Carbon shoes, Orthotics & Triathlon Injuries (Myths, misconceptions with Podiatrist Matt Fieldsend)

This podcast is brought to you by Trivalo Coaching, where we help triathletes and cyclists like you train smarter to race faster. I'm your host, Jordan Donnelly, and on my left is former Australian Ironman champion and head coach of Trivalo Coaching, Jared Donnelly. Welcome to today's episode. In the episode, we had a special guest on the podcast today who also happens to be a fan of the podcast. He confessed to us that he is actually a listener, a triathlete himself, but more importantly, a podiatrist, and that is Matt Fieldson. And we really loved the chat with Matt today. We got to explore everything to do with the foot, but as Matt explained, you know, the foot isn't isolated and the body is a global moving structure and so things that happen with the foot aren't happening in isolation. It was a great chat, just exploring foot and ankle mechanics and everything up from there and how that can impact triathlon performance, triathlon injury risk, how you can potentially prevent common injuries, how you can rehab common injuries, areas to focus on, and a whole lot more, which Matt really talked about in detail. Some really clever ways of thinking about the body, some really clever principles for prehab and rehab, and some really clever principles for just understanding concepts of the. Of the body and body biomechanics that can help you in your training and your racing and hopefully to stay injury free. So we absolutely love the chat. Thank you, Matt, for coming on. And without further ado, here is Matt Fieldson. All right, we've got podiatrist Matt on the line. Matt, thank you very much for joining us. Firstly, I know you're a personal fan of the podcast and secondly, I just said, how do I introduce you in terms of where you're from? And you said you've got three different clinics that you're actually working for, so give us a bit of an introduction. Yeah. Who are you and where are you from?

Yeah, yeah. So I do spread my time in podiatry around. Around three different clinics. So the one I'm sitting in today is. Is Evolved Physio on St Kilda Road, who. Where I work with a couple of great physiotherapists and I also have work with Mitch Anderson, who obviously got the introduction with you, and former guest on the show. So we have a really good relationship due to his triathlon interests and also his foot and ankle interests. And then I work with a really good group of sports podiatrists at up and Running podiatry. We have a few different clinics around the place, a couple of very Keen triathletes there as well. I'd love to hear that. Yeah, the two business directors are quite strong triathletes, like Kona Entrance, so they've done pretty well. And then from my local footy club in North Road physio, I work for North Road Podiatry. I'm the one out podiatrist there, so I spread my love around those three. So great week. Interesting.

Definitely. Definitely. Well, welcome to the episode. Welcome to the podcast. We can't wait to chat all things feet in this episode. But to start with, like I said, you are a fan of the podcast yourself. You say that you listen to it, which we're grateful for. And gratitude is one of the things we start with. So we're going to do that segment. We don't do it with every guest, but seeing as you know the podcast, we're going to dive into it. So, dad, welcome to the episode. You can start us off with some gratitude.

Thanks, Jordan. And my gratitude actually relates to our guest. And on that general theme, I am so grateful that there are so many experts in their fields, such as Matt in podiatry and the other guests we've had who are really willing to give their time freely to give all our listeners the tips that they're absolutely hanging out for. So that's my gratitude. So thanks, Matt, for being on board.

Thanks for having me.

That's a great start. Matt, you can go next.

Yeah, I think listening to these a lot, you know, one of the easy ones, one of the gratitudes we always have is family. But under current circumstances, we haven't been able to travel, to spend time with some, and particularly in a job where we're still considered essential. Your co workers have sort of become your little family and been people that you've been able to lean on a lot. So I'm really grateful for the great relationships that I have with the co workers that I have at the different places that I work at that have made it so much easier to get through a pretty difficult time and sort of being that little family away from home.

Fantastic.

Very grateful for all of them.

That's a great one. Good stuff, Matt. And my one is actually pretty similar to that theme. I'm grateful for my housemates, obviously, not being able to see family, your housemate really become your family. And if you didn't like them, then it wouldn't be too fun. But fortunately for me, I really like them and they've actually been a really good presence to have at home to try and switch off. We've Been trying to do some fun things just to get out of our routine and it has really helped with the lockdown. So that's my gratitude. But without further ado, let's get into the episode. So, Matt, dive in. Tell us about how you got to this point in your career. And you've got a pretty heavy sports background and injury background. So take us back to the start. How did you up to this point?

Yeah, yeah, I played, played all sports as a kid, you know, had a crack at everything. I grew up in Wollongong and it was all soccer and rugby and so on there. Cricket, moved to Perth. That's where I found the love of AFL footy and continued to play cricket until cricket and footy until about the age of 16 where footy sort of took over. I was playing TAC cup footy and probably was. You had to be super good to continue to play cricket and footy. I'm trying. I probably wasn't good enough at cricket so concentrated on footy to try and make it there and didn't quite make it straight away but continued to play footy until, you know, 33, played some VFL footy with Casey Scorpions and Port Melbourne and had a long time at DLC in the Bafra in the first division ammos as well. Study wise. I always wanted to do something in, in the physio world probably first of all, I was very injury prone all the way through my career. Spent a lot of time in physios from the age of 12, 13, breaking hands, dislocating fingers, dislocated elbows, just the simple things early on. Didn't get too serious too early. So I started a science degree majoring in nativity and physiology straight out of school and at age 19, blew my ankle out pretty badly. Had a full ankle reconstruction and so along the process of that became more interested in foot and ankle mechanics and saw a good podiatrist and you know, had some, had had some orthotics that helped but also a good rehab program that helped me to get back into it and yeah, that sort of set me on the journey towards, you know, doing a second degree and a master's in podiatry after, after the science degree.

