The Secrets To Staying Injury Free with Brad Beer

We all lose strength as we age, and past 30 years of age where we lose strength the most is the calf. So the plantar flexors take the biggest hits.

This podcast is brought to you by Trivelo 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. Our guest today, Brad Beer, is known for his expertise in treating running and triathlon related injuries. As a physiotherapist with over 15 years experience, Brad is not only just a physiotherapist, but he's an exercise scientist and has worked with a wide range of high level athletes and national programs. He's passionate about outputting helpful content for runners. He's also the host of his own podcast, the Physical Performance show, which really aims at educating athletes, which of course we love. And by way of sporting background, Brad was a junior elite triathlete himself and has collected multiple podium and championship wins at an age group level. And dad, our goal in this podcast is every episode we want, we want to give you, the listener, something that you can implement into your training that is going to help you directly. And we do our best to really press some of our guests, sometimes with directly applicable questions that can be tough to answer. But bat. Brad, being a podcast guest host himself today, was great in providing educated answers that are really important for athletes to know about injury. And I guess from our point of view, we want listeners and we want athletes out there to really start taking it upon themselves to educate themselves more about their bodies, about their injuries. And I don't think it's good enough anymore as an athlete to leave it all to the practitioner, leave it all to the physio or the osteo, or to your sports doctor, sports physician to do everything for you. You need to be as well educated as possible that when you get a niggle or you get an injury, how are you going to treat it? What information do you need to know? What do you need to learn to help prevent this in the future and get yourself back stronger? And so that is what this episode is filled with. And I think if you can really listen and pay attention to these things, you're arming yourself with good knowledge to help you get through your training and actually get to race day in the best shape possible to perform.

Yeah, Brad was excellent in doing exactly what you've just summarized there. We really want to have experts on our podcast that are going to give useful information. And we're not just, not just getting people on just for the sake of it. We're getting people on for a reason. We want to get experts in the field. And injury is one of the biggest issues in sport, in, in any sport in the world. So at some point or another, you are going to face some sort of injury, whether it's your own fault or whether it's outside your control. You are going to be on the sidelines. And we all love sport, we all love playing sport. We've got a passion about it. And that's why you're listening to this podcast, because you want to get some more information that's going to help you become a better athlete. And so having someone like Brad, who's actually an experienced triathlete himself and is, you know, I love people who can talk the talk, but they've also walked the walk. So his knowledge as an athlete and he's had plenty of injuries himself, he talked about he's had bone stress injuries and really that's probably got him more motivated to prevent that from happening and to find out what things he should be doing to prevent that. And this is what we're trying to get the experts on this particular podcast. And Brad is a really high level expert in his field in understanding what creates injuries, what is best to do about the injuries and how quickly you can get back into your sport. And the last point on that is to prevent it from reoccurring. Is one of the things that I'm really a really big pusher of is only because I've made that mistake myself. And Brad really highlights this is you can take control of your injury, sure we're all going to get injured, but letting it reoccur is like training the same way and expecting yourself to improve. So doing the same activities without strengthening the injury area that's weak is going to cause the injury to reoccur. And if you don't take it upon yourself to get the advice and do the rehab, then you will be facing the same injury repeatedly, which is what I have done, which has prevented me from running since the early 90s. And my lack of understanding of the rehab process in the 90s was evident. And this is what Brad's so good at, is really giving simple exercises that can keep you on the park. And I really enjoyed this episode.

So we finished off this year with a lot of injury based podcast episodes, but that is because we are so passionate about getting this education across to you. And it's just honestly One of the most underspoken but biggest limiters for age group athletes is getting to the start line fit and healthy and, and we put so much effort into, into training and the 1% is nutrition and all these other things. Yet we neglect some information sometimes about injury and it stops people from enjoying their race day. And you're in a position where you're two weeks out or four weeks out or six weeks out from your race and you have an injury and it ruins your whole experience. It ruins all the hard work you've done. It ruins the fact that you've paid entry, you've paid massive entry for some of these races, you've paid airfares, you've paid accommodation. And so getting to that point without a disaster happening is absolutely key. And in this episode you can look forward, we talk really specifically about lower leg strength, lower leg exercises that you can do, which will be golden for your improvement and strength and injury prevention all around that infamous calf muscle, what you should be doing weekly to give yourself the best chance of staying injury free. But not only that, performing better. We talk about cycling and swimming injuries specifically. But what I really liked from Brad was talking about the risk grade and risk factor of injuries and where you can afford to push a little bit and take a little bit of risk as an age grouper and where you need to absolutely back off and you should take no risk because that injury has a high chance of, of being a long term injury. So lots to look forward into in this episode. We hope you enjoy it. Here is the episode with Brad. Brad Beer, a fellow podcaster in the triathlon space. A very big welcome to the show. We're grateful to have you on.

