Live With: Bryan Kinslow

Welcome to episode number whatever of Live from Dream Run Camp. As always, we are presented by 80/20 Endurance. We are also a proud supporter of the Coaches of Color Initiative. We are receiving applications for our next apprenticeship, so if you are a member of the BIPOC community and you are an aspiring endurance coach, um, do visit 8020foundation.org and apply. And if you would like to support the cause, you can visit the same website and donate. That would be much appreciated. One other commercial announcement before I introduce this evening's guest. We have a special retreat called Run, Write, Repeat happening this August. From the 15th through the 18th. So if you are a writer who loves to run, or a runner who loves to write, um, we would love to have you. Um, this is going to be kind of an intimate affair. We're capping registration at 12. Um, spaces are filling up, but we would love to have you if you fit either of those descriptions. That's Run, Write, Repeat. You can learn more about that by visiting dreamrunncamp.com and hitting the events tab.

All right, enough for commercial advertisements.

Uh, so our guest this evening is Brian Kinslow.

Hey, welcome Brian. Thanks for having me.

Um, Brian, I have, uh, introduced you before as Abby Chan's better half. Yeah, um, I think it's still that way.

That's all right. Oh, she's my better half.

It's one or the other. And so you are a physical therapist working out of Evolve Flagstaff, just down the road from here. You are, as of very, very recently, the official physical therapist partner of Dream Run Camp.

Yeah.

Thank you. Yeah, thank you for accepting that overture. Yeah, um, and so that is what brings you to the sectional.

Yeah, comfortable sectional too.

Yeah, so, um, am I still in frame? Yeah, I'm just like, you know, I like you and all, but not so close.

Let me go figure that out.

Um, so, you know, I think What's fun about sitting down with you in particular for me is like a lot of folks who have sat down in that exact spot or reversed previously, I've already known the answers to almost all the questions I'm gonna ask them. With you, much less so. Like, I don't know about— I didn't know much about your story.

Yeah.

So it'll be fun for me to learn about it, and everyone's story is interesting, so it's gonna be— it's gonna be fun for you.

YouTube.

Yeah, so let's start there. We definitely want to get into your expertise and how it's relevant to DreamRun Camp and runners more broadly, but let's start with like, who the fuck are you, man?

Yeah, so, uh, we were just talking. I grew up on the East Coast and, um, I didn't always know I wanted to be a PT. I remember I was like, I had a knee injury or something in high school and I always did well in school. My mom was like, what, what do you think you want to do? And I was I don't know, you should be a PT. And I was like, ah, that's boring, I'm never gonna do that. Um, so worked for a few years after college and I always wanted to move out west. Um, I was working in kind of unrelated, some marketing roles, um, but was like a part-time CrossFit coach actually. That was kind of my original like entry into kind of working in the fitness wellness space, but, um, saw some injuries in that space and kind of wanted to to help people a little, a little more deeply. And so eventually just took some prereqs at a community college to see if I liked going more into the sciences. This was after my undergrad degree and eventually kind of, you know, committed to that and came to Flagstaff for physical therapy school and met my wife Abby, who's born and raised here. And then shortly thereafter, we started Evolve when I was kind of fresh out of school and It's been almost 7 or 8 years now, so never looked back, I guess.

But yeah, well, I'm asking you to look back.

Yeah, you know, but yeah, so that's, that's kind of a little bit. And always had kind of a sense, you know, being an athlete myself and being kicked around in the healthcare space a bit, that it's tough as an injured athlete. Sometimes the providers don't know what you want to get back to or how to don't speak your language necessarily or just tell you to stop doing the thing that you want to do. Right. Um, and, and just so had a sense that there's some way in which to operate a little bit differently as a physical therapist. And that kind of led us into Evolve where we, you know, Abby being a dietitian, you know, it seemed like a really natural fit. I mean, for us as a partnership, but also professionally to, to try to combine some of that in a more holistic viewpoint. Yeah.

Um, what were your, uh, um, was there a particular sport you did in youth that was kind of a passion or a forte?