And did you sustain injuries as a continuum all through that period and as an expert in your field, you must have been shaking your head going, what am I doing? Why am I getting so injured all the time?

Yeah, yeah, I basically did. I don't reckon I've seen too many injuries in the mainstream injuries that I see in practice. I'VE had a lot of them myself after that foot. When I had the ankle reconstruction, I tore my peroneal tendons off all my lateral ligaments. So they were all, they were all sort of put back together.

Makes me shiver with.

Very poppy ankle when you do that. Yeah. But very stiff post operation. So then, so I had, you know, all the, all the usuals after that. So, you know, Achilles tendinopathy, plantar fasciitis, all of those things. Sort of trying to get back to playing. Then I had. What else did I have? I had my foot landed on. So I had broke three metatarsals sprained on this frank ligament, which is kind of like the ACL of your foot. Had a contact injury to my calf, so that opened up my calf and drained blood out of that. I've had a knee reconstruction. I've torn my pec off my shoulder and had it reattached. Yeah, yeah, yeah. Broken a few of the bones.

The list goes on. You said seven off air. You were saying seven major surgeries on your lower legs, is that correct?

Yeah, I think, I think there, thereabouts. Yeah. A couple, couple of knees, ankle reconstruct stuff. Yeah, it adds up.

But at least, you know, you can, you can vouch for the. Any rehab because you would have had to do it all firsthand.

So. Yeah, yeah, yeah, I've, I'm, I'm an expert at rehab, at least on my own body, so hopefully I can guide some other people with the principles as well.

On dad's point, I mean, injuries can be frustrating, but they can kind of be. Feel like they come from two points in a contact sport like footy, it just can be unavoidable. Sometimes it was the contact that did it and other times it's your biomechanics and it's something that you could probably prevent. So how was that balance for you among all the injuries?

Most of my injuries were, were contact injuries. I was always pretty good diligent at being, doing all the extra things with rehab, prehab, all those kind of things. But then managing the. Your mechanics and the way you moved was super important with how quick you could get back. So if you didn't like. I was always a lot with a lot of those injuries, I was always. Usually if someone told me, you'll be back in 12 weeks, I'll be like, I'll be back in eight. And so what can I do to make it? What can I do to get there faster? What can I do? What can I do within reason and make sure I Pass all the tests before go back to play. But I was always looking for how can you do this the best way?

Is that the right way to go about it? If a patient was saying that to you, I mean, would you, is that alarm bells for you?

Certainly, yeah, absolutely. And then there's, then there's the realistic of how much more quickly can you make it. Because there's certain biological processes that take a certain amount of time to happen. So you know, you probably break a bone and if it's still, you know, union, so they don't, it's not, it's non displaced. You can't raise the fact that that's going to take six weeks to break. So six weeks to heal, I should say. So some timelines you can't mess up with too much. Some you can a little bit. But like all those, all of those times I was in, I was playing a reasonable level and had good health care. So I had to pass certain tests to be allowed to go back to pay as well. It wasn't all, I wasn't my own decision all of the time.

Did that make you think obviously these are almost unavoidable injuries that you've, you know, that you've sustained, but did that make you really hone in on the soft tissue stuff? I'm definitely not going to have any of them and do the preventative stuff which is what the listeners I think really need to hear a little bit more about because they only start thinking about that when they get the injury. And I'm in the same position, I've done that myself, just rest, ice and then expect to go straight back and it'd be okay. And it's invariably going to reoccur unless you do something about preventing it to happen again 100%.

So like whenever you do an injury obviously at the time, even if it's, let's say it was a contact injury, so at the time you were performing well enough that the tissue capacity of your body, if you didn't have that contact injury was at the same capacity as the, of the activity that you were doing. The tissue was able to deal with the load that you're putting through it. As soon as you stop doing an activity, you know, if you don't train for a little while, you, you get loss of tissue capacity, you're not as strong. So but what we'll often do is we've had two weeks off, but I'll just go straight back to the previous level of activity. Now your tissue is deconditioned in that time, if you haven't done anything about it. So you are already at injury, at risk of having an injury unless you've done something to mediate the fact that you will have lost tissue capacity. So you've either retrained or you've done some sort of cross training, et cetera, et cetera. So, yeah, that was super important in coming back from all of those injuries, is ensuring that whatever we're talking about, that you have, the. Whatever tissue you're talking about has the capability to produce the forces required to complete that activity. For example, I talk about, say if you break your foot, so you put in a moon boot, so the bone heals, but your Achilles tendon doesn't do anything for six weeks, it doesn't stretch, Jordan, etc. So you. Now you. You're. You get out of the boot and, yeah, your, Your foot, your bone works well, but you can't do four calf raises. So how are you going to produce four and a half thousand contractions on a 10k run? You know, there's a mismatch there. You need to. We need to recreate that ability.

Yeah, absolutely. So how did you bridge the gap between footy and triathlon and especially with this injury background?

Yeah, well. So, yeah, often one of the first things you could do was ride a bike with a lot of those operations that I had. So I got into riding a bike and. And obviously, and some swimming. So, you know, there were cross training things that I was allowed to do to maintain some cardiovascular fitness, so that when I. You'd get back to 40, that you could, you know, keep up faster or you could return to play faster because you'd maintain some cardiovascular ability. So I'm doing all this swimming and riding and going well, why not, you know, in the off season when I'm having a crack, when I actually run at putting it all together and I'd watch some Hawaiian Ironman stuff and so on as a kid and sort of had a. Had a loose interest in it. But, you know, until you sort of got on a bike and did a bit of swimming, didn't think about putting it all together until then, and it just sort of grew from there.

And you've got the bug now, do you?

