why we even get injured in the first place, what would you say to leave us today with a few high level top tips you would give our athletes for avoiding injury? BJ: So the ideal scenario is to get screened and see where the deficit is and attack that specifically for that individual because it’s going to be unique for each person. However, if we had to throw a grenade and if we had to take as many people down with one or a few philosophies of treating the body, the areas we would target in the PT world...we talk about mobility and stability. Mobility is what people talk about when they refer to flexibility or stretching or what not. Stability is what a lot of people would call strength. However stability is different than just isolated strength. It’s the right muscle at the right time, all these different things. What’s fascinating about the human body is that in our perfect design, we operate within this pattern of regional interdependence. Not to get too sciency on it, but if you think about how our body is designed, each area of the body has unique properties of both mobility and stability applied to it and how it performs for us in those areas. Each area does a little more of one than the other when we’re operating in full, normal function. For example, our feet need to be stable. They need to be mobile, but they really need to be stable. A lot of research and R&D go into shoes to help us with this. We know the foot naturally needs to be stable. You go up the chain next to the ankle. We need a little more mobility in the ankle. You go to the knee and the knee needs to be stable. You go to the next joint at the hip. The hip needs to be mobile. Obviously it needs stability too, but it needs mobility. The next area is the lower back. The lower back needs to be stable. Andrew: I’m picking up on a pattern here, BJ BJ: Thoracic spine, your mid back, needs to be mobile. Your scapula, shoulder blades, need to be stable. The shoulder joint needs to be mobile. So this interesting pattern in a lot of us, especially those of us that live in America, we sit a lot. Sitting is the new smoking. We tend to lose those patterns in some way, shape, or form. Especially in triathlon. We’re hunched over on the bike and we tend to lose some of these patterns. Again, if we could throw a grenade at triathletes and we just started talking about mobility first, we could probably cover 75%-90% of triathletes that need these techniques. If we targeted three main areas of mobility, especially in triathletes, it would be ankles, hips, and t-spine or mid back. So those are the areas that need to be mobile like we’re talking about. And a lot of triathletes and runners that I screen all the time are horrible in those areas. Andrew: I sense a mobility and stability podcast episode in our near future. BJ: Again, there’s a lot of techniques that you could throw at those 3 main areas for mobility. But, in general, a lot of people could intuitively figure out what their body needs in this regard. If you’re attacking your ankle mobility, your hip mobility, and your thoracic mobility on a regular basis, you’re going to solve a lot of issues for yourself without knowing any other information. Cool down theme: Great set, everyone! Let’s cool down. Andrew: Just a few episodes back, on episode 56 to be exact, Elizabeth and I talked with TriDot coach Jeff Raines about marathon and half marathon training. At the end of that episode, we wanted to share some marathon stories from members of the podcast audience. So we got several great submissions. But only one could make it onto that marathon episode. Today I want to share another story from a TriDot athlete. This comes from Lauren from Michigan and she shares about taking on a scenic course and fighting through injury to get to the finish line. Lauren: Back in 2014, I was scheduled for my 5th marathon. Mountain to Beach Marathon in Ojai, California. I was hoping to requalify for Boston, getting myself in pretty good shape. And about 3 weeks before the marathon, an old ankle injury just flared up sort of out of the blue. It got to the point that I could hardly walk normally, let alone run. I took 2 weeks off before the marathon. Not running, I would try to get through a mile or 2. We were headed to California, me and my boyfriend at the time, and decided to make a go of it. At the start line, I told myself to just get through the half, I could call it quits after that. I powered through the half and I was cruising. Everything felt good. I was holding a 7:40-7:45 pace. I told myself it’s starting to hurt, but I’m going to keep going. Around mile 16, it’s really talking to me. And all of a sudden the marathon narrows down from nice, open roads and winding to basically chain length fence, 6 feet high on each side of the sidewalk that we’re running down. There’s only refreshment or break stops every couple of miles. So by the time I get to one of those break stops I’m at mile 18 and I think I shouldn’t stop now. I should keep going. I’m really gimping along at this point. Another couple miles, now it’s mile 20, I might as well finish. I decided not to stop and and that ankle is talking to me. The race continues to slow down because that hurts. By the time I got out from that chain link fenced in area where there would be any reasonable way to get out of there or have someone pick me up, you’re at mile 23 and you can see the finish line. You can see the ocean, so obviously you’re finishing. So I gimped through the last few miles of that race, finished okay. Obviously not qualifying for Boston, but respectable. Around a 3:45 or so marathon. My ankle was the size of a grapefruit within 3 minutes. Just a wreck. And I felt kind of silly for finishing. Obviously I could have hurt myself quite a bit. But I was happy I finished. Disappointed with the time, but obviously that was the best I could do on that day. I was probably a little foolish for running on that day, but I did it and we moved on with our vacation. The next day we had dinner reservations and I’m gimping around everywhere. I can’t do anything cause that foot is a wreck. And my boyfriend at the time is dragging me down the road late to our reservation and I’m thinking, “I’m injured here and you’re dragging me all over town.” We got to the restaurant and at the end of the night he got down on one knee and proposed and we’ve been happily married for 5 years. A bummer of a marathon story, lessons to be learned not to run marathons on hurt ankles, but it ended up okay and obviously a happy ending. Andrew: Well, that’s it for today, folks. I want to thank BJ Leeper and TriDot coach Elizabeth James for talking injuries with us today. Shout out to TriTats for partnering with us on today’s episode. Head to tritats.com to get everything you need to make your mark on race day. And make sure you use coupon code TriDot at checkout. Enjoying the podcast? Have any questions or topics you want to hear us talk about? Head to tridot.com/podcast and click on “Submit Feedback” to let us know what you’re thinking. We’ll have a new show coming your way soon. Until then, happy training. Outro: Thanks for joining us. Make sure to subscribe and share the TriDot podcast with your triathlon crew. For more great tri content and community, connect with us on Facebook, YouTube, and Instagram. Ready to optimize your training? Head to TriDot.com and start your free trial today. TriDot--the obvious and automatic choice for triathlon training.  
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