Stay on Track: Running Injury Prevention with Blaise Dubois

Foreign.

I'm charlie redding.

And I'm claire fudge and this is.

The tribe athlon podcast.

The first days pain is always a good thing to tell you, okay, don't do it. The senior of pain have one interest make you avoid the gesture, the posture, the movement that is painful.

That was Blaise Dubois and this episode is Stay on running injury prevention. Blaise Dubois, a former consultant for Athletics Canada, has a notable background in sports psychotherapy. So after graduating from university in 1998, Blaise quickly specialized and earned a diploma in sports physiotherapy. He's now a very respected figure in preventing running injuries. He co owns a physiotherapy chain of clinics and he's the founder of TheRunningClinic.com where they help runners avoid and recover from injuries. So I got the opportunity to chat to Blaze about the psychological stages. That's difficult to say the psychological stages of an injury, the impact of nutrition on injury and recovery. I really enjoyed chatting to him about barefoot running. So something that we know, is that a kind of trend, a fad or is it really worth going back to? And also the concept of training with pain. So I know you're really going to enjoy this interview with Blaise Dubois. How would you like to grow your business whilst working less and enjoying your work life more? Well, that's how we help people at the Trusted team. We do that through workshops which happen in person and online. We do that through regular online learning that you can just do from your desk at lunchtime and and we do it through in person events that make fun tax deductible things like golf days, dinners, wine tasting, all of that fun stuff. They help you build stronger relationships and enjoy work more. So if you want to know how we can help you grow your business and improve your work life balance, go to thetrusted team to find out when our next free taster event or free webinar is so that you can find out how we can help you grow your business and get your work life balance back. That's thetrusted team. Come join us at one of our events.

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So, Blaze, welcome to the Tribe Athlon podcast. Really looking forward to chatting. I know there is so much that we're going to be able to cover today. I always like to hear the story behind the, the person that we're interviewing to start with. So tell us a little about your Swiss roots and about your running background and, and then maybe go into your professional roots after that.

Yeah. Hi, Charlie. It's very a pleasure to be, to be here with you. So my Swiss root, I'm born in Switzerland, the French part of Switzerland. And I immigrated in Canada when I was 10 years old. But I live in the mountain, isolated, in a house that have. The bathroom was outside. There is no hot weather. But I have very nice memories of my young age. And I remember we were in a school in a village where we were seven from the grade one to nine, all in the same class. So it was really like the old. So we never see that anymore, but it was. I have very nice memories about that.

Fantastic. And tell us about your running because you're a runner as well. I mean, I know that predominantly we're going to be talking about your profession as a, in the, in the kind of injury prevention space, but tell us about your own running background.

So I started running when I was 7. I remember in Switzerland I go see my grandmother that was at 7k from my house and I enjoy running, I have no idea why. And I start running like that. My family did never run. I. We didn't have TV when I was young. I don't know, I was just loving jogging. And so I, that was the first time I was jogging and not very regularly. But when we arrived in quite a Quebec in Canada, I was pretty good for the 1k at school and I was winning the 1k. So before the Olympiad I was training a little bit and, and when I arrived to the secondary school, I started to the cross country to go at the provincial championship and have a lot of fun for running. And I become 800 runner. So when I, I was more a fast runner. So for the 800 I run until university I run. I was not a very good one, but I run two minutes flat on, on 800. And so that was the beginning. And after that I finished university in 1998. And at this point I started to do road race, 5k, 10k. I run two marathon and I start to run trail and now I'm running just trail and because I enjoy to go explore the mountain, I start to do ultra trail. But I'm very bad. I'm very, very bad. I did a 100k in Mexico last, last fall and it was, it was not very good. But I enjoy to like be on my feet long time and to explore many mountains, see beautiful part of the world. So that's my story about running.

Awesome. And I think, I think you know, it's all relative. I realize that. And you got you dealing with some of the top, top runners in the world. So I get what, how, why you said it. But there's going to be a load of people that are listening to this going. You call yourself a very bad runner and yet you've just run 100 kilometers. So it's, it's kind of, it's all, it's all relative, isn't it? But I get, I get what you mean. And so what took you into your profession? So give us, give us kind of the summary of your profession, but also what took you into that profession.

Yeah, so when I was young I was always injured so I was in contact with physios and I say okay, this is the job I want to do like help runners and soccer player because I was playing soccer when I was younger too to, to be able to, to do their sport, to be functional and. And I make my. At Laval University at the medicine faculty there is a physiotherapy program in Quebec City. So I, I did it. I finished in 1998 and just after that I become a physio full time. Most of my caseload was runners. So I develop an expertise on this and I start to give conference to give courses for health professionals. I become owner of PCN physiotherapy clinic. It's a group of 14 clinic. Now I am one of the main owner of this group and we have 240 employees. And in 2008 I founded the Running Clinic that is a continuing education organization that go around the world to teach courses about running, injuries, prevention, treatment, diagnosis, etc. And we have actually probably 50 speaker around the world. We have a big part of our business that is done in France. We give close to 100 course per year now. So it's a lot. And we develop Italy this fall I will move, I will go in China and Japan, we go in Norway and Greece. So we go pretty everywhere. And yeah, and I was knowing that I need to speak English to teach, to teach around the World So you know, when I immigrated in Canada, I immigrated in Lac St. Jean. It's north of Quebec. And nobody speak English there. So my first real contact with the language was pretty late in age. I was adult. It was at university that I was reading scientific article in English. And I have a hard time for doing that. The beginning. So we decided with my wife to go three months in B.C. the west of Canadian to learn English. So we go there in a family and we. During three months I didn't speak English with French. Sorry. With my wife. And we were there with my kids. I have one daughter. One. One daughter and one son. And my wife was pregnant. And we go there in a family. And the morning I was going to school, the afternoon it was my wife and we mix it. And after three months I realized that my English was not really better. So I have a very hard time with this language.

Yeah, well, you're doing excellently and it's your. Your. Your. Your English is dramatically better than my French. So no, don't worry, you're absolutely fine. Now I know having. I know some of. About some of the content that you teach in the running clinic.

But you.

One of the metaphors that I picked up that you talk about a lot about is peace and love. So is that a good way to explain the type of education you provide in the running clinic? And if it is, explain what you mean by peace and love.