Jordy and Jared, thanks so much for, yeah, for the invitation. Big fans of what, what you both do with Trivelo. I have some patients that are coached through Trivelo and they, as I said off air, they all rave about the experience. So, yeah, it's a pleasure, appreciate it.

We'll drive straight in and we want to know straight away, there's a few aspects to you that we want to talk about, but the main thing is your main line of work is physiotherapy and helping endurance athletes and triathletes return to form as safely and as smartly as possible. But we want to know straight off the bat when, what does physiotherapy mean to you?

To me, it means returning people like you just said, Jordy, back to their physical best, whatever that looks like. So everyone has different physical endeavors and Goals and ambitions and there's no, no goal more important than the other, whether it's elite sport or recreational sport or, or you know, anything in between. So yeah, it's a real thrill. I've never lost the joy of being been a physio in 16 years. Anyone that walks through the door, I try and give the very best to. It's just such a pleasure to see them. We call it the physio finish line through the clinic at Pogo and we want everyone to get there. Everyone deserves an end to rehabilitation and it should be a guarantee.

Other than that, is there been many people that you've just scratched your head and gone. I actually don't know how to help you anymore. We've gone to the end of the line and I'm thinking almost a little bit selfishly here because I've always loved running and I just can't run and have you had many people in that situation?

Yeah, it's a good question, Jared. You do see, I mean, you know, some cases can be what we sort of refer to as like clinical conundrums like they are. You know, there's a few layers and they, some people may have been bounced around between practitioners and. But I always approach step one should be an accurate diagnosis. And normally, Jared, if people are experiencing persisting or persistent pain or dysfunction or limitation functionally to what they want to do, whether it's running or whatever it may be, I've observed over the 16 years there's often a failure to have been accurately diagnosed or they've been underloaded with rehab like they're the, they're the, the two main reasons I see people that get stuck with conditions and you know, a classic case is someone that's been treated for a tendinopathy, say and it's not a tendon like in the Achilles tendon region. There can be nine different, different conditions or nine differential diagnoses and no one means to miss things, but someone at the onset's dismissed it and they've been treating it like a tendon when it's a tendon sheath or a posterior ankle impingement, for example. So, so everyone should be able to absolutely get to where they want to get to. There's certain times when people's expectations may need to down regulate. So you might have someone cycling through bone stress injuries and they may have to adjust their behaviors to accept that they have to do less intense running or less volume work bone workload to reduce their risk. But yeah, I fundamentally believe everyone should be able to get to where they want to get to. Happy to talk off air too Jared, and see if we can help you, mate.

That would be gold. Just following on from that. So the expectation is really about being prepared to do the work and giving yourself sufficient time. And one of the things that we come across a lot of the time is. But my race, Jared is in six weeks time or 10 weeks time or four weeks time. And that's one of the things that I suppose you have to deal with in giving people reality checks. Is that a common thing you have to the time factor that people are trying to rush towards and not giving the injury the appropriate rehab and the time that it should have?

Yeah, spot on, Jared. You're spot on. It's, you know, you can't accelerate biology. Like there might be little hacks and tricks and things that you can do to potentially speed up some tissue healing. Like someone's got a bone injury, then if they aggressively deload it and maybe go on crutches for a week or two, maybe that helps to settle it down a bit quicker. But in general terms, you know, you can't accelerate that tissue healing and, and it can be hard for athletes and I understand why to sometimes accept that. But it's the job of a practitioner working with the athlete to help them readjust their expectations and they make the decision at the end of whether they want to put the foot on the start line knowing that they're going to have to accept that they're 50% run fit or, you know, whatever it may be. So I think it comes back to clear communication, realistic expectations and. Yeah, and doing the work. And it's a journey, it's. It's not easy but knowing, knowing an end date is key. So it's always nice to know when athletes events are and you can try and you know, reverse engineer to make sure they're ready but there's times where they're just going to have to accept that they're not going to be either at their best or it's better to not put a foot on the start line at all.