Yeah, big time. Really big time, yes. I've done. Done quite a few. I've done about four. Four halves now and quite a few triathlons and having family that lived in Noosa and going up there and saying that, you know, the massive event that is the Noosa Triathlon and everything happens around it just, I saw it as something that could scratch the competitive itch. Post football.

Unreal. How have you transitioned physically from reasonably high injury prone career as a football player? Have you transitioned to keep yourself injury free as a swim, bike and run athlete now?

Well, I was always pretty good at doing a lot of gym based stuff with football because I was, I was small basically to play footy. So I had to, I had to do a lot of work in the gym to protect myself basically. You know, I was often giving away 10 centimeters and 10 kilos to the guys I play on. So in order to not get broken any more often than I was, I had to be pretty strong. So I think having a good gym and SNC background has allowed me to make that, that transition to a degree. And then a lot of just reading and research as to, you know, like two, you know, building loads and how much you should do and then getting a coach as well. So, you know, eventually getting a triathlon coach so to work in with. They don't control my S and C side. I do that myself. But you know, making sure that we're building volumes and loads and intensities in the right way.

So we want to get into some of the specific or common injuries that triathletes might see. Just before that I want to ask a more general question about what are some of the lessons you learned with mental or physical resilience, with dealing with all these injuries personally and applying that to your career?

I think most of the time there was always like an end goal. So you know, the period of time there was something I had to work towards. And I think when I was sometimes I'd ask for it because that's the type of person I was. But it always worked better if there was steps that I could achieve along the way. So little milestones that you could tick off. And that always helped the mental approaches, obviously particularly dealing with a surgical injury that there's a long period of time. But it's like if you reach this level of range of motion, then you can do this activity. If you reach this level of strength, then you can do this activity. And so always having little goals along the way I think feeds into particularly athletes. We're competitive. So if you can give them little goals to reach along the way, they're going to want to work towards that. And that really helped me mentally. And yeah, I'm not sure there's much more I could say on that. I just know how much I love to compete. So I just wanted to get back There. And that was often a big enough driving force in itself that's really great.

For the listener to hear because, you know, when you're injured, you think it's doom and gloom and you need to change the mindset, don't you, so that you can turn it around to say, right, you know, I'm missing the passionate thing that I love to do. Let's see, work on things that I can control, which is the rehab. And you know, getting yourself to a position where you're, you're not doing the rehab properly, when you are able to actually go back onto the training field, you're going to possibly injure yourself again. And they're the key things that you actually need to concentrate on is doing the rehab and waiting out the correct time and having these little goals, like you've said, to pass. And you know, we have lots of people come through our coaching business where they have various injuries and this is one of the biggest issues that I have with them is they're so motivated to get, to get back as quick as possible. And as you talked about, you know, getting the structure of the tissue to be able to cope with the activity, you know, they, they still think they're superhuman and they can just resume where they, where they left off. And it's a great message that you're sending to the listeners, which is you need to do your time properly and you need to progress once you're, once you've been given the green light, you need to progress slowly to let your body adapt. And that is one of the key things that I have the biggest arguments with people is, and I'd say why did you go and do a 50 minute run when you haven't run for five weeks and now you've got soreness everywhere and you need four more days off? Is that something that you come across regularly?

Well done. We all know as boring as it can be is consistency is key and you get more out of HERO programs and the consistency of not missing sessions than you do out of doing one really good session and then not being untrained for a week. And that goes, that goes the same to a degree with, and having, like you just mentioned, you mentioned recovery. Like even with our, within the rehab, it's the same as your training principles. You want to minorly overload and then recover for a day or two. So have a lesser day or two because that's when you adapt. Like you only get better when you're, the only training you're getting better from is the training you recover from so you do the training and then you need to sleep, eat well, do all the rest for a little while and then you do another session. And they're just little building blocks. If that session is like 15, 20, 30, 40% harder than your previous session was and the tissues don't recover well, then you don't get to. Also there's three or four days where you don't work on all the tissues around it because you're resting. And so you actually go backwards instead of forwards. So that building in the box of rehab the right way and being consistent is so much more important than having one big super session.

Let's dive into some common injuries you'd see, especially in the triathlete scene. And yeah, for, for these we'd love to know kind of what their prevention would be to stop it happening in the first place. But if it does happen, you know what, what the treatment, best type of treatment is, because I'm sure through these injuries guarantee the listeners will have experienced one of them if you just list some of the main ones.

So yeah, yeah. And it's interesting like, so there's heaps, obviously there's heaps of injuries in triathlon, we spend so much time on your feet, putting out so many hours of training. But some of the foot specific ones you might see can be like tendonopathies. We've got multiples, you know, Achilles tip, post perineals, et cetera, fasciopathies, you know, plantar fascia, itb, bone stress injuries, metastasial stress fractures, joint pains and sprains, intermittent tarsal symptoms like neuroma and bursitis, blisters, they're all ones that are just within the foot. And then, you know, foot mechanics can then play a pretty significant part in more proximal injuries like shin splints, patellofemoral joint pain or anterior knee pain, hip pain, lower back pain, like glute, tendinopathies. So the list goes on. But the causes are often multifactorial between an interplay between the intrinsic factors, so what's going on inside the body and extrinsic factors. So extra injury factors are stuff like, you know, your training loads, frequency, intensity, volume, the type of training surfaces that are being trained on footwear like weather conditions, the patient's diet or the client's dietary habits. And intrinsic factors that might contribute to the injury could be age, gender, you know, height, weight, bmi, bone mineral density. So you know, that goes into area like reds, relative energy deficiency, their strength, like we're just talking about what's their tissue strength, like their biomechanics and their movement patterns, the way they run or the way they ride or the way they're on the bike, and their previous injury history. So we know the biggest risk for any injury is having had that injury before. So that outweighs the risk for any injury. So. But what we can generally assume with just about any injury that occurs is that if the injury occurred, the load that was placed on the tissue exceeded the capacity of the tissue. And that's when we. That's when that sort of sits at the top of the pyramid of why you get injured. So you put too much load through a tissue, it failed. We have an injury.