Um, soccer for a little while, and then I was sidelined kind of middle of high school with some knee injuries that, looking back, I think like weren't well treated and ended up getting like a pretty, pretty big knee surgery looking back when I was like 18 that So I kind of didn't play soccer after that. So I think I've taken an interest in kind of knee and foot and ankle injuries because that's what I suffer from. And so when soccer was out of the picture, it was actually swimming was the bigger thing for me. And then got into kind of mountain biking and running just on the, on the side outside of just organized sports.

One thing I know you would never do Is run an ultramarathon.

I mean, I just started training for one. What? I'm not a natural-born distance runner. I've done some, some halves and kind of 20 miles plus in Grand Canyon here, but, um, but yeah, it's, uh, I've never committed to and trained for a marathon or or longer. Um, and so we'll see, we'll see what happens. But I'm excited to kind of apply the things that I teach all the time, right? Um, and Abby's trying to figure out how to fuel me appropriately when I— when we get to some longer distances.

Yeah, I mean, I'm interested in that because, um, you know, you know, there have been times when as an athlete I've been very self-conscious about the fact that I'm also a writer.

Yeah.

And so like, um, like fear of hypocrisy is like a pretty— had been a pretty strong driver for me. It's just like, I do a lot of preaching. It's like, you know, am I practicing what I'm preaching? And so, but I found that very helpful, you know. It's like, it's just a form of like an internal accountability.

Yeah.

Um, And so are you finding that as, you know, as you enter this kind of chapter, um, of like having a similar kind of accountability, I guess, to what the preaching you do?

Totally. Yeah. I mean, we're early days, so our mileage is not very high, but yeah, try to organize several runs a week. And then a lot of what I talk with my patients about is the importance of, um, some sort of resistance training, whether it doesn't even have to be with heavy weights, but, you know, some couple of times a week dedicated session to support running and, um, and just fitting that in when you have a full-time job and other things outside of exercise. So kind of realizing— I don't think I was way off the mark, but, you know, trying to figure out how to prioritize what's most essential about that routine to, to keep you healthy as you, as you run. I think as the distances get even longer, there'll be some more learning there of, yeah, how do you best structure and organize that, um, particularly when you're having a big mileage week. Um, yeah. Um, but I think there's two— I think sometimes PTs are afraid to make— I mean, nobody wants to get injured, but I think sometimes PTs are afraid to admit that, or, um, you know, if they haven't gone through it, they might not know what it's like. So sometimes I think, of course, we don't want a major injury, but having some minor tweaks and things like that, I think could be a big learning process. And so, um, just knowing that, so that's probably gonna come up. And yep, we all have an injury history, and how do we kind of manage and prioritize that? So that's kind of what I'm excited about, and it's got me like excited about training again. Not that I wasn't, but it's kind of like you go through the motions. Yeah, yeah, yeah, yeah.

You need to mix it up sometimes.

Yeah, exactly.

Toss a hand grenade.

Which for me, long distance running That's a hand grenade.

See what happens.

Yeah, yeah, yeah.

Well, I mean, shoot, you know, I got long COVID and I'm training for an ultramarathon.

I know. So it's like, yeah, you know, it just like doesn't have to make sense.

You might still be faster if, if we were going to wager on this, like, my money's on you. I'll just, you know, put it that way.

Yeah.

Um, no pressure. But you have no idea. Yeah, so I'm interested because you could have a passion for the activities and not feel a calling to be a helper within those passions. So what is it about your makeup that made you want to be someone who, yeah, you participate, but you also pass on?