Yeah. So yes. You know my personal why it's in French we say grandi like growing by innovating. I don't know if it's. The translation is good.

Yeah.

But I keep time in my schedule to think, to be creative and to develop some tools and some theories for health professional. Because I teach that and many people was knowing the price. When you have an ankle sprain, what do you do? The acronym is price. Was price. And we developed the peace and love. And we developed the peace and love because there is many new thing coming in the literature saying that we need to change the way we treat pathologies. So the peace and love was one of this. But we developed the mechanical stress quantification. We developed the love for overuse injuries, the peace and love for acute injuries. And if you want I can just explain was the peace and love. But this just one of the theory would develop at the running clinic. So yeah. So the peace it's an acronym to the piece is what you do immediately after your injuries. So when I say P is for protection, E for elevation, A for avoid anti inflammatory modalities means all the Type of pills that are anti inflammatory and the eyes. C is for compression and E is for education. So it's the acronym that what we do in the first three days when you have an acute injuries like you fall, you have an ankle sprain, you have a muscle tear, that's the piece you do immediately. And after that you have the love. So when we say we speak about the love it's L for load, O for optimism, V for vascularization, doing cardiovascular activity and E for exercise to normalize your mobility, your strength and your proprioception. So this is the acronym of what we do. And the LOVE is what we do also for tendinitis, knee problem, like all the overuse injuries for runners. We use the LOVE as the acronym of the treatment for this type of pathology.

Okay, so. So this is the treatment of it. But you also do in your courses, I assume I understand the prevention of the injuries as well. Is that corre correct?

Certainly, certainly. We have a lot of thing we expose in our course about the shoes, about orthotics, about stretching, about strengthening, about mechanical stress configuration. And this is the most important one, like how to manage the load you apply in your body to be sure to not be injured. This did the key thing to. To prevent injuries. And we expose all the science of that in a manner that the health professional runners and other health the coaches can learn something simplified to apply in a practice. But yes, we speak a lot about prevention. Even if the peace and love is the treatment plan for short term the peace and more long term the love.

I see. And is the other courses designed initial and we'll go into some of the sort of detail of the advice that you give. But are they designed for professionals like. Like physiotherapists? Or are they designed for just running enthusiasts and runners themselves? Or is it both?

So we. We have for we are for everybody. The only thing is that it's better when you give a course of two days about the. The. The. The. The base of the course is the new trend in the prevention of running injuries. And this course are the fundamental of running injuries are first of all for health professional sport doctor, physiotherapist, chiropractor, podiatrist, etc. So this is in two days. But we decline this course in a one day course for coaches where we take off the diagnostic part. But there is so much good thing about prevention that is good for everybody. So we have all the. The. The. The. The question about the shoes, the running technique, the stretching, strengthening that is very good for Coach. So we have a specific course for coach and we have also general public conference lecture for running enthusiasm. Even if there is some time runners that are not coaches and not health professional and come in a two day course. But for sure it's harder a little bit Brilliant.

That's. Yeah, that sounds fantastic. And we'll come back to where people can find those in due course. But. So let's. Let's talk about injury prevention. What are the key things you mentioned minimalism and shoes and I believe that's one of them. What are the key things you find yourself talking about when it comes to preventing injuries?

When we speak about prevention of running injuries it's the mechanical stress quantification. It's the good dosage of what you will do to be sure to don't go over the red line. That's the red line is the maximum capacity of your body to sustain a mechanical stress. And if you go over you will stress too much a tissue specifically and you will start to develop micro tear inflammation and pain. And pain. Initially it's the best signal you can have to tell you okay, you need to slow down. So the first thing I tell to patient the. The my patient, my client is you need to listen your body and you need to quantify pretty well and going easy. The the. The. The increase your volume, increase your intensity, increase your denevelation, your d increase Everything must be increased very gradually to be sure that your body adapt in 80% of the case patient come see me in clinic injured and we can identify one part of their training load that was too much for their habit. So that's the key thing. It's a lot before the shoes that we love speak about and it's a lot more before the running technique that this is the new trend and we speak more now.

So I remember reading when I started my running about the fact that you should only increase by 10% each week and I think that was 10% total mileage over the course of the week. Is that. Is that the best form of measurement or is there a more scientific version? I think that's. It sounds like that's in tune with what you're saying. But is it just straightforward 10% or is there a better way of measuring it?

So the 10% makes sense for most of people but there is actually probably 6, 7 scientific paper that tried to validate this 10% and was not means that some people can be 15 some part of your life it's maybe just 5 because your body is more I will say tired like you are psychologically more prone to injuries, you just divorce, you don't feel good, you hit not very good in this time, you don't sleep enough. And all those things will decrease your capacity, the capacity of your body to tolerate stress. So the 10% make sense for a general public. When I give general public conference, I speak sometime about the 10%. I say okay, for most of people is 10%, but the 10% is about the volume. But when you take the jogger, the recreational runners, volume is probably the only parameter that they use because they don't do hills and they don't do fast training. So they just run. So volume can be an interesting point. But when you have an eye level athlete or someone that is used to run faster, doing two times per week interval training with speed, this is a lot more stressful for the body than just the volume. So my mechanical stress quantification will focus often with eye level athletes a lot more on the quality than the quantity. Even if we need to look the quantity too. And for trailers it's pretty simple is how much D +D minus you do because this is probably the key factor for stressing the body. How, how many matter of denevelation going down you accumulate in your week. This is probably a key factor to your mechanical tolerance, your knee, your all the stricture that absorb the shock when you go down. So 10% is not. It's interesting, but it's not really the specific rule to answer your question. We can take all this parameter and we cannot make a mathematical formula to say okay, you go over your maximum capacity. You know that you go over your maximum capacity when your body tell you. Because if, even if we make a mathematical formula and during one week you cannot sleep well because you have anxiety and stress and, and you have a lot of. You just lost your job and your wife leave you and I don't know the worst thing you can imagine at this moment of your life. You cannot tolerate the same level of stress that if you are happy and everything is fine and you produce a lot of good hormones in your body because you're in love, you have a good job, etc. So your body.

Yeah, so that's really interesting. I was going to ask you about the impact of stress on your propensity to get injured and your ability to recover from injury. So you're. I think what you're saying there is if you're really stressed or not sleeping well or whatever, you're much more likely, you can tolerate less training or you're more likely to get Injured and equally does that apply to when you're trying to recover from injury? If you're stressed and you know everything else, then you recover more slowly. Is that, is that correct?