Brilliant. Gold nugget to understand. Yep.

Yeah, yeah. So if you take. So if we take one simple type of injury. So let's talk about Achilles tendon pain, a really common one that you'd say in runners and in triathletes. So extrinsic factors that might contribute to the tissue capacity of the Achilles tendon being overloaded could be you've added running speed too fast or you've added hill running too fast. You've changed out your shoe to one with a lower heel drop and integrated that too quickly with too high a volume training. So there is, like, extrinsic factors. Any of those in isolation could cause the injury, or if you did all of them at once, you know, obviously you're increasing the likelihood of injury. And then intrinsic factors might be you've had a previous history of Achilles injury or you've sprained your ankle, you've had a history of calf muscle tears, you've got sciatica or low back pain, and that's neurally inhibiting the calf muscle from functioning properly. So, you know, there's lots of different things that could happen there. And that's where probably that's where we come in as the. As the practitioner or the podiatrist is to assess the patient and see what is the major contributor to why that tissue's been overloaded. Get that full picture. So training history versus the full assessment that we'll do on the patient and then go from there.

Can you see much. If you were to look at some of your athletes who come in injured, can you see much from if you got them to walk or to run, if they're able to run, obviously, when. When they come in injured. But can you see some things that would contribute, such as you said, with the biomechanics of. Of their potent, you know, the actual running style and we talk about running.

The landing or something.

Yeah, yeah.

So there's basically when, when they come in, I'll take them from. There's, there's almost like a, there's a basic raft of assessments that I'll do that go from the very simple to the more complex. And you can often, I'll start with the simple stuff but sometimes you get to a certain. And we're not going to go past here because the tissue is not, tissue's not covering with this. So we're not going to go put into run. So I'll start with just double leg standing in front of me. Have you got any pain at the moment? Yes. No. Can you stand and get them to stand on one foot? Balance on one foot? So how stable are they on one foot? Where's their foot rotating? Is their knee rotating? What's their pelvis? What's their lumbo pelvic stability like? So the foot and the hip are really important because they both generate rotation. You know, the foot supinates, pronates, rolls in, out and the hip is obviously a ball and socket joint. So and the knees, the meat and the sandwich between those. So if we often, if we get knee pain, it's generally because there's something going wrong at either end above it. Even a single leg balance test is giving us a little quick picture how those two interacting. Then you do a double leg calf raise test. Are they getting any pain there? If they're getting 6 out of 10 pain there, we're not moving on to a single leg calf raise test. They can do the single leg calf raise test. So we're going to do, we're going to do some double leg jumping, hopping. If they can do no pain, then we're going to single leg hop. And when we're looking at that, I'm looking what their foot's doing, then their hips doing what the knee is doing, all of those tests and I'll do all of those before I even make them walk usually particularly if they're a runner because that's still, that's a progression in the difficult, the complexity and the increase in load of tests that you might do. Then I'll definitely watch them walk and if they've been okay to hop, they'll probably be okay to pop on the treadmill and run. Once we get them on the treadmill and run, we're looking at step length. Where is their foot landing in relation to the center of mass? Both from side on and from behind or in front. Are they crossing over their midline is their foot way out in front of their center of mass? You know, do they run way too upright, tip over too far? They've got a lot of hip flexion. You know, what's their again, what's their lumbar, pelvic control like? One of the last things we look at is their foot mechanics because sometimes if you change any of those other parameters, you'll get a different foot mechanic. So it's not the be all and end all, but we certainly take it into account. And then you want to look at is what's the tissue that they've come in that we've determined is injured and so where along this pathway is it being loaded and what can we modify to reduce the stress on that tissue?

That's a really good summary of the process. And it made me think while you were talking, if someone came in and presented with your plan out of injury to change some mechanical aspect of their running stride and they've been doing it for 40 years, how difficult is that process?

Well, that can be really difficult to change someone's running mechanics. And sometimes, and sometimes you might think that they need to change a few things and it's better to do that step wise, like pick something simple. And sometimes you might try in on the treadmill, you might try a few different cues and see which tends to work for them. And then if some of them aren't working, then just get them to work with one. That's and all. And once you're changing their running mechanics, I've got to have already been satisfied that the tissue, that the injury is going to cope with running anyway. So sometimes that's a decent way down. Depending on what the injury is, that might be a decent way down the pathway. And then it might be, I don't think, I think they run okay, but they're still going to get sore. So what are the, what other things can we do to modify the load on that tissue? So there's other things as a podiatrist that we can use to, to, to modify the load on, on the tissue. And that might not just be the way they move. Obviously intrinsically it can be the way they move or their strength. But extrinsically it might be, you know, we could use a different shoe here or we could put something inside the shoe which could just be some padding or a heel lift or an ortho or some orthosis. So which we can use to modify the loads that get put on tissue so it doesn't necessarily need to break down the running mechanic.

Yeah, the assessment example you just gave of kind of all the factors that you could be thinking about is unbelievably thorough and I would say also reassuring for anyone that, you know, is potentially wanting to see you, for example, as long and other professionals, as long as they're this thorough as well. But it is such a wide spectrum of potential factors, so surely there must be some extremely common factors that present themselves over and over again ahead of the less common ones.