Yeah, that's a good question. Um, I think to some extent, I think part of how I see my job is seeing patterns in different things. So patterns of movement, you know, as any healthcare provider, you do a lot of assessment, and so I didn't kind of make sense out of that. And so I was always drawn to that from like a movement perspective. Um, and then Yeah, I think that's maybe just part of my nature. If I see something, you know, I'm not going to be the guy at the gym that goes up and corrects me, but, um, don't be that guy. No, don't be that guy. But I think it— yeah, there's some innate thing of, um, yeah, that I think just helping to kind of guide people and come alongside them and to, to help them to see some of those patterns and then find ways to work on them. To me, it feels really fulfilling to kind of help people to get where they want to go. Um, and I think like almost everybody— like, I've been at PT conferences or courses where they do this, they say, you know, raise your hand if you have something that hurts right now. And like, even a group of PTs, everybody raises their hand. But I think when people are in pain, not only does it limit them from doing maybe what they want, but it affects bubbles out for the rest of their life. Oh yeah. Their relationships, how they show up at work, maybe just their overall stress response. And so I think in a small way, I see like using the knowledge I have to help people hopefully having kind of a ripple effect, not just on their ability to run or to do what they want to do, but how they can then show up and hopefully that makes the world a better place, as cliché as that sounds. But I think that when people are in pain, they are more reactive. And so I think it's, yeah, it's fulfilling for me to see people say, hey, this doesn't hurt, but also all these other things have fallen into place in a good way.

Yeah, I'm super interested in the phenomenon of like finding your individual within a profession, you know, like physical therapy. Because like you could easily be just like, you know, straight from central casting. Like, I don't know exactly what the prototypical PT is, but like whoever that is.

Yeah.

And then, you know, and so, you know, when you're actually going through the training and seriously considering making it your career, you know, for decades, in the future, you know, you're paying attention, you know, like you're a sponge, like you're absorbing, like you're being taught a lot, you know, you're doing all this hands-on stuff, but like there can be this process of sort of like, um, you know, losing your religion a little bit, you know, it's like some of this is a little bit of a kind of like it's more than teaching, it's kind of indoctrination, and like I actually like I'm not quite feeling it completely.

Yeah.

And then you're like, well, you know, you have to decide, is this still a worthy path to go down? And then if your decision is yes, then it's like, well, how do I find my space within the profession where I feel like I'm doing it the way I think it should be done?

Yeah. Yeah, I mean, that's 100%. I mean, first, PT in school, you're trained— a lot of times we think of PTs and roughly maybe how I practice seeing people for pain and injuries, um, in an outpatient type of way. But we're trained to work inpatient in the hospital, uh, to do neurological rehabilitation after, say, a stroke, or to, um, learn the basics of something after a spinal cord injury, pediatrics. And so actually, like, what most people think of as a physical therapist really was only like a third or less of what we spent 3 years doing in school. And that was kind of a little jarring for a lot of people who came in with kind of that. But you learn a lot along the way of how to work with people and the rest of how just the body works as a whole. And then you kind of funnel, funnel down. But I think physical therapy, probably like any other profession, is subject to some, some like pendulum swings. And so for a while it was it was, you know, kind of maybe stretching is the, the thing. Um, and then for, you know, then it was kind of dry needling, like every PT was kind of dry needling every, every injury. And then, yeah, now it's kind of, you know, which I think is a good thing, is, you know, that every injury needs strength training. And it's often the case, but not always. And so I think trying to find the middle ground of, okay, these are all tools, but what is my overarching kind philosophy of how do I filter through, you know, what is— what's actually going on, and then which tool do I need to apply, rather just having a hammer and only using that, right, every time. And so that's really what I've focused on in our practice, is how do I kind of systematically see somebody, you know, systematically look at their biomechanics and what's going on, but also see them as a person and to, to come up with a plan that doesn't just use, you know, what I've used on the last person.

Right.

Yeah. Um, and I think in PT it's tough because a lot of clinics, they just get really busy. Um, it's hard to have those, those kind of filters.

Yeah, it's like an assembly line.

Yeah, yeah, I think that's like a lot of healthcare right now. And so we've tried to push against that as best as we can. Yeah, we have time to to really have conversation and to consider and reflect and to figure out what's the right plan and the best tool for what's happening.

Yeah. I want to open up the floor for questions. If anyone present, if you feel like caught wrong-footed by this invitation, I can ask one more question, buy you time. To get your question together, but if anyone has one, just ready to go.

Just so you guys know, kind of physical therapy pain, and you probably can't diagnose anything here, but give it a good shot, or, but also kind of training or strength training, things like that is kind of definitely in my wheelhouse. Um, how those might relate to an injury or, you know, so yeah, whatever, whatever comes to mind.