For sure? For sure. And is it's the first thing I told you, it's the load you apply in your body. But the second thing is how can you can tolerate and adapt to this load. So there is always two things. There is the level of stress you apply and you are, you have your capacity to tolerate the stress. So if your capacity decrease for the same level of stress, you will be injured. And one of the things you can do is try to increase your capacity to tolerate more stress and be able to train more and increase capacity means be very gradual because the body adapts to the stress. But also be sure that your terrain, I don't know, you say that your body is able to take it means sleep well, be less stressed, eat well, etc. And I think that sleeping for recovery is probably the most important factor. And especially when we become more old.

Right. And is that so normal? I mean the general advice would be eight hours, wouldn't it? And you know, I'm quite keen at tracking my sleep where I use the OURA ring to do that. But when I up my training load, should I be taking my sleep beyond 8 hours or is it just still 8 quality hours is still good enough? Or again, does that, is there any science behind that or.

Yes, there is science. It's not my scientific expertise, but I deal with as a clinician every day with this type of question. So I read a lot on this, even if it's not my expertise. But when you increase the level of physiological stress by increasing your training, you increase the needs of sleeping. So your eight hour can increase. And it's not eight for everybody. Some people is seven, some people is six. But even at six is very rare to have someone training a lot that have just need six hour of training without impairment of the brain and the recovery. So really probably eight hours, probably where most of people are, but some people need nine and some people seven is okay. And when you increase the physiological demand in your body, you increase your needs in sleeping. So your eight hour will probably become a nine hour. And when I train more sometime I need to do some nap. And because my body has me to and is always the same thing. Do you listen it or do you take caffeine and because you're tired so you can wake up and you can still be there. And so the best is for sure it's not to take some drugs to. To awake you. And be sure to listen your body and when you need to sleep more, you sleep more.

Okay, brilliant. And you mentioned there the. The brain and the impact, you know, the impact of the brain. So I heard you speak about the psychological stages of injury and also the need for the brain to recover from the injury as well as the actual body to recover from the injury. Can you talk a little bit about the psychological stages of an injury, but also how do we get our brain to recover and why do we need our brain to recover?

Yeah. First of all, I would like to speak about a very interesting study of Riot 84 subject and showing that after three weeks and of an acute ankle sprain, the grade of the sprain did not correlate with symptom function and pain. Instead, psychosocial factor in particular the adaptiveness in response to pain. Explain more the variability. The variation in symptom and limitation after the ankle sprain means psychological factor is more important than how much important is your sprain. Okay, so that's crazy because for me an ankle sprain was just an ankle sprain. Very easy, very simple. And you have the grade one, two, three and have an ankle sprain. And the three, it's more. It's because your ligament completely tear the two, it's partially tear and the grade one is just stretch. But the thing is that for the recovery your psychosocial factor are more important and predictive of how you will repair that. The grade of the. Of the ankle sprain. So I will. It's just to tell you that the brain is so strong in our recovery and, and that's the first thing that you need to understand. Very, very. So that's the first thing the brain is.

Can I just clarify exactly what you're saying there? Because I just want to make sure I understand it. So I think is what you're saying, essentially your body is recovering, but you also need your brain to know that your body is recovering. Is that what you're saying?

Yes, but I will go further. If you think you will be good and you're positive in your recovery, you will recovery a lot, a lot faster than someone that is more negative about the prognosis. And to say, oh, I have an ankle sprain, I won't be able to run for three months, etc. The brain condition and dictate how fast you will repair also is not just the grade. And even the great of the grade of the ankle sprain is a less good predictor of how you will evolve that what you think?

Wow.

So that's, it's just, it's just to tell you that the brain is a key factor for recovery Reaper return to, to running. It's very, very important.

And so the follow up question to that then is what brain, what techniques should we be using to stay positive? I mean other than getting good sleep and reducing stress and things like that, are there any brain techniques we can use to recover more quickly?

Yeah, that's a good question. As a clinician, I try to tell to my patient, okay, don't worry, most of people with this type of injuries will reaper pretty fast and you can help you by thinking positively. But you know what, some people have a hard time to think positively and some people, even when it's very big injuries, they always think positively. So it's a state of mind that sometimes we can influence a little bit. We can become conscious of this but it's not always easy to, to say okay, I need to be positive, but I'm my ankle, I cannot run and I depress because I cannot run. And but you know, some people have also brain that sensitize more to chronic problem means that a little injuries can become chronic because your neural system is sensitive and you just need to put a little bit of oil in a, in a, in a fire and the fire become very big. And for some other people because they think positively, because they, their brain doesn't sensitize to the pain. So there is some people that are more vulnerable to become like developing chronic pain and some others absolutely not.

So, so that would, I'm assuming that ties in quite nicely with Carol Dweck's research around mindset, isn't it? And the growth mindset versus the fixed mindset. Somebody with a growth mindset is therefore more likely to recover more quickly than somebody with a fixed mindset of I am injured and yeah, that's, you know, that's the problem.

Yeah, exactly. And when you say you, you, you asked about the stage of the injuries and you know you can have a, like someone with a new moderate pain of the Achilles tendon, no psychosocial factor, smart with the rest and the progression. And we don't have stage because it's recovery pretty fast. And to deal with it we have someone with an important injuries like a big knee sprain with miniscule and ligament tear with a vulnerable neural system means that this person tends to be more depressed easily or more negative. And with many other psychosocial factors, like I said before, like divorce, lost his job, money issue, etcetera. And the second person will pass through first of all, have a very poor prognosis of his injuries. Means that it will take a certain time. And it's possible that he passed through all the stage of grief. Denial, anger, bargaining, depression and acceptance. And that's for some people with injuries that is complex in a parent. That is complex. A body does it complex. A neural system that is not very malleable. I don't know, you say in English like adaptable. This person can really have a hard time and passed some months to. With all the stage of. Of grief.

And so just to. Just to recap, what were those stages of the psychological stages? So it was denial first, wasn't it?

Yeah, but it's the same that when you lost someone, when you have. Right. I see you and it's Daniel. Anger. Bargaining. You say bargaining in English, but bargaining.