Yeah, yeah. So like some of your real basic ones are if we're talking strength. So we know as runners, probably with all the, the assessment that's out there, the two probably most important muscles to work on for endurance runners are your soleus. It, it produces and absorbs so much force with every step that you take when you run something like six times your body weight that it absorbs with and produces with every step that you take at slow to moderate speed running. So basically anything we do in the triathlon world, and then your glutes, so, you know, so maintaining your, your pelvic level, so, you know, your glute made stuff. So if you're going to do anything, you know, strengthen your soleils, strengthen your glutes and, and sometimes that doesn't even take a long time. So, you know, it can be three minutes at the start of a run. What else are we talking about? Some regular things that you see. So, yeah, so definitely like it's a cast, slightest calf strength, you know, how many, how many calf raises can, can you do? And you think sometimes you have patients come in and they've got, you know, Achilles pain or they've got plantar fasciopathy or this. And they're saying, I'm running 60Ks a week. Why? And you know, I've been doing this for ages. I can't figure out why, you know, I've got, I keep getting these kind of injuries and.

So.

Well, and they can only produce 12 crappy calf raises in the room. And as you guys probably have a reasonable background is what is the calf got to do when you do your 60Ks for the week and how many contractions has it got to produce and at what force?

6 times body weight as well. You make a good case there.

Yeah, yeah. So a calf raise where you're not leaving the ground is one times body weight. So if you're not able to do a decent number of those. Yes. In running, you're going to swap from leg, leg to leg. So there's a slight break, et cetera, et cetera. The. There's an elastic storage in the Achilles. It's not just the calf muscle that does the work. But yeah, that's, you know, that's an indication that the tissue capacity is lower than what the activity level requirement. So that's what we see all the time. Then when you talk about running, some of the ones you see with people that are having a lot of bone stress and anterior knee pain is over striding. So just their foot in relation to their center of mass, it just tends to be way too far out in front. And just mechanically you think about if your foot's in front of you, it's very hard to use to propel you forward. So it's basically a break until you get it underneath you and you can push off it. It's pretty hard to push forward off your foot when it's in front of you. So that's just one that we felt that we probably see a little bit as well.

I reckon every single person that's gone to a physio will have left with some sort of glute strengthening exercise at some point. But probably a less common one that you walk away with is calf strengthening exercises. So apart from calf raises, actually, if you're up for it, I'd like to give you a live example slash test because I personally have had, um, a recent foot injury and have been doing calf raises and some other things to help. Um, think if you've been a runner for a long time, I would assume, and correct me if I'm wrong, that you will have naturally strong calves. You know, being a runner since my childhood, for my whole life I've been able to do calf races to the cows come home. I just think it's a natural process. But I, I have found with, by increasing that, you know, all the muscles around the calf, yeah, everything front and back starts to get a bit tighter. Cause you're doing. And then, so I feel like I'm foam rolling more and doing some other things to try and loosen it. But then you're doing the strength stuff and it's, it feels like it's kind of a cycle that's contrasting itself. And it to me can feel a little bit like it's wasting each other's time. You know, doing the foam rolling to loosen it and then doing the strengthening to tighten it. So what are your thoughts on that?

Sometimes it can be around the programming of when you're doing that, that, that, that rehab. So one of the calves are an endurance muscle. So you know, your Soleils, if your Soleil didn't turn on. You can't stand upright. So it does, it does tolerate large volume of load. I think. You know, who was it that said, Arnold Schwarzenegger made a funny quote. You know, we all know, I'm sure everyone remembers Arnie. So he used to talk about. He did all of his body parts three times a week except for his abs and his calves. He'd do them six days a week because they could tolerate the extra load. Yeah, but, but so I think if there's, there's still like, just like you do with the rest of your training. There's heavy days and light days, and I think it's. I like to, when I'm incorporating sort of calf rehab or foot and ankle rehab. I like you to do it on, on as particular triathletes do it on your run days. So you do it beforehand. It doesn't tend to take away from your performance in the training that you're going to do. And then if, if I'm getting you to do it second daily, so maybe you know, three to four times a week or slightly more than that, then you actually get your caster. Get a full day off on your swing day or your, or if you swim right. On another day, you don't do your rehab on that day. It's getting like, it's getting that time to adapt. You get two sleeps in between when you're going to do it again. You all know that tissue recovery happens overnight. So sometimes it's in the programming. Sometimes people get, oh, I've got to do my calf raises every day. I've got to do them five days a week. And they do them on the days they don't run because they don't want to interfere with their running. But when does the calf break? So sometimes it can be a programming thing.

That's a really great point. Do you have any other exercises off the top of your head that would go along with something like calf raises? Cause it's just a pretty common one.

Well, it is, but there's just sort of different ways to do it. So you like just, just doing a straight leg is, you know, it's good, it's reasonable bang for buck. But doing something with a bent leg, doing something in a, like in a running position. So a forward lean with a, with a, with a bent leg can be really helpful if you really loading it up with a Smith machine when gyms are available is useful. So yeah, I think, I think just. It's like anything with training. If you do the one thing all the time and you don't give it any variety, that's the only thing you can do, you know, if you only, you become good at that, you become good at that. If you only do long slow rides, you'll be good at long slow rides. If you only do long slow runs, you only be good at long term. If you have variety in your program, you can do work any different energy systems and different positions and different strengths. The same thing with rehab. You need to put, you need to work the muscle in different lengths and in different positions to get the best outcome. So changing the stimulus is really important.

It's a great point, great answers. Are really happy with that.