I have more of like an overarching question. I'm wondering, do you agree or not agree with the statement that pain is part of running? Because we talked about this yesterday, that what's part of running? Pain. Like having a niggle somewhere, is it like part of the game, or do you feel like it could be avoided to a large extent? I mean, pain is very wide, of course. It's very— there's a very broad Yeah, range of pain, but that's a good question.

Um, and I've debated that too, of whether— and I think sometimes I work with my patients first at a base level, and I don't think you mean this, but what do they mean when they say it hurts? Because we can use the word hurt to mean like the discomfort from a hard workout that might be a healthy— it's like, oh, that one hurt a little bit. And I'm not talking about kind pain or injury. And then there can be, yeah, maybe a little niggle that, you know, warms up and kind of works its way out. And then there's maybe something that causes a limp or swelling or things like that. So I think there's sometimes different— I don't know if other languages are different, but I think sometimes English, we have limited vocabulary to describe some of those types of discomfort. I think to be human though is to have some sort of pain or discomfort. And so I mean, there's sometimes that it's like the body does weird stuff. And so sometimes I'll, you know, like anybody get out of bed and it's like, oh, my knee felt a little funny on that couple of steps, and that kind of fades away. And so whether that's just kind of this like aberrant like nerve impulse, or was it, you know, we are kind of a moving living system. Um, and so I think to some extent to, to like, and even if we just sat here on the couch, something would start to hurt. So I think we can avoid some types of discomfort. And so when it comes to training, I think, yeah, you're going to probably feel some things, but I think it's being attuned to your body and recognizing what it means. Like if you do a big run with a lot of vert uphill and downhill, you might feel kind of the tips of your knees. And so kind of being attuned, I think it's probably tough to avoid some of that, but it's some of that sharper pain or pain that kind of takes your breath away or maybe changes your stride or limp, I'd like to think that can be by and large either avoided or reconciled and resolved pretty quickly. When people say that they have to run through pain or that running is going to cause pain or, you know, consequences down the road, like, I don't necessarily agree with, with that. So, so day to day, like, whoo, I trained kind of hard, I know I did that, I think that's probably normal. But beyond that, um, I think to be good at running at a high— I don't even know, high level— at any level, you have to train yourself to be comfortable being uncomfortable. And I do think in some people that changes our nervous system a little bit, meaning like how our brain reacts to stimulus coming. It does. Coming in. And in some runners, I think that causes them to maybe perceive things that somebody else would see as an injury as, huh, that feels a little off, but nothing. And then they don't notice it till it kind of really blows up. And so I've seen that. And so I don't quite know how to reconcile that other than kind of giving some self-monitoring tools. Maybe it's range of motion, or maybe it's a couple movements you do most days to kind of do a self-check and see how things are going. But, um, 'Cause I do think runners can change how their nervous system perceives things. So, anyway, it's kind of a long little tangent, but—

Great, great question. Great answer. So that question came from, I forgot to acknowledge, we have a full house this evening. And so, yeah, things are buzzing at DreamRun Camp, super excited about it. We have like a pretty international cohort here now, proud to get more. So we've actually rented out a second house, uh, so we can accommodate more people. It's just down, uh, the road from here, and there actually is still— things are filling up quickly, but we have plenty of capacity still through the finest months, um, of the season. So, um, but yes, it's exciting. So that question, part of our international cohort, came from our first European Dream Runner, but not our last.

Welcome.

Um, yes, Renee, uh, from the Netherlands, um, asked that very astute question. Not her first, probably not her last. She's here for 4 weeks. So thank you for that great answer. Um, any— anything else from the panel, uh, before? Because I got one or two queued up.

You look like you have one.

Nope, nope, nope. Um, I'm interested in Danny from Canada.

Yeah, international.

All right, yeah, it counts, it counts. Yeah, I know he eats ketchup-flavored potato chips, okay? It's a different country. That is not the same.

Something you may never You guys have to catch up to us. Um, so, so I'm interested in, uh, just, just generally philosophically, like, approach to, um, uh, like, like running training, like, and all sort of like contrast this against what I understand, like, more like strength training.