I just want to follow up from what you were saying and we'll work out when we re edited where we stop and start that one. So the next question following on from what you've just said is have you had many athletes that in your opinion shouldn't actually start the race but because they're motivated and they'll tell you that I've paid for accommodation at ZFS and I'll just go and do the race anyway and in your opinion, that could actually do more damage to them, to their injury and possibly be really chronically long term. Have you had to have those tough conversations where you're saying, hey listen, this is not a good idea, but at the end of the day you can't really make that decision for them, can you?

Yeah, exactly right. It's a, it's a shared decision making process. But at the end of the day, the athlete or the patient, you know, in healthcare makes the decision. But it's the job of the practitioner to outline risks and, and help them make a, hopefully a wise decision and yes, to directly answer that. Jared, the instances where those conversations are needed are around like for example, high risk bone stress injuries. So the soft tissue stuff like your sore shoulders, your tendinopathies in your shoulders or your joint related stuff like kneecap pain or gluteal tendon, you know, the side of the hip gets aggravated, the hamstring tendon, Achilles tendon, these things, the worst that someone can do is flare themselves right up so they can't typically do any ongoing damage to themselves other than having experiencing quite a marked flare. So, so there's a bit more wriggle room with soft tissues, but there's no wriggle room at all with, with some types of bone stress injuries because they, they're categorized into high risk, you know, medium risk and low risk. So you know, some of the high risk sites, as you both would know, are things like the femoral neck. If someone's got a femoral neck bone stress injury, they should not run or hop a single step more because there's real threat and risk to their, their bones integrity and you don't want to split that and end up with a pin in it. It's the same thing for the front of the shin, the anterior shining and a bone, for example, in the foot like the navicular. So there are some really high risk bone stress injuries. So there, you know, they need deloading aggressively and quickly. And so yeah, absolutely, those conversations are necessary at times.

So we, we're big advocates of the 8020 principle. Just applied generally not talking specifically about polarized training or anything like that, but most of the time we just see 20% of the same things and that makes up 80% of what you see, you know, and I'm really curious, does that apply to injuries for you? And are you generally seeing 20% of the injuries you're seeing cover 80% of patients? And if so, what kind of areas are you, are you finding you spend the most time on with endurance athletes?

Yeah, it's a good question, Jordy. Definitely, you know, the common injuries, the difference is individuals are different. They've got different goals, they've got different training backgrounds, they've got different risk factors. But yeah, if you work in endurance sports with, as a, as a, as a physiotherapist, you, you tend to deal with bone injuries. So bone stress injuries like you know, we just touched on whether that's the pelvis, the femur, the tibia, the foot or tendon related injuries. So typically your Achilles tendon conditions, your proximal hamstring or upper hamstring conditions and, and then you've got your joint related concerns. So you've got your, you know, your runner's knee, your kneecap pain, hip pain and of course, you know, some back pain stuff as well. So yeah, you do see an overlap with the conditions but it's never boring. And just like coaching athlete, it's, it's always individualized so it's always, you know, making sure decisions are made around their circumstances. Even though it might be the same injury that the last patient or athlete had that walked through the door.

And some, some of those common injuries, and I'm talking more the tendons or soft tissue injuries rather than the bone injuries. If someone's continually presenting, recurring the same injury, is your, is your method to say hang on, let's just stop, stop and try to rebuild that a little bit better, stronger, so that it's got more resilience rather than just the band aid of, you know, people think because it's not hurting and I don't have to do that rehab work and that, that's one of the conversations I seem to be having a lot of the time is just because the injury is actually not hurting anymore, you don't abandon, you know, it is an area where you're weak. So you may have to continue to rehab this ongoing. Is that an experience you're, you're finding?