Yeah. Look, just one thing I wanted to ask too. While we're on sort of stride patterns and running technique and yeah, a lot of our athletes, when we're asking them to run slowly, as in a recovery run or an easy day, I get the feedback that I can't run slow. And then I start thinking, well, if they change their running action when they run slow, are they actually almost creating an injury potential because they're running differently to what they would normally run when they stride out? And, and it's a real conundrum with actually trying to give them the right response as to look, you should be running the same way whether you're striding out, whether you're running easy or whether you know. And definitely not changing your action depending on the speed. You know, when I look at the Kenyans run and they're jogging as a group, as a warm up, they look the same way as when they're striding out winning the 1500 meters at the Olympics. They've just got this beautiful, you know, rhythmical action. Except they're not running 2:30 pace, they're running 5 minute K pace. But it looks the same.

Yep, they do it. Have you seen some of the warm ups that the Ethiopians and the Kenyans go through with all the different marches that they do and it's literally like a marching band. Everything happens at the same time. They do all these incredible movements. They're super coordinated as well as being good runners. It's not an accident that they're able to do it that way. And yeah, I think it comes from practice and sometimes some help as to what are the things you're doing well when you're running faster, what's your body position like, what's your foot position like? But I think it's sometimes just a little bit of practice too. I don't think you, I don't know, we've just spoken about the fact that I think sometimes it's good to give the body a different stimulus and sometimes what's running is hitting the ground in exactly the same way all the time. And I know you guys are big advocates of hill running and trail running and that kind of thing. And what is one of the reasons you're a good advocate? Because we're not landing in exactly the same position, loading the exact same thing the same way all the time. So potentially don't get too caught up on it if they're not getting sore. If it's just I can't run slow, I will do it because it's better for your energy systems.

That's awesome. I felt like saying that. Just do it.

Just do it.

Don't say you felt like. I've heard you say it multiple times.

I don't know. Go find a friend that can't run you as fast as you can and run with them and talk to them or something like that. That's a good one. They're not going to run off one of their mates or something like that. I think that works pretty well.

Now, what about one of the myriad of opathies that you listed at the start, tendinopathy? What kind of prevention or sources of, you know, problem in that regard? Because tendon muscle is slightly different, you.

Know, so, yeah, it is to a degree. Tendons tend to take longer to get like, tend to take a little longer often to show up in injury, but they also take longer to heal because they've got poor blood supply and so on and so forth. But the thing is, tendons need load. Like it's their job to attach a muscle to a bone and stretch and then pull on, pull on the muscle and get the joint to move. So they don't respond to rest. So you need to, you need to load them or they won't get better. It's just about having that right recipe of how much load can tolerate. And so that's, that's why you go through, say that like the raft of tests that we did, you get to a point that they go, this is okay, this is okay. This is okay. That's not okay. And so it's all right. Well, we need to build our volume. What's just okay? So we just want to like, mildly overload, recover. Mildly overload, mildly overload, recover. And, and so to avoid it. It's, it's basically, I think any of the, almost any of the injuries that I've spoken to you about is all the same things that you would do with your coaching program generally is don't introduce anything too fast. It's like, don't have someone that's come to the, the Trivella coaching club and they've, all they've ever done is ride on Beach Road. And we say, all right, six weeks that you come here, you're going to ride up and down the 1 in 20 every day. So you've got to introduce hill running slowly. If you've got a new shoe, introduce it slowly. So shorter runs, slower runs first. If you're going to do some, some hills, start with, you know, once a week, you can do some strides on a 2% hill. You're not going to go run up to 1 in 20. It's all of those things. Introduct introducing something with gradual overload. It's just that it's like a coaching principle. Yeah, yeah.

Applies universally as well.

Really does. Yeah.

And look, we could, we could probably go through the list of injuries infinitely, but we wouldn't, we wouldn't get very far in this podcast episode. But let's talk about kind of two main topics that I think will be of big interest to people, and that is one is the topic of orthotics. And you also just spoke before about, even in injury rehab, not quite the full kind of orthotic, but just putting in little heel raises or raises somewhere in the feet just to help with kind of injury rehab. So talk to me your thoughts on kind of the uses and myths around this.

Yeah, I think there's, there's a lot of myths and misconceptions around orthotics, and some have probably been created by podiatrists and some are just beliefs that other people have about them when they come to them. So, you know, some of the myths that people sort of subscribe to is that no one needs them or that everyone dichotomous belief that not like everyone needs them and everyone should have them. There's, there's the myth that they correct the skeleton, that they weaken or brace the foot, that they can only go into a neutral running shoe, or that they're a life sentence. Like, once you've got them, like you're gonna have them for life. And they're probably all myths. Basically, you can break them all down. And so that's the way, the one simple way to think about it that I like to use to start off with is that so if someone gives you a set of eyeglasses because your vision's going, we do see that as A life sentence. You say, I'm going to have glasses for the rest of my life if you're given just about anything else. So if you hurt your shoulder, you're given a sling or you sprain your ankle, you're given some crutches. I like to think of orthotics as a sling or as crutches. It's like once you get them, what's the period of time that I need to use this for? Now? There's some times where that can change and alter. So that's probably the short version of that. I guess if you want to use a longer version, you could say that orthotics are like drugs. Okay. So if you put five white pills on, on the table, you like, one could be for heart disease, one could be an antibiotic, one could be paracetamol. If you put five orthotics on the table, people think they all do the same thing, but just like the prescription for the pills is different and they're going to affect things in different ways, the prescription within the orthotic will do different things and do things in different ways. And then if you're talking about the length of time, if you cut your foot and you got an infection, you might have antibiotics for four or five days and then that's it. So for some injuries within the foot, we might only need to put a heel raise in to let it settle, or put an orthotic in to let it settle, or even just strap the foot with taping to let it settle. And then you don't need that again. Then there's something that might last a little bit longer. So you might get an upper respiratory track. In fact, you need to take cortisone, prednisolone. You don't. You're not going to be enough for the rest of your life. But it might only take it for a few months.

Yeah.