Yeah.

Which I think you're obviously based in CrossFit. Um, and like, I would say like the— I don't know if you agree or disagree— the good coaches or practitioners will sort of like, they'll probably do some sort of like functional diagnostic. Yeah, like an FMS or something.

Yeah.

And then they'll like probably like create like stability, strength, and then layer, um, you know, like, uh, capacity on top of that.

Yeah.

And volume and more ballistic stuff or whatever.

Yeah.

Um, In running, I've noticed, and there's like a huge amount, just, just my— it's like, you know, you typically just like run.

Yeah.

Um, and but here's the thing, I've seen, I've seen people be really successful just running and then just like getting better. And then I've seen people being much more nerdy about the biomechanics of it and doing more of like a layered sort of like stability, strength, you know, getting your biomechanics sorted out, maybe through some like PT or strength training, and then layer in capacity on top of that. I've seen actually kind of both systems work, and in my personal experience, I've actually noticed that like volume sometimes, if you're doing it right, kind of the machine kind of figures itself out. But I'm always like just wondering what you think maybe the balance is, or is that individual, but like how do you approach it when you have someone who wants to just like obviously get better, have fun, not get hurt, What's your, what's your approach?

Yes, a couple things come to mind. I think first there is kind of an ongoing debate about the extent to which we even can or want to change somebody's like running gait. Like, it's definitely— research shows we can influence it, but as far as like completely changing how somebody runs is really challenging because to some extent how our brain and our nervous system coordinate locomotion, which is gait, walking, or running, is by and large on an unconscious level. So it takes a lot of energy to actually change how you run. And so if anybody's played around with the running gait, you might notice it's cardiovascularly harder for at least a couple weeks until your brain kind of, you know, normalizes some of that. And then how much reverts back once you start focusing on it. So there's kind of debate to what extent can we influence running gait. That aside, I think there's kind of a general, you know, principle of training for anything, a specific adaptation to an imposed demand. So basically, the body is going to adapt to what you tell it to do. And so if somebody wants to be good at running, I think And I've been guilty of this for myself in the past because I historically have not been a good runner and I've gravitated more to strength training. And so when I've tried to run in the past, I think probably haven't run enough, and I've done other things which maybe were helpful for my physical fitness overall but not so much for running. And so I think there has to be a certain amount of doing the activity that you want to be good at, but at the same time, there's probably a floor, kind of a baseline of some range of motion and some stability and some movement coordination and kind of strength that we want to have. And so there's— I will often take— often I'll do it as a return to running test if I'm working with somebody with an injury that shuts them down. We can kind of take what we know about the running stride, how much range of motion we need at the individual joints, what are the joint forces going through the various muscles and joints. And we can break those apart into different things that are testable one piece at a time. Um, and, and then we can put somebody through that and see kind of where they, where they break down a little bit or where they're, where they're lacking. And so to me, if we take the component parts of running and, and somebody is missing there, if they're not in pain, I won't tell them to stop running. Um, but with those might be some high priority to kind of shore up to potentially reduce injury risk. Or if I'm working with somebody getting back to running, I usually want them to hit some of those criteria before we start layering on a lot of volume. Um, and then beyond that, it's— we want to continue building on some of those things with some strength training. But I think there's probably a seasonality to it. Like, strength training will often do periodization. Um, and so I think in maybe a winter season, if your mileage lower, that's maybe time to focus on some of the strength. But spring, summer, if your mileage is going high, we don't want the strength to detract from running at that point. So I think it's kind of a— it's definitely a little bit of a tug of war, but I think there's probably some prerequisites that are a good idea to have managed. Um, like you need a certain amount of range of motion in your hip to get through the stride smoothly. If you have less, that range of motion has somewhere. It might go into your back. Exactly. You need a certain amount of, you know, calf capacity in order to run uphill and to stabilize going downhill. So that's kind of what I measure, is, is do we have kind of the baseline? If we do, let's make sure you're, you're, you know, you're ramping up your running. But as you're ramping up the running, let's— and this is what I'm doing now figure out a routine where you can keep some of the strength stability stuff so that way it just doesn't go by the, by the wayside. So I think sometimes those lower miles can be a time to build a routine that you hopefully hang on to as you get longer. So I don't know if that fully answers your question, but those are some of the things I think about. Yeah, um, I guess last thing I'll say is because I think if you do too much of something else, then that could start to pull, pull away from it. However, one thing I do see that is coming in my related that I think can be a mistake is where often runners, but can be triathletes or swimmers or something, they try to make their strength or their stability or cross-training work look exactly like the activity. Meaning I've had swimmers where they try to make their strength training exercises look like their swimming stroke. Or the classic thing is runners who, um, you know, will stick with pretty light weights, high rep kind of only. And really, if our, if our cross-training or strength training looks similar to the sport, we're probably better just doing the sport. Um, and so I actually think the strength training should be related and informed by the sport, but might be a place to use different weights, different speeds, different directions, because we're trying to fill in gaps that you're not getting from the sport itself. And so I think that's sometimes a mistake of we don't want to do so much it pulls away from running, but it shouldn't also look exactly like running. At least that's kind of what I think. It's supported by science and what I've seen work. I don't know if you kind of agree.