Yes, we do. I'm not sure that's the term you would use in. In this place, but it's like when you try to.

To. To. To.

Yeah, I know what you. Yeah, bargaining is. It's the. It's the right. It's a. It's the right term. But I'm not sure whether it's. Yeah, so it's denial, anger, bargaining, bargaining, depression and acceptance. Ah, okay. Yes.

At the end, the last stage is okay, it's happened to me now I move on. Now I will do what I need. I will do my exercise. I. I will focus on the good thing. I'm lucky to not be dead. To just have a knee. Ankles. Knee sprain and let's go.

And so again, somebody that moves through those stages more quickly is likely to recover more quickly, I assume. Is that what.

Yeah, like I said, if someone have a. Like a new little Achilles tendon pain after two days he rests and he Start gradually. And he never passed through this stage because this stage is when something go wrong.

Yeah, I see. Yeah. Okay. Okay, brilliant.

Because that was the. Your stage of an injuries. Yeah, it was. Your question.

Yeah.

You said psycho.

Psychological. Psychological stages. Yeah, yeah, yeah. And in Claire's absence, I have to ask the question that she would have asked, which is when we're talking about the impact of different factors on recovery or on our. On how prone we are to get injured. What's the impact of nutrition on the likelihood of getting injured and the likelihood of a speedy recovery.

Yeah. Again, it's not my scientific expertise, but as a clinician I answer to a lot of thing. And I follow. I did some course about running injuries because at the running clinic we have Anthony Berthoud and Isabelle Morin are two nutritionists, one in France, one in Canada that build all the course of the running clinic about nutrition and they speak about nutrition for recovery and for, for like it's, it's a little bit more complex but we know that global health is a predictive factor of recovery for any injuries. So if you're healthy means you will, I give you an example. If you're old, smoker, stressed, poor sleep, bad nutrition, habit, you will repair a lot slower than the other person. Okay, so but this is the general health condition and there is some data actually and I refer to the work of Anthony Berthou, he just write a book in French that is a big, a big, a lot of, a lot of science in it and they explore all the science about nutrition, injuries etc and showing that a healthy. I think you say microbiota.

Microbacteria or. No, the microbiome.

Yeah, exactly, exactly. So this is a very important thing for health and this can influence the low grade inflammation and many health problems. So having a general health condition influenced by nutrition and influenced by how healthy is your microbiota. Microbiome. This is one of the link we do between nutrition and injuries.

So this is a really important point, isn't it? Because if somebody's injured, I know if I'm injured and I can't do what I want to do, I kind of feel like well, I'm going to sulk, I'm going to, I'm going to eat rubbish food because I never eat rubbish food or I don't eat much rubbish food when I'm, when I'm in the heart of my training. So your instinct is to kind of go, well I'll just eat, you know, rubbish because I can't train anyway because I'm injured. But actually eating healthily puts your body in a better place to recover more quickly. So it's, that's, that's really interesting.

Yeah, for sure. The only thing is that it's a long term process. Means that yeah, if you eat, if even if you eat badly during one week, I don't think it will be a big difference for your injuries. It will be maybe a difference for your, your stomach and your etc. But short term, but for injuries, for inflammation, for recovery, nutrition won't have a very big effect. Like you rest, you do cardiovascular activity to increase metabolism of your tissue and increase repair and recovery. This is an acute effect. But nutrition is a long term process. Be healthy, having a good microbiome, it's a good thing on Long term.

And you just touch on something that I wanted to explore more, which is I was fascinated when I listened to you about the importance of exercise in the recovery process and speeding up the recovery by, by doing exercise. So talk to me a little bit about that and talk to me about, you know, when is too much, you know, is, is a bit of pain okay or is, is it okay for certain types of injuries and not other types of injuries? And why is exercise so important as part of the recovery process?

Yeah. So the V of love if the vascularization as soon as we can. When you have an injuries, if you can increase your metabolism and your vascularization in your tissue by doing a cardiovascular activity that not stress too much the tissue that is affected or inflamed or irritate, that's the best thing to do. And you need, you can do two times a day, 20 minutes of cardiovascular activity to increase the speed of your recovery. Now you have a knee problem. You have a knee problem because you run a long run and you irritate your knee. You have a PFP patellar femoral pain syndrome and you do bicycle. So bicycle is still stressful for the knee. So maybe it's not the best activity you can do. Maybe it's better to swimming, to swim with the pool between the leg and not moving too much the leg. But you can still do cardiovascular activity without using the affected tissue. The L of the love. It's the load. Soon as we can, we load the tissue that is affected, but in the dosage where you, you are not reproducing the pain or in a very controlled way. And that's your question, how much pain I can have if I have an injuries? And I will tell you it depends of the acuteness of the injuries. When it's acute, we won't, we don't want pain. When is it chronic? We accept some pain. It depends of you. Of you means are you very sensitive to pain or not really. So some people don't feel the pain, but create a lot of inflammation after. So those people must be more easy. And some people interpret the pain like, like very important all the time. But it's not very dangerous because they over over feel the pain. So for those people, I will say, okay, you can have a little bit of pain, but the pain must not stay more than 30 minutes after your physical activity. And the day after you must be able to do again the same training you did the day before.

Right. Okay.

And there is a third factor. It's depends of the pathology. So there is Some pathology where we say, okay, I don't want pain like the IT band syndrome, no pain accepted. If you have like stress fracture, no pain accepted. If you have a muscle tear or muscle pain, you can go on pain, no problem. Because it's a very high metabolism tissue. And even if you go on pain, I know that the tissue will still repair even on pain and you can continue to train. If you have a tendon, a chronic tendon, example, an Achilles tendon that is painful and is a chronic means that you have pain since more than three months. You can train with pain, but the pain must live, must come back to the normal level during the 30 minutes following your physical activity. And the day after, you must be able to do exactly the same training or more that you did, you did the day before.

Oh, so that's interesting. So, so the, the Achilles part made sense for that. What about somebody that's got a calf tear, I think you were saying? So you gave that example, but just use that as an example within what you've just said.

Yeah. So for a calf tear, because this is the more frequent pathology for runners, long distance runner, I accept a pain up to four out of ten from the day three.

Okay.