Yeah, absolutely. That's a, that's a consistent theme through my, you know, 16 years of being a practitioner. Jared the absence of pain is great, but that does not equate to the, the rehabilitation being complete. They're two different animals. An example being a bone stress injury. You could have a high grade bone stress injury and within three or four or five days of deloading it, I. E. Not running, you might not feel pain. But if you return to pain after a week of being off it, you're, you're not, you're not ready. You need probably another 3, 4, 5, 6, up to 12 weeks depending on the side of bone stress. So you're spot on. And that last point you made, Jared's a great one and that is that certain conditions require ongoing rehab while anyone has the ambition of staying active. So something like that would be a persistent Achilles tendinopathy, something, you know, a sore Achilles that's lasted for more than 12 weeks. The athlete's likely to need to do tendon related rehab and specifically like calf related strength work while ever they have the ambitions to continue competing and running. And I appreciate that sometimes the juice isn't always worth the squeeze. So you know, the tax that people have to pay to play, sometimes they can't fit it in with their time. And we all know triathlon training is demanding. So then it's the job of the practitioner to have realistic expect conversations with the athlete and well, this is the work that you would need to do to get a result. Can you fit it in? Do you have the mojo to fit it in? And if not, you know, what do you want to do? So yeah, once again communication is so key and you're right, spot on, Jared.

I want to focus on the lower leg specifically and keep it soft tissue based. And I want to know your theory around something like the calf. The calf itself has from some practitioners. It is the golden muscle to try and keep strong, keep active. It's the key ingredient to rehab. I know you've posted about it a bit and it's something that I feel like has a bit of misconception around it. How often should you do calf raises? How important are they in prehab and rehab? Soft tissue around the calf muscle muscles, the tendons around the Achilles. Very common areas of injury for endurance athletes forerunners. What are your personal principles around that area and what should endurance athletes know about that?

Yeah, it's a great question Jordy, and I'd agree with you. There seems to be a bit of a growing awareness and conversation around the importance of calves which, the role of the calf or calf calves, which is I think a good thing to see happening. I have a little, you know, maxim that I share with the athlete and that is below the knee is the key. So if you look at the, the force, if you look at the contribution to force to propulsion, when we run, 50% of it comes from below the knee. So it reasons that if someone's weak there that they're losing force and ultimately it's pushing harder on the ground that makes us faster. So you immediately get the athletes here when we, you know, educate them on that. You know, no one wants to have a handicap or a handbrake onto their performance just because they're weak in the calves. And you know, we, we all talk and I wrote a book 10 years ago about the importance of some hip stability and things, but I really need to do another one to talk about how important below the knee is now up around the hips, for example, the, the lateral hip, like the gluteal muscles there, they'll work up to three and a half times body weight equivalents per stride, whereas something like the soleus, the deep calves, eight times body weight. And that's whether we're running a three minute K or a six minute K. It is generating huge force every step. The, the gastroc which sits on top, it's going to generate about three and a half times our body weight. So the hardest working muscle in our running body and the second biggest muscle in our body happens to be the soleus. And the irony, and this is where it gets really interesting, is that we all lose strength as we age and past 30 years of age where we lose strength the most is the calf. So the plantar flexes take the biggest hit. So you've got this, you've got this often mismatch of masters athletes maturing, getting weaker and weaker, trying to do their ironman, achieve their ironman goals and long course triathlon goals or whatever it may be. And their common injuries will as a result of their calf weakness, be Achilles tendinopathy issues or Achilles issues, plantar fascia issues, fasciitis and calf strains. So it's quite predictable.

So is there a routine you recommend to counter that and what should people be taking on?

Yeah, great. And obviously it can always be individualized, but in just like general terms, something's always better than nothing. So there's gold standard ways to get it done and then there's just practical ways for people to get it done that can fit into their 15, 20 hour training weeks, getting ready for an ironman or whatever it may be. So, so some simple sort of guidelines, Jared and Jordy would be, you know, some good quality single leg standing calf raises. Like the mistake people make here, and I've made it myself in, in years gone by where people just rush the reps. So we're talking about standing hand on a wall, single leg calf raises. You'll ask someone how many can you do? And they'll say 30, 35, 40, 50, and you immediately know that the technique's going to be poor. So as a sports physio we actually take a lot from the Australian Ballet because we've got a world leading program on on feet, lower limb ankle injuries, for example, and there's very few athletes on the planet that have better calves than ballet dancers. Right. So Sue Maze at the Australian Ballet has really taught a lot of the Australian physiotherapy sports based scene that form really matters. So we'll talk about putting a metronome on that's 1 second up, 1 second down, driving through the big toe, making sure people don't roll out, getting maximum heel lift and then monitoring that they don't rock their body to generate the momentum to get up and that they don't bend their knee. And when you give those cues to someone and you put the metronome on, beep, beep, beep. One, one, two, two, you'll get even really high performing athletes that are bombing out at somewhere between 10 and 15 reps. And here's the Australian Ballet not letting people hop or jump if they can't do 25 of those with excellence. So, so that's a little tip and then you can take it like something at home. People could do how often, you know, as often as they can. Minimum three times a week to probably have an effect. But then you've got gym based stuff and there's no doubt about it, people can make much bigger gains with their strength via gym access. So that would be heavy single leg standing calf work and heavy seated calf work. Saying a Smith rack single leg's important because it's, you know, you can miss a weakness on one side doing double leg work and it needs to be heavy, like actually really heavy. So the athlete should be bombing out around eight to ten reps and trying for something like three or four sets.