So some conditions, you know, tendon injuries within your foot, you might need to modify the load in the tendon for a few months until the tissue capacity returns and which might allow you to continue to train in the meantime. And then there's, there's the much other end of the scale, which is, you know, some people get, given they have a heart attack, so you're on aspirin for the rest of your life. You might have a, you might get a joint fused in your foot, you know, from some serious injury. Yeah, that's maybe one rare case where you might be on orthotics for the rest of your life, I would say. Most of the time when, when we're talking triathletes, we're talking about the tissue somewhere in their body has been overloaded. We want to use the orthotic to modify the stress on that tissue so we can shift the load somewhere else. And that might allow them to return to training earlier or do a higher load, Continue to do a higher load of training. And in the meantime they need to increase the tissue capacity with their rehabilitation. And then once that relationship has flipped so the, the tissue capacity exceeds what's required for the activity, then maybe they don't need the orthotics anymore. And again, you just don't whip them out. It's, you know, we wean them off. Don't use them for your shorter runs, you know, you don't use them in that pair of shoes, et cetera, et cetera. So that, does that sort of COVID some myths, et cetera.

That's absolutely, absolutely brilliant.

I've stolen all of that from Dr. Ian Griffiths, who is like the doyen of just describing how orthotics work. So all of that, his wording. But yeah, he's a good person to listen to if you want to get any more detail on that.

Nice to give him credit.

Yeah, absolutely.

Yeah. So that sort of, I think is really cleared up a lot of the questions that I had in my mind and I'm sure the listeners who are, every, every time you think of foot and calf and leg injuries, you think, oh, I need orthotics. So it's great to hear the variations that that can be assessed around. So I'm really, really pleased with that response. And that kind of brings us to the next topic, which is, you know, the trend recently has been the carbon sole in running shoes. And I'm really interested in what your thoughts are and how that could be related to potential injury, you know, because they are quite a different shoe to what we've grown up. You know, I was talking to Jordan about this the other day. I grew up with a pair of, you know, as a 10 year old, I had a pair of really basic flat running shoe, racing shoes. Tiger, they were Tigers and they had the minimalist, the original Nikes. Yeah, yeah, they were, they were just so tiny and, and you know, you wonder whether that was a reason why I ended up having so much calf injury for my whole career as a runner. But, you know, had I had the availability of the shoes that we have now, you know, where do you see the shoe trends with, in relationship with injuries and potential issues? Obviously, I don't want to talk about how the shoes are making people faster. I'm more interested in whether it's affecting their potential to be injured and, you know, down the track, the real problems they might have with the wrong shoe choice.

It's hard. The shoes haven't really been around long enough to have. For us to have significant statistics on increased injury rates, and particularly because they're not being worn by everyone. Cost is a limiting factor with some of these shoes. You know, they're 360 bucks a pop. They only last 300ks, so there's that kind of thing. And I, I think it's hard to not talk about what they do do to explain what they might do. You know what I mean? Like so. And because one of the interesting parts is that, and I'm again like to give credit, I'm just taking this from stuff that Simon Barthold has explained. But with a lot of these super shoes at the moment, and a lot of people get caught up on the carbon plate and that being the really important thing. But a lot of it's the, A lot of it's really the change in the foam. So your traditional EVA foam that's in most of the shoes we've been using up to now has like about a 60% energy return. And so the Pebax and the Zoom X foams and so on that they're using some of these shoes has a 90% energy return. So the amount of force you put into the shoe, it's giving you back so much more. But again, that has a certain lifespan and only lasts so long. But the other part is it's super unstable.

So.

And you're talking about really high stack heights to get this really high energy return. So you're getting higher off the ground. So higher off the ground. If you want to talk injury risk, well, you think about a moment arm. It just means that your, your, your rotational movements in your body have further to go. Have you ever run behind someone wearing any of the alphafly necks or, or the next percents that has pretty sloppy running mechanics and that like everything's just going all over the place, particularly once they get tired.

You definitely. I've definitely seen footage of it already here.

Yeah. Yeah, so. And sometimes. And I also question, you know, how long, how long has that person had that shoe for? You know, like your, your elite marathoners are just putting a fresh pair on to around the race, you know, so it's not fatigued, but so coming back to the carbon plate is it might be just the chassis for that foam in order to stabilize it a little bit, makes it a little stiffer. So there's. So there's that conundrum. They reckon that the foam probably makes a bigger contribution to why it's better. But there is that sort of. It's sort of the geometry of the carbon plate as much as anything else is that, you know, it's actually almost better if you sort of midfoot land on it and it rocks you forward and throws you forward. And the combination of the two means that, yeah, there's less plantar flexor muscle fatigue over time. And that's why it's more. It's more relevant to the longer runs as well. You know, in marathon is half marathon is too, because that's when calf fatigue is more important. The longer the run, the more important that becomes. So having the carbon plate in there does change the amount of force that goes through the big toe joint. It does change the amount of ankle joint moment force that there is. The other part with it though is it's being something seemed to be with the ones they've created so far. You have to be strong enough to bend the plate. So a lot of the most, it's been much more successful in the male running fraternity and has been in the female running fraternity so far. And it'll be interesting to see whether they have to change the thickness of the carbon plate for that to change. But I think there was the American running trials that I think the first five athletes in the men's were all wearing the same shoe, whereas in the women, I think only one of the top five was wearing a super, you know, a super shoe. So it's having different effects in different places. You've got to be strong enough to bend the plate and so does that affect the injury risk? And if females are using it and they can't bend it, or a lighter, a lighter male with poor plantar flexor strength is using it. Are they going to get injuries at the joints further up that are taking the load? Because the foot hasn't actually been been able to produce a bending force. So it's, you know, that's, that's a lot of talk.