So very early we accept having a certain pain if the pain doesn't increase during your jogging and if the pain don't stay after you're jogging. But running a little bit on pain can be integrated very, very early. For muscle tear, we are very aggressive now a lot more than we were 10 years ago.

Wow. And so just to be clear, so that's. You can tolerate 4 out of 10 pain on that muscle tear while you're running, but it needs to, that pain needs to have gone 30 minutes after you finished running.

Yes. But maybe you start your running with a pain of 2 out of 10. So I need, I want that the pain come back to two because that's normal at the time.

I see. Yeah. Yeah. Okay. Wow, that's really interesting.

Yeah. And when you have an acute injuries, you, you can take times a little bit like take three days where you try to avoid pain because the first days pain is always a good thing to tell you. Okay, don't do it. The signal of pain have one interest make you avoid the gesture, the posture, the movement that is painful.

So you need to listen to it to start with. But yeah, with, with something like a car tear, you can get back on it way quicker than I would have probably. But. And then, and then, so gradually you're increasing that load, but with that constant. Right. Okay. You Know, it still doesn't get to more than four. Still doesn't goes back to how it was before. Within half an hour.

Yeah. So like doing a little bit of stretching can be integrated pretty soon. Doing strengthening with load at slow speed can be integrated pretty soon. Jogging slow can be integrated like some days after. But if you want to do fast training, like plyometric stuff, acceleration, abcds, the drills, all those stuff must be integrated very gradually later because this is the way we endured again. And a calf.

Okay, okay, that makes sense.

Always quantify. When I say the mechanical stress classification is, I do something that I consider to be like a level of stress, and I listen my body, how do you feel? You feel good. Perfect. The day after, you increase the level of stress and you increase again day after day, depends of how your body react.

Okay. Okay.

There is, you know, in medicine, we have, we add in the time a lot of protocol, like you have a fracture, we have six months in cast, six weeks in cast. Sorry. And after that, we have a protocol when you have a muscle tear, we have a protocol when you have an ACL rupture, we have a protocol when you have a surgery for that, we have a protocol. Now all the protocol doesn't means nothing now. Means that we just listen the body. We, we do a good mechanical stress configuration, a good graduation of the load, and that's all. And that's for every pathology.

Brilliant. That's really, really, really fascinating. Now, I heard you, you. We've kind of touched briefly on minimalism and running shoes. And are you still a big fan of the barefoot running approach and minimalist shoes? That's really not very easy to say, is it? And, and if so, tell us, tell us why. But tell us how. I remember when I first read Born to Run, I went straight into vivo barefoot shoe, and I was like, about to buy a pair of running shoes. And, and the, and the, the salesperson was very good and said, you know, have you just read Born to Run by any chance? I said, yes. And they said, right, in that case, go away, learn to run barefoot, and then come back and buy a pair of shoes. Which I thought was amazing, given that they just told me to not buy a pair of their shoes. So tell us a little bit about how people graduate into that sort of approach to running if you think that's, that's right to avoid getting injured in the process.

First of all, if someone want to integrate barefoot running, it's pretty hard to be injured because your skin will always be the limited factor for your progression. For most of people. So. So if I run barefoot I will say okay, run 200 meter barefoot and maybe one minute and that's all. And you put your shoes on after. And if you want you can increase day after day by one minute more. So day two you can do two minutes and three minutes and even that is a little bit too fast. So probably you will do some plateau and you will progress gently and probably your skin will be the limited factor if you run on asphalt especially. And with this the risk of injuries will be pretty low. If you buy a pair of minimal issues. And when I say minimalism, there is a continuum between the more maximal issues and the more minimal issues. Means between 0% minimalist and 100% minimalist. There is all a continuum. And so when I say minimalist means nothing. You can buy a five finger that's you know, the five finger is 90 and more minimal issues. In UK you have Vivobarefoot. There is some shoes that are 100% minimalist index shoes. But you can have like a minimalist index sale by the industry that have just 50% of minimalist index means that is they are not so minimal. You can buy a Nike Free 5.0 very flexible but stick. You can buy Oka 11, 4 millimeter of drop but very high stack. So that's not minimal. So we define minimalism by five criteria. There is the flexibility, the weight, the stack, the drop and the control of Pronation technology. And all of this criteria make the minimalist index. It's like a rate we can give to the shoe. So when you say minimalism versus maximalism for me it's not very clear because there is all continuum between both extreme. So if you buy like Innovate 225 that's what I run with. This is a 70% minimalist index running shoes. And this is the shoes. I run ultra trail with this type of shoes. So it's minimal but it's not five fingers. I cannot run a lot with five fingers because I'm not used to. But if someone want to be used to with that, it's not a problem. And why I'm running with this type of shoes because first of all, all the literature show that drop cushioning and motion control doesn't prevent injuries first and doesn't increase comfort. This is a perception we have. And the thing is also it's that most of people is probably 95% of people in UK, in Canada, in Europe that run with maximal issues that have a minimalist index between I will say 10 and 30, 40%. So pretty everybody now run in maximal issues. We are used to that. So because the population is used to run with maximal issues, we need to be careful when they change habit. If they want to move to a minimal issues and they go too fast, they will be injured. Because running in minimal issues increase the level of stress in some specific tissue, like the Achilles tendon, the plantar fascia, the foot in general that was weakened by the use of maximal issues. So when you chronically use maximal issues, this tissue are protected, protect the tissue, make him, make it weaker. And if he become weaker, the day where you move to be barefoot, because you go in Cuba, you go in the south and you go in flip flop and you go barefoot on the sands for one week, you come back with some prolonged fascia pathy. I see a lot of this in Canada because in the middle of the winter people go in Cuba. That's a classic.

Yeah, so, so, and actually so with. With the minimalist shoes. So it sounds to me like I was talking about the extreme of kind of almost barefoot shoes like the five fingers, like the vivo barefoot. And it sounds like there's. There's several stages to get there. I know. So for example, I have collapsed arches. Would those sorts of shoes still be better for me? Would they even kind of help my feet or you know, is that. Is there are any. Are there any types of situations where people should avoid the minimalist shoes?