No, I mean, it doesn't matter whether I agree. You're right. Uh, but yes, I'm buying what you're selling.

Yes.

Um, yeah, so, um, quasi-personal question, but I know you through your wonderful wife Abby. Um, so she, um, you know, I, I moved to town with my wife from Kentucky. Uh, we were looking to open Dream Run Camp. Um, I was looking to put a team together. I wanted a dietitian Yeah. Um, AJ Gregg, a person whose opinion I trusted. He gave me all my restaurant recommendations when Taki and I lived here in 2017, and they were spot on always. So I'm like, if he recommends a dietitian, I know she's good. And, uh, as you well know, like, uh, Abby is like just a dynamo. Yeah. You know, and, uh, and so, I mean, I think she's fantastic. Fantastic. I'm pretty sure everyone she encounters does. And so like, I think of like— and now I'm getting— I'm sort of like, so she was, she was like the gateway to you for me. And so like, I feel like we have some catching up to do, but I'm getting, I'm getting to know you. And so, you know, and I can draw certain contrasts.

Yeah.

And so like, I think of it like you two like as, um, members like of a band and like like Abby's like the lead vocalist and like you're on bass. Yeah, not drums, bass. You're holding down the rhythm. Yeah. Um, how accurate is that perception?

I think that that's fairly, fairly accurate. Yeah, I mean, she, uh, yeah, and you guys maybe haven't met her, but yeah, she's really dynamic. Uh, it's definitely more active on kind of public-facing social media than I am. And, uh, yeah, brings a lot of energy to everything we do. And then I try to bring energy as well, but I think she just has a different kind of fire to her at times. And, um, and often, I mean, the role in like our business— I treat patients, but I do more of the back-end admin stuff and kind of keep the lights on in that way, make sure everybody gets paid and stuff like that. And, um, so yeah, I tend to be a little bit more of that, that be in the background holding it. Yeah, so that way she can shine. So I think that that's fairly accurate for sure.

Yeah, you're pulling your weight.

Do what I can. Yeah, yeah.

I mean, you don't want to be in the band without the bass player.

And sometimes I think she'd agree with this, sometimes she'll get, you know, up here and it's like, well, let's bring it down. Sometimes I'm here and she helps me kind of bring it up.

Right.

I think there's a balance and in that way, for sure.

Yeah, yeah.

Um, yeah, you know, one of the things, you know, I like Abby's personality, but I also like things that are like— that I like in anyone. I like the uniqueness of each person I befriend, but also there are certain traits that I am very drawn to. And definitely one I just know from experience, it wasn't like an agenda or anything, it's just a pattern. Yeah, you look patterns. Like, for me, it's conscientiousness is like super high. Like, I am just drawn to highly conscientious people. Yeah, just like, like, give a shit kind of people. Yeah, really give a shit. And like, Abby is very conscientious. And like, I'm— I get the sense that I don't— I don't know how you two could possibly work if you weren't also.