Is there any way to be really specific and say your calf in terms of the gastroc is quite strong, but the soleus is weak. Is there any way of actually being a little bit more detailed about specific exercises that are going to help the soleus? And seemingly that's taking the biggest load eight times times compared to three and a half times. Is there any differentiation you can make.

There on assessment, Jared? Yeah, you know, it gets a bit complicated because they still both like synergistically work together to produce, you know, a heel getting off the ground. So. But in, in simple terms, an assessment you could do in a gym setting or a clinical setting is in a Smith rack, you know, and you, some clinics have access to this. We've got the force plates here, but you can Put a force plate under someone in a Smith rack and get them to do a maximum isometric push up into the bar in a seated position. So that gives a, a pretty robust look at someone's ability to generate force out of their soleus. And then you could do a seated 8 rep max test. So you know, Jared, let's see how many kilos you can push out for eight reps in this seated position. So that's. And then you do that in a standing position which is more your calf, your gastroc. Sorry. So the seated's more the soleus in simple terms. And the standing based assessment is going to give you a bit more intel about your gastrocs. But you normally see people just down regulated in both of those as opposed to one's really weak and the other's not. Good question though.

Just some unbelievable tips in there. And I think you can't underestimate how these little things can make a huge difference, especially for the age group athlete. And you gave two key examples there. One is that as we age we get weaker and so it just becomes more and more important to do these things. And secondly, what you said was brilliant. I thought that you can have the gold standard, which is great, but also something is better than nothing. And a little tip like what you just gave about doing some high quality standing calf raises, making sure that you're doing them with good form, even just adding a little bit of that per week for each age group athlete would be so beneficial because one is better than zero. And if they just did it once a week, that's probably going to make a big difference. Would you agree?

Absolutely. And I think that's just that grace based approach, isn't it? Like no one likes to let anyone down, whether it's a coach or a therapist. And I think we just gotta be so mindful, I'm passionate about this as a physio, that it's gotta be realistic. Like I get really frustrated when I see people with 16 with exercise programs 16 items long, I'm just like, how does that happen? You know, there's actually studies that show any more than three exercises from a home program, the compliance rate falls through the floor. So it's kind of incumbent on the therapist to go, right, what are the two or three big things that need to really be addressed here and then? And that work's got to be progressive. So I liken it Jordy to a batch of fresh fruit. You know, here's your fresh, your first batch. Go and suck the ingredients out of that and then we'll give you the next batch. So they know that it's going to be progressive and scaling up and it's going to change. Like, people should not be doing the same stuff 16 weeks into a rehab program they did on week one, something's seriously gone wrong if that's the case.

I love that. And I think when you think, think about things progressively as an athlete and knowing that there's an end goal, it's the exact same principles of how training program works. And they're not going to try and do the best training program possible in the first week. We've been quite specific here on the lower leg, and that's really hard to, on a podcast, give specific advice because every case is going to be a little bit different. But I would love to know, do you have any other go to recommendations of exercises, whether they're in rehab or just a weekly routine? Is there one or two other ones that you think would give an athlete the best bang for their buck if they just wanted to add something else in?