There is not a lot of reason why we need to avoid minimalist shoes and especially not collapsed harches. Like you said, pronation foot, pronator foot, flat foot are not linked with pathology. Okay, so maybe I will surprise you, but actually the prospective study and the systematic review don't show that flat foot or cause different injuries. So it's like a big nose. We are born with, we grew up with, we are fully adapted to and it's not a problem. And this we need really. And that's the default of health professional, podiatrist, physiotherapists and sport doctor that was considering flat feet like a problem and is not. So we need to go away of this false assumption. So the thing is also is that if you have like a collapse harches and you do a lot of pronation and you are in a very soft shoes, it's possible that the softness of the shoes bring you in a more pronated position because you're in a soft mat. So being on something more firm. More firm. I don't know. You say in English, but yeah, that's. Yeah, you probably do all the pronation you have and not more. Because remember that your feet inside the shoes do what they want. So your collapse harches on the feet, on the, on the shoes are the same that outside of the shoes you don't sit. But the foot is doing exactly the same movement even on anti pronator system. Do all density and all this stuff doesn't correct the pronation and the. The movement of the foot? Absolutely not.

And what about the trend for everybody to be racing in carbon plated shoes now is that an exaggeration of the problem of the maximalist shoe or is it Obviously they're generally very light. So is it sort of on that scale they would do well on the minimalist. How do carbon plate shoes fit into all of this? And particularly with the view to injury.

So about the injuries we need to be careful because the rigidity seems to transfer force from a little bit more to the talus. So the. The bone of the foot. And we have some stress fracture case series now about using this type of shoes. So we need. Even if you integrate this type of shoes you need to be a little bit gradual. Gradual and progressive. The thing is that if you're used to have a big bulky shoes like 95% of the public of the population, these shoes will be one of the good thing because you will have a very light shoes to race, but big like your training shoes. So the difference won't be. So there is a big stack, a big drop, a lot of rigidity. So if you're used to train in Isaac Nimbus, Cumulus Brooks Adrenaline like the standard of the industry, this shoes is pretty. Is pretty the same about the stack, the drop, the flexibility. But they are very light. The next of Nike, the Nike Vaporfly Next is 180 gram. That's very good. The old generation of shoes that won the Martin with was a 240 gram a lot heavier and thinner. So they were using like medium malice like between maxi and mini, like in between. But and they were not fully adapted to this type of shoes. So they were finishing the marathon with a little bit of soreness. And because the shoes was a little thinner. But at the same time even if they were a little bit lighter, they were not like like the new generation of shoes, the carbon plate shoes. So the real innovation of Nike with these shoes is to make a big bulky shoes maximalist, but very light. But with a very good marketing. They sell tons of these shoes. And we know actually that the carbon plate changed nothing about the performance. So probably the foam Help a little bit. And probably there is a big variability between people from minus 11% of O2 consumption to plus 11%. So some people wear these shoes and decrease their performance but they are so convinced that it's not a big deal and they just pay more than £300 to have it.

Well and also I would suspect paying 300 pounds for a pair of trainers also creates a placebo effect as well in itself, doesn't it?

For sure. Exceptional placebo effect. When you pay this price for a shoes that is everybody want try to copy and that the best in the world use it for sure. You have a huge placebo effect.

Yeah. So I know the placebo effect. If you buy expensive branded paracetamol it works better than the cheap paracetamol even though it's identically from a chemical perspective. And even if you know that it's. That's the placebo effect, it still works better.

Interesting. I didn't know this study but that's very interesting and for sure is exactly the same.

So one of the things, one of the other things that you do actually. So we ask. I'm going to kind of tie in two things here. I'm going to. Maybe I shouldn't but I. We always ask the previous guest, which was ultra runner James Poole, to ask the next guest a question without knowing who that is going to be. So James Paul's question was if you weren't doing what you currently are, which I'm going to refer to as your physiotherapy world, what would you, what would your next best thing be? Now my understanding is that you actually do some business coaching particularly around the sort of Freed company concept, don't you? So would that be the next best thing if you weren't doing your running clinic stuff and if so tell us a little bit more about what you do in that space.

Yeah, yes. Maybe it's this. You know I do a lot of thing. I. I create two nonprofit race in Quebec that we organize. We are now we have one that is the 10 edition and is a very successful race. There is a trail race, a road race and what are those races called? Trail La Clinique du Cour and There is a 5k on road and is since 3 years is the Quebec championship. So there is all the best athletes in the province of Quebec that are there very fast race a lot of people under 16, 15 minutes on 5K. So very interesting. So I love to do that like organize like event for people and having fun and. And the other thing I did is I wrote a book in French that is the bestseller in France and in Canada. But I think that maybe this fall we will finish in English because it's pretty old translate. So maybe we will be able to publish for Christmas in English.

Brilliant. And what's the English translation title?

So it will be the Running Clinic Health by Running, something like that. I don't know the title exactly, but I'm not the translator, don't worry. But I wrote a book that is. There is inside the book there is 50 expert international experts that contribute to. For a 12 page each. So it's really very dense and we cover everything, the nutrition, the sleep, the etc. So it's very interesting.

Fantastic.

I love also working with my hands and going on the wood and make trails and so maybe this is my best. I don't know, maybe I will become like. Oh, you say that in English, working in the wood like that cut the tree. Yeah.

Like being, well, sort of a lumberjack type.

Yeah, exactly.

Yeah, yeah. Oh, that sounds. Well, it sounds like you're the sort of person that you're never going to be bored in retirement, are you? If retirement ever exists. You're going to have. You've got lots of things going on. So tell us a little bit about this. Tell us a little bit about this Freed company concept. I'm reading. I don't know if it ties in with this. I'm reading no Rules Rules at the moment, the book about Netflix and how Netflix has no company policy on holiday. It has no company policy on spending. It just kind of trusts in people. So is that. Does that tie in with the sort of corporate work you're doing?

Yeah, it's pretty the same, you know, with the run because I manage two companies. There is PCN Physiotherapy Clinic. So that's 14 clinics, 240 employees. And there is the running clinic that is worldwide but is a smaller company. At the running clinic, we don't have a vacation. So we take vacation when we need, when we want, when we. And we organize our work to be sure that we can take vacation. So if I want to take like one week, I need to transfer my work to different people. And there is no hierarchy of decision. So I can take all the decision I want and my colleague too. There is some rules means that if I want to take a decision, I need to consult the expert and the people that is concerned about the decision. And at this point I can take the decision for the company. When we take a decision is always about the in French we say le bien comme common good.