Yeah.

But I mean, is that something you're cognizant of, like, in practicing your performance profession, you know, just like— this is kind of a softball question because you can only answer it one way, but I mean, what's the truthful answer to, like, you know, I just throw that word at you.

Yeah.

And you think about the work you do, what's the resonance?

I mean, I think a lot. I mean, one thing on just a more superficial level is something we tell our staff is that when people— that every detail matters, even if the, the client or patient doesn't notice it. It's like you, you walk into a place and you're— people pick up on, they pick up on a feel. Um, and they might not know why. It's like you walk into a coffee shop and you're like, man, this place got a cool vibe.

Yeah.

You might not pick out everything that does that, but it's the level of the music, what they're playing, the decor, how the chairs are organized. And you walk into a place that looks similar, but it's just a half a note off. So And I think from that sense, that carries through to, I think, my work too, where I tend to— I think maybe sometimes it's frustrating for the patients, but I tell them, in my opinion, it's part of the process, especially if I'm seeing somebody who's had an injury that hasn't seen success, you know, in the past or elsewhere. So I think the details really matter from, you know, because I could give you an exercise that maybe looks straightforward or simple, but how you execute it really, really matters. Or I think kind of the nuances of your movement or your kind of how you, um, different aspects of the exam or different things. And, um, or even kind of how I will program the exercises. It's not just here's 5 PT exercises, go do them. It's like this one is for this reason at this time, right? Kind of the next one. And so I think I do my best not to like overwhelm people with that, but I think often it's some of that attention to detail can go a long way in making the simple stuff really powerful. Or if you need to go deep down the rabbit hole, you know, you've, you've checked all the boxes, you know, well up front, if that makes sense. Even like simple things like we do a lot of assessment, and so whenever I have I have a physical therapy student kind of shadow me. I take them through the first thing you learn at PT school is how to assess a joint range of motion. So I'm looking at your knee. I might take a minute to look at how it's— because that can give me some information. Whereas if I just boom, go, I might not pick up on it. And so, um, so yeah, I think that, that rings, rings true. And I think when people get, um, lose sight of that, that's when it starts the— yeah, you don't get as good of an experience, or you can start to miss, miss things and be less effective. Yeah, so softball, but I think that is something I truly try to pay attention to.

And yeah, I was just teeing you up. Yeah, kind of knew the answer.

Yeah, um, yeah, or even things like— sorry, but how we're, uh, we're starting to bring on some part-time PTs and big on even like how the format of their program to the client looks to me will impact their adherence. If they get something that has some typos or the font is like different, like that stuff drives me crazy. But also the patient's going to be like, I don't know, it's not as like—

and so just a little fly-by-night, that extra, that extra 30 seconds, I think.

So those small things I think can make a big difference in that movement.

Yes.

Yeah.

Yeah.

But, um, I want to open up the floor to any other questions we got from the group. Yes.

So I'm curious to hear from a physical therapist.

Yeah.

When should you see a physical therapist?

Good question.

That is a good question.

I think a couple times. Couple different occasions, maybe. If there's one that you either know or know by reputation and they understand both the activities that you want to do and how to support them, I think checking in once or twice a year is not a bad idea to just kind of get an assessment of strength in different places, movement patterns, um, maybe having them put eyes on the training plan so they and work with your coach. Um, and so I think I've had a lot of success with people over the years that I maybe only see them now a couple of times a year, but we now have a history and we can track things over time. Um, because something that can happen with endurance sports in particular is the muscles that are most active to go in a straight line become overactive and some of the more stabilizing muscles can start to, um, get what's called inhibited or they can start to change. And so having somebody else put eyes on that for you can sometimes be really helpful in keeping things, injuries at bay. So that's one, is maybe once or twice a year, not a bad idea.

And then like going to the dentist, like going to the dentist.

Yeah, that's actually something that some PTs will say. And then I often will tell people, and you all probably know, like soreness from a hard workout, so delayed onset muscle soreness, typically peaks within 24 to 48 hours. And even if