So if we look at the known risk factors with our biomechanics that correlate with running injuries, there's actually only two variables of how we run that actually are correlated. So that's over striding, which is a coaching type of process generally to help people with. And the other one is hip dip. So, you know, we've all seen it that obviously the pelvis collapsing under fatigue as we run. And so it's interesting, the research doesn't actually show that if you strengthen people's hips up, that hip dip actually changes. But I think that's just a limitation in research as opposed to, you know, how could it not. If you strengthen up, you would expect that to reduce. So I'm, I'm big on trying to help people, Jordy, have the best pelvic control they can still have. And, and one of the. There's every muscle group around the hip matters for that. So the extensors, the glute max, the, the ad ductors on the inside of the groin, the hip flexors, and then the hip ab duct is on the outside. But to, you know, to sort of answer the question, one thing that I think every endurance athlete, triathlete, runner should do is some side work. Anything on their side, on an athlete's side, side bridging is best bang for buck in terms of hitting those hip abductors. So, you know, there's exercises that, things like clams, you know, laying on your side, lifting the leg up and down. There's been research, that research done that looks at the continuum of muscle activation per exercise. And something like a clam is so low down on the list for activation, people may as well not even do it. So for many years I've said, kill the clam, don't do it, but just get people on their side. Do some side planks as a minimum. And, you know, and how do you get people to do that? I've gone away from being really prescriptive and saying, right, you need to hold it for 45 seconds. And now I've just sort of shifted in recent times to Jordy, use your three best efforts, give it all you got. Three times. It doesn't matter if you're failing towards that third set. That's what we expect. But you got to go to that point of lactate to get the best adaptation. And I think people really enjoy that because they see it like a challenge. They want to come back and tell you how long they're going for. If you tell them 45 seconds, they get there and maybe there's another 30 seconds in them. So, you know, do some side planks three times to absolute fatigue or twice or once. Something's better than nothing.

That's great. And, you know, some of the advice you're giving here in terms of the rehab and keeping yourself on the park, as we call it, able to get to the finish line, not only in your rehab, but in the actual race to start the race is really what we're trying to, trying to help all of the listeners out there. And let's face it, everybody at some point in time is going to be faced with the fact that they've injured themselves, whether it's a running injury or a bike injury or a swimming injury. And that's sort of where I want to go next is, you know, specifically on the bike. We've talked a little bit about running and the load that the running stride pattern generates through the body. What things are you seeing on the bike? And then we'll get to the swim later. But just quickly, what things are you seeing as the most predominantly obvious injuries that you're having to face with bike riders?

Yeah, it's a great question, Jared. I mean, apart from trauma, which unfortunately, you know, can be part of the, the triathlete cyclists athletic journey, coming off the bike and breaking, breaking bones and all the bits that go with that back pain obviously is quite common and I know you both will have encountered that with athletes prepping for the long course triathlon events. So lower back pain and kneecap pain. So sore knee is very, can be quite common. And probably the third thing would be the hamstring tendon. That proximal hamstring tendon as it, you know, comes off the, the sit in bone. You often see long course triathletes, particularly master's age, sometimes battling with that and that's partially got to do with the time on, on a time trial bike. And there's greater compression on that tendon which can aggravate it. So that'd probably be the big three, back pain, kneecap pain and proximal hamstring tendon tendinopathy.

And then I know it's tough and we do put our guests under pressure with this because we're always just going. Our big goal for endurance athletes is getting to the start line and, and getting to the start line in a position to race. And half of that is the training, you know, being confident in the training you've done so you can form, but the other half is just getting there healthy. And that is such a challenge for the age group athlete. So we always just imploring a guest like you, just if you can give any little tip of again, what do we do about that? So they're the three common injuries. What could we just start doing? Even if it's a simple tip that could help someone increase their chance of getting to the start line healthy. Yeah.

So not specifically speaking of those three injuries, Jordan, just in general terms for sure. Yeah, yeah, yeah. I hesitate to say it because it's almost so cliched, but I'm exactly. I share the same belief, like get to the start line. I mean, the nature of high performance sport is a bit different. Like the very nature and definition. They have to push the boundaries and sometimes they're going to get it wrong and hopefully most of the time they'll get it right. But when it comes to age group participation, obviously there's some very competitive and motivated age group athletes. But I think probably the thing that we're all clear on the fact that running is associated with more injuries than cycling and swimming. So if we sort of speak to running, the thing I sort of see probably being a greater risk factor than it needs to be for a lot of age group triathletes is the intensity. Running there is just such a greater risk of injury, whether it's bone or tendon aggravation with the speed work. So of course we need some intensity running in there. But depending on someone's background, with injury profile, their goals, you know, it's obviously going to depend on what that programming should look like. And of course we can all always get it wrong. But for example, like a bone injury, a runner could tolerate going from 50km a week of running to 100km a week quite easily with, with only a doubling of risk of bone injury if the pace was aerobic and steady. But when that runner then increases the intensity, the, the risk of a bone injury is actually exponential. So that's probably my big tip is just be very mindful of, of, of the how and the when of the intensity running. And that's where you need a good coach. Right. Because by yourself you're going to stuff it up most of the time, me included.