But yeah, you're spot on that. It's been too short a time to actually know. And I have seen arguments both ways exactly what you're saying, you know, because there is the natural thought that it might cause more injury. But then I've seen the arguments the other way that it's actually helping prevent injury. So it's interesting to think about. But Talking about shoe trends and this kind of ties into the orthotics as well. Because I thought like dad, I thought that point you made was absolutely brilliant. And I'm someone who definitely had some of those beliefs around orthodox. Like once you've got them, you've got them for life. I definitely believe that previously. So it's great to clear that up. But same thing with shoes. I mean, not just the carbon plated super shoes, but so many top end shoes now, sorry, I should say mid range shoes now. The technology has just come so far. You know, your standard trainer that you're going for your easy runs in or your training sessions in, not your super ratio. The technology is just super advanced as well and they've changed the height of the foam and everything. And I guess not looking so much from an injury perspective, but just from a foot biomechanics perspective. Do you think that that's similar to orthotics and it could just assist people in their foot biomechanics? You think that's a good thing?

100%. I think it's person specific. And to be honest, the orthotic, it never works on its own. So it's always the net effect effect of what the orthotic does inside the shoe. And if you change the shoe, the effect of the orthotic will be different as well. So like as a practitioner, when you take that into account, you know, what shoes is this going to get worn in? And it might be really good in and effective to offload the tissue. We're intending it to in one shoe, but then when you change the shoe it might be absolutely horrible. And so the net effect of the orthotic in the shoe is super important when we're trying to rehab an injury for sure. I think that kind of thing is important to be notable. And what shoes are they using when we do have an injury and is there a tissue we're trying to protect when someone's otherwise robust? I think the most important thing is you're comfortable in the shoe. So comfort, just like if you put the shoe on and you're happy, you tend to be pretty. Like the run tends to go all right. Yeah, absolutely agree with that. Yep. Yeah. So that's comfort's actually, you know, in all the studies they do what, like what shoe fixes this and the other, when person picks the most comfortable shoe for them, that tends to like lead to the least injury risk. Yeah. But then from there I think the other things to take into account are other principles that we've already Spoken about. So don't change anything too quickly. So don't go from doing all your runs in one shoe to a completely different type of shoe shoe and do all your runs in that shoe. On the flip side, I think it's really good to have two or three if you can afford it. Different shoes running at the same time that are all slightly different. Because what's that doing? It's just like you're training. It's. It's making your tissues tolerant of slightly different things. It's just like another training modality realistically, so your body's not getting used to one position. And one thing that's a.

That's a fantastic. And it really makes me think about the treadmill, which is sitting right behind me in the picture.

And I changes your running mechanics as well.

Exactly right. And I've said to Jordan many times, I can run on the treadmill, but the minute I go outside when each foot has potentially got a different landing angle, I am not able to cope. And you've almost answered that question. It's when I land on the treadmill, I'm landing on the same spot. Pretty much step after step after.

Exactly. Step up, step, no camber. You get a little bit of give. So, you know. So we're talking about when you're trying to offload something with someone who's running outside too, not only have you got, you know, the foot, sorry, the shoe plus the orthotic environment, what happens when they go run on a camber on a cambered road? Like, that changes it all. That changes it all again. So, you know, there's a lot of variables to take into. And like when you say with if for some people, treadmill running might be really good. So if, you know, there's certain positions they absolutely can't get into, but if on the flat and a little bit of give works for them, then you can. If you've got someone that's trying to come back from Achilles tendinopathy, that's the last place you probably want them to run. Gives a little bit. So it's going to stretch the Achilles a little bit more. The ground's moving away from them, so that's going to stretch the Achilles a little bit more. So that's probably going to aggravate their tendon versus running on the pavement. So we probably want that person around the tendon, the someone the bone stress injury. Starting running on the treadmill is going to be a better idea because the impact is going to be lower. So we start them there so we can we can use those things to end to our detriment?

Yeah, absolutely. And it's become a pretty popular trend among the pros to really transfer a lot of their training onto the treadmill. And that is just because of the massive load they're doing. And they would be doing that just to offset some, some injury risk. Obviously they need to be able to run fast on the road, so doing all their hard training on the treadmill is not going to help. But more they can do on the treadmill is just exactly in line with what you're saying.

Yeah. That means, as you say, so they can work their body systems without stressing their bones and their bones and some of their tendons as much. Those kind of loads and bone stress injuries is really big for those guys that can mitigate some of that stuff.

Yeah, for sure. Well, no, it's brilliant thinking, I guess to finish off with is what would you want listening to know or understand about podiatry, about your work? What would you, what would be the take home message you want to listen everyone with?

Oh, that's a tough one.

Always is.

Yeah, yeah, yeah. That is a super tough one. Yeah. I just think that, you know, I think don't think about the foot as just shoes and orthotics and the foot environment, it actually has a significant effect on, on the whole body and what happens up above it. So if you're having trouble with, you know, anything up to lower back pain and you just can't put your finger on it and you haven't had a had a think about podiatry, then potentially come have a chat with us and if we're not the person you should talk to, ideally, if we're okay doing our assessment as we have, hopefully we can point you in the right direction.

Yeah, that's really great. Well, that's a great way to finish. Matt, thank you very much for coming on. Really valuable insights and as dad and I both said multiple times throughout the episode, just really clever ways of thinking about things. That's just great. Principles not only for the foot and your body biomechanics, but as we've already found out, these principles apply through training and through most other areas. So really good way of thinking. But thank you very much for coming on.

It's been a pleasure. It's been really, really good to join a podcast that I've listened to quite a lot. So glad to spend some time with you guys. Thank you very much for having me.

Thanks, Matt. Cheers.