Common good.

Yeah, common good. And there is triste faire there is satisfying the client B the employees happy and perunity of the organization. So every time I take a decision I need to take make my decision according to this tree sphere and but I have the power to do it and there is some rules but I have the power to do it because there is no boss in the organization. So when we want to do something we want to we speak with all the group we use the all the collective smartness, intelligence. I don't know you call this. And. And we. We move on. And so that's how we function at the running clinic. And we have a. It's not translated in English yet but we have a website entreprise entreprisefranchy.com and is all the tools we use inside the organization to manage, to organize, to function.

So this is essentially a company where there is no hierarchical structure. It's do you still have an organization chart with different roles but it's just that no one's more senior than another. Basically everyone's on the same level. Is that right?

Exactly, exactly. So there is no I'm the founder but I'm not the boss. And because there is a hierarchy of expertise means that there is some people a lot better than me for doing the marketing or for speaking about different thing. My expertise in it's on creation of content teaching. So I'm focusing on my expertise and we work in sales so I can be part of the marketing sales example. But there is a leader of these cells that have all the knowledge and the expertise and the experience that is the leader. When I say leader because I don't want to use the the term boss but because there is no hierarchy of. Of a decision but there is a hierarchy of knowledge. So we. We are confident we let people work in their expertise a lot more interesting.

And and this is for the running clinic where you said. Did you say There was about 15 employees in that or so or did I miss make that up?

Yeah, we we are 63 total.

Oh 6. 63. Okay.

We have 50 speakers but we are 12 in the core business means the people that organize everything the website etc. But we have the other company. PCN is a physiotherapy clinic. We are 240 and we just flatten the organizations in three years. So we have sphere of leadership inside clinic and the best for the every leadership sphere take care of the management of this specific sphere.

Topic and how does this work when you bring in a new employee that's got a huge amount of experience in a particular sector, but doesn't necessarily know the culture of your business?

Yeah. So when we hire someone, first of all, many people come work with us because the culture, so they know the culture before because we. Our branding, our marque employer in French again, sorry for my English, but people know that when they come in our business, it's a culture, it's a freed culture, it's a free company. So that's the first thing. And when they come, there is onboarding process that is very complex because we want to be sure that they become very good very fast and that they understand how we function. So for every new people in the organization, I give a talk how we organize our culture inside the organization. What's the rules? Because being freed company doesn't mean we have no rules. We have a lot of rules, but there is no hierarchy of decision.

Yeah, it's interesting actually. So one of the things that, and I don't know if there's any examples of this in, in your business, but one of the things that Netflix talks about is because they have no holiday policy if the. So they don't have a flat structure. So if the, the leader of a team takes very little holiday by default, everyone underneath them takes very little holiday. So one of the, one of the rules of having a no holiday policy is that the leader has to take a decent amount of holiday because that encourages the employees to take a decent amount of holiday or the team to take a decent amount of holiday. And they know that the productivity then is better because of that. Is there anything, any examples that you can give me of how, how you have, you know, the rules that you have to set to get the best out of the team in this sort of structure?

Yeah. What you said about the Netflix is very interesting because one of the problem when you don't have vacation organized and structure and policy is that people sometimes don't take enough vacation.

That's what they found. They found initially that people took less because when people have a holiday allowance, they're worried about losing it. So they take it because they're worried about losing it. If they have no holiday allowance, there's nothing to lose, therefore they just take less.

And it's interesting also when you say the leader must show the example by taking holidays and you know, I'm the type of guys that I'm always in vacation or I'm never in vacation, I don't do the difference Because I work Saturday, Sunday, but I go run when it's sunny in the middle of the day and I organize my schedule to be happy and I work a lot and, and I love, I love that. And. And probably that's maybe a problem for some people in my team because they see me sometime as a leader of some cells that are maybe not taking a lot of vacation. I don't know. But yeah, you know, all of this thing when you, when you lead a company, a free company, all of this thing comes up during time and you say okay, maybe we need do something for this specific problem because we realize that sometimes people are very tired but still working and don't think to take vacation. And we address this. We meet every week during one hour. Tuesday morning at nine, we meet for one hour to give energy, to know what we do. Every everybody to be on the same line for the project, etc. And this keep up alive and keep up like organized. So sometime we see someone tired and say okay man, you need to take a vacation now. And yeah, it's. I don't know. You say that. I don't know what to say exactly about our company because it's functioning pretty well. But it's difficult to define sometimes how we function because it's so out of what most of people live like most of the company have structural hierarchy. There is a bus they decide, they give to the other one. You apply, you have some tasks. In our business we don't have so much task. We have responsibility and we organize our job around that.

And it must be. I would imagine that in that sort of environment, you have to have a clear set of goals for each different person in the team. Is that. Is that how it kind of. Is it focused around goals and. Or for each different member?

Yeah, we need to have a why a collective why. That is a pretty clear. We need to define pretty well what's the common good. And after that everybody we like last month we fix our priority for all the falls until Christmas. So everybody know pretty what they need to produce, when they need to do. And at this point do everybody works and do the job they need to be done for create richness in the organization. And if we create collectively richness, we decide collectively what we do with this richness. So that's another thing. At the running clinic we decide all together what's the salary we have. So there is. There is no boss. So we decide and what recently because the COVID Because many things we need to decrease our salary and it's not a Decision of the boss is a collective decision because we didn't produce enough money to pay everybody like we. We said. So we decrease and now we are working to come back to, to normal and we hope that we will be able to increase.

And that's. And I suspect that that means that people take that sort of news or decision because it's a collective decision. Much better than he said that. That's not fair. I'm so. Yeah, no, that's brilliant. Now one of the, one of the things we've also got is we ask guests to ask. Sorry. Listeners to ask a question. So the question we've got for this episode, which was from Max. So thank you, Max. What do you beat yourself up about?

Means what I do bad?

Well, no. What do you criticize yourself for?

Yeah, yeah, yeah. Okay. I lost a lot. Too much time on social media scrolling like the. I really need to stop that. That's a big, big problem for me when I say it's a big problem is that I lost probably, probably close to 30 minutes, one hour in a day to doing this type of thing and not working on my computer for real job. And so that's one of the thing. And the other thing is I eat a lot. Too much chocolate. I come from Switzerland. I love chocolate and I eat a lot. A lot, a lot. So sometimes I do like it.