And I guess, I know, I know it's hard to answer, but I guess with cycling and swimming, when the risk factor does seem relatively lower but you're still getting some sort of niggles coming through like joint pain in the shoulder or back pain like you mentioned, or knee pain. Yeah. What do we do there to help prevent that when that's where we're trying to get more of our intensity normally?

Yeah, great question. I mean if we jump in the pool for a moment, you know your common swimming conditions are obviously shoulder related by and large and typically tendon aggravation. So a tendinopathy of the rotator cuff. So there can be simple tips that the athlete can do you want to keep them in the water. I know the Australian swim team have pretty much at high performance centers ban the kickboard just because there's a out of range great load of compression on the shoulder. So a simple tip would be put your fins on but don't use a kickboard. Put your arms by your side. For a swimmer that has a sore shoulder, it's always worth looking at the hips. They're often quite tight in the hips and that's going to affect their shoulder. They often get weakness around the cuff. So some appropriate specific conditioning exercises that can get done are key. And funny enough, it's always worth looking at the ankles of the athlete. Oftentimes there's been a history of ankle sprains or some sort of ankle pathology and therefore they're not getting the propulsion from their kick. So it actually creates a bit of overload in their shoulder. So it's always worth having a good holistic look at a sore shoulder, not just the local area. And then on the bike once again, you want to keep them on the bike as much as possible. So back pain, unless it's so acute that people can't put their shoes and socks on or get their bike shoes on, you know, keep them on the bike. The tissue isn't normally the issue. It'll calm down, it will get sensitized. So education to let them know that the pain that they feel with their back doesn't equate to tissue damage might be really key. We use the analogy that if you've got soreness from something that's not high risk, like a high risk bone injury, then when you feel a higher rate of soreness, it doesn't mean that you've damaged that area anymore, it's sensitized it. And the equivalent to that, the analogy is like a sunburnt shoulder at the beach. You get in the hot water, in the shower, you have a hot shower and it feels yuck. But the skin's no worse, it's not more damaged, it's just irritated. So when an athlete understands this sensitization versus tissue damage paradigm, they're often more empowered and less fear avoidant to get in the water and swim. They're more confident to get on the bike. So it comes back to a lot of education.

It's a really good tip there because, look, I know a lot of people will think, oh, my back hurts, I need to rest this. And actually I feel it's the opposite. You actually need to get some more blood flow and keep movement so that you. I've experienced this myself. The more I rest, the worse my back pain seems to be. And that's just my experience. And I'm sure from yours, from an actual, a medical point of view would probably nearly back that up.

Yeah, absolutely. It's funny we're talking about sore backs. I, I had a really sore thoracic spine yesterday in the pool at the swim squad. It's an irritated disc from holding my 16 month old daughter out in front. And it was stabbing pain and I knew what it was and I started to get in a little bit of like panic because I'm like, oh my gosh, this is going to keep me up for a while. And then I'm like, hold on, put your fins on, put your snorkel on, go to the back of the lane. The pain isn't equating to any further tissue damage. It's aggravated. And I got the rest of the session done and it was pretty slow, but I could still turn the arms over. And I felt quite, quite accomplished. Came to work, did my normal work day. I'm back here tomorrow and it's much more settled. But I could only do that because I've had the lived experience to know that when my back sore, it doesn't mean I should stop. Exactly like you said. So.

Yeah.

And we actually know that running for back pain is generally a great thing, unless they're so flared up that they do need to rest, to have a couple of days to calm the farm and then get back out there.