I was gonna say if it's dark chocolate, it's good for you anyway, isn't it?

Yeah, but it's not dark first. A lot. It's a lot when I. I have some cruises sometime and I eat like, like the big lint. Like the big one.

Oh, wow. Yeah.

And I can pass through one in one day.

So I thought you were gonna say the big Toblerones that you see in the airport.

Yeah, also. Yeah, yeah.

But they're painful to eat, aren't they? You end up with the one of the Alps sticking in the roof of your mouth. It's not. They're not easy to eat. But. So I'm going to give you. Before I ask for your book recommendation, I'm going to give you a book recommendation actually because based on what you beat yourself up about and being distracted by, by social media, I just read a brilliant book called Indistractable by near el spelt N I R E Y A L Near E L Indestructible. It's about how you can stop yourself being distracted by social media. Email, WhatsApp, all of that kind of absolutely brilliant book. So I would check that out. But what would be I always ask people for recommendations on books that you found helpful. Ideally books in English please would be really appreciated because at least that way we can. I can add them to my reading list. But have you got any books that you find yourself recommending to people?

Oh, there is a lot. I will give you the author of different book because I don't know if you know Alex Hutchinson.

Oh yes, Endure.

Yeah, Endure. And there is. He wrote different other book and it was very good. Alex was. Is one of the experts that make some page in my book but this is clearly a very good one and there is a Daniel Luberman that published another one. I missed the title but it's very, very good too about the. The evolution of human being.

Daniel Lieberman. Is that the exercised? I think is that right? The book? Yes.

Yeah, I think so. Yeah.

That's a. Yeah. Both of those are exo. So did you say there was another book by Alex Hutchinson? Endure and another one I think he.

Wrote like three, four.

Oh okay. I love Endure but I haven't read any of his others so I shall look up the others.

Yeah.

And what was it about those books that you find yourself recommend recommending them?

What do you say?

What, what, what. What is it about those books that is you did you find so powerful.

Open mind about how the body works like. But I am a lover of the body working like. Oh, it's working how. It's like the book of Alex is interesting because you learn how you can stretch your brain by the reality by going further than what you think you can really be able to go. Yeah, but there is a. A lot of interesting concept in those book.

Yeah.

And you know I don't read a lot and that's one of the thing now with the social media and I, I think about Instagram and the little capsule that you can, you can learn a lot of things too. So that's one of my problems. I. I scroll on social media and I, I read a lot of stuff that doesn't make sense. But there is very interesting thing on little capsule on different things that you can learn very fast and very quick.

Yeah, yeah. It's. It's a. It's a. It's a blessing and a. The opposite of a blessing. I'm not sure what the saying is but like for example my, my youngest daughter is. Is really keen on tick tock and I hate tick tock as a social media. I think it's. I think it's awful and yet she'll come out with some really interesting facts and you're like, where did you get that from? How do you know that? Oh, I saw on TikTok. So there's some great stuff there. You can learn a lot of good stuff but equally you can, you can become, you know, you could just lose hours scrolling through nonsense easily as well, can't you? So it's a blessing and a curse. That's the saying I was looking for. Blaze, it's been absolutely brilliant. It's been really interesting chatting to you. I think there's a huge amount to take away from this, this interview, particularly around kind of preventing running and recovering better. So preventing injuries and. And recovering from injuries better. I think that's absolutely brilliant. But I love the stuff about the business as well. I think what you're doing there is. Is really interesting where, if people want to watch or learn from the running clinic, where's the best place to find out what courses are going on? Are you ever coming to the uk? You know, tell us a little bit more about where we can find you.

Yeah, if they go on therunningclinic.com they will find all the course we have online because we have different course online. We have also the fundamental of running injuries that is by zoom one times a year in English because so if someone from England want to follow the course it's possible most of the time is Jean Francois Coulier that give the course. You know what's special with the running clinic is that we have a systematic weekly review of the literature about running. So we are looking for close more than 2,500 title every month about running injuries, prevention, treatment, diagnosis, et cetera. And we keep all the thing that is pertinent for runners and for health professionals and that's built continuously our course. So our course is updated all the time with this literature and Jean Francois Esculier have a baby one week ago so he takes some some weeks months off but he's the guys that develop most of the English part and he's the guys that went in UK last time some years ago. So we will go back to UK for sure and on the website of the running clinic you will see all the course. We give elearning presidential and tons of information about the mechanical stress configuration, the minimalist index, the peace and love. We have different blog, different articles that you can follow there. So yeah, everything is on the website and we have for sure social media stuff that my team take care of.

But yeah, brilliant, excellent Blaze, it's been absolutely fascinating. Thank you so much. I'll be, I'll be looking out for you in the UK for sure.

Thank you very much, Charlie, and sorry again for my poor English and my big accent.

Your English is exceptionally good. So thank you. That's it for this episode of the Tribathlon podcast. If you want to to find out more about Blaze, the best place to go to is therunningclinic.com but he's also on LinkedIn as Blaise Dubois. Dubois is spelled D U B O I S and on Instagram he's blaisedubois. So keep up the amazing training and keep on the amazing learning as well. And. And in the meantime, keep on training. If you like what we do at the Tribathlon podcast, you've got to register for TribeTalk. It's an email that comes out every two weeks, packed full of everything to do with swim, bike and run, but also nutritional help, business coaching and a whole lot more. Whether that's books, videos, TED talks, apps or technologies, it's packed full of ideas that can help improve your speed, sport, your life and your business. So register for it@tribathlon.com and you'll be sure that every two weeks your inbox is full of some amazing ideas and resources to improve your life. And remember, this episode was brought to you by the Trusted team and by fourth Discipline. So if you want to find out more about how the trusted team can help you grow your business and improve your work life balance, go to thetrusted team. And if you want to find out more about how fourth Discipline can help take your performance in sport and life to the next level, go to fourthdiscipline.com. If you enjoyed this podcast, please do review it and share it because it helps other people find what we think is really valuable learning lessons from amazing athletes. So please do that. You can also find the whole back catalogue@tribathlon.com and you can also find out about the Tribeathlon app, which helps people find events, find people to train with and enjoy their events throughout through their tribe. So check out tribathlon.com.