You've done a great job of answering our pretty tough questions and actually turn them into some pretty specific advice, which is a really good effort because we do have some tough ones. And I know we've only got a couple of minutes left, so I do want to just finish off and talk about your other area of expertise. And you were a high performing and still are a high performing triathlete yourself. Some great accolades to your name as a triathlete. Plus you've got your own podcast show where you've interviewed some great guests over the journey. So I want to quickly finish off and just ask, the sport of triathlon, you're so involved in it, what does it mean to you?

Well, it's kind of been in many ways my life. Like I did it as a kid, that's the first thing that I fell in love with through my junior sport, apart from soccer, which sort of every kid, male, boy, often, you know, boy does as they grow up. But it's the first thing that I really was passionate about. And, and I remember thinking the only thing I ever want to do is triathlon and if that's not an option, then I'll do physio, because I was always at the physio, so I've combined them. So what does triathlon mean to me professionally? It's, it's where I like to, to spend my time working. It's just, I think it's just a nice parallel to life. Like there's the ups and downs, you have your wins along the way, have plenty of down times, but it's just that achievement of whatever the goal may be to the athlete, it's a fantastic sport. There's so many different versions now, whether it's off road, long course, short course, sprint, you know, aqua bike. So, yeah, I don't know if I've answered it well, but that's what it means to me.

Jordy, that's perfect. And you've, you've interviewed a wide range of guests in a wide range of elite sports, but a lot in triathlon, cycling, running. Again, tough question to finish off with, but who is your all time favorite guest and why? What did they teach you?

Oh, gosh, that's brutal.

Oh my gosh Especially when you've done 350 podcasts. Yeah, I'm intrigued because is there someone who's taught you the most that you've gone, wow, that's just being gold.

I mean, it's biased by what I do. And it's a cliche to say that we do though, right? Because I know you would as well. With what, what you do with Trivala. You learn something from everyone and that's. Is there any greater currency in life than learning? Like, it's such a thrill, isn't it? So because of what I do as a sports physio, I'm always trying to improve my skill set, knowledge and an application of that. And my own personal injury history has been a lot of, unfortunately, bone stress. So someone that I just have a great admiration for is Stuart Warden. Professor Stuart Warden, who's based out of Indiana University, used to be at the Australian Institute of Sport. His research is really informative. We had Stuart on circa 200 episode 283, talking about one of the narratives he'd written in a, in a journal article around preventing bone stress injuries. So I really enjoyed that. That was really holistic conversation. So I know I can only give one. So I'll say I've learned heaps through Stuart Warden.

I like that if you were going to rattle off a couple more that, that were your favorites that were in the mix.

Yeah, I mean, sentimentally, I grew up as a junior triathlete in the 1990s, when, you know, Jordy, you wouldn't have been born. But obviously dad Jared's right across this, you know, the, the F1 series here in Australia with the St. George to his blue, etc. And, and the only person I wanted to be in life was Brad Bevan. You know, he, he. I had cutouts of him in my living room. I had posters, had all the books. He was laminated on my books. Although I did put Greg Welsh on there on my English book in year nine when he won the Iron Man 1994. But, and so, yeah, Brad came in very early in the piece, maybe episode 26, seven years ago. And, and I remember the night before, barely sleeping because I'm like, you know, and you'd be the same. You want to respect your guests time and everything else. And you, you want to genuinely get the most out of the opportunity to, to help people. And I felt a real responsibility and it was just a lot of fun. And off the back of that, you know, we've, you know, sort of become, you know, friends. So if you had told me as a 10 year old kid getting into triathlon, just, you know, worshiping the feet of Brad Bevan that, you know, as a 42 year old now I'd know him as a friend and you know, once again, is there anything richer in life than learning and good relationships? So that'd be probably one of my sentimental favorites, mate.

That's a great way to finish. Well, we appreciate your time and coming on. We know you've got to go and we'll definitely look to have you on again because we've got more and more questions we want to ask you and we only scratched the surface today and like I said, you do a great job of scratching that surface and then giving some real goal tips to people, which is what this is all about. We're just trying to give the tips that the tiny ones that can make a difference and that's all it takes is you might pick up one thing here or there that really makes a difference to your training and your racing. So, Brad, thanks so much for joining us on this episode.

Jordy and Jared, thanks so much for the opportunity and yeah, more than happy to pop on anytime.

Appreciate it, mate. Thanks everyone for listening and we'll see you in the next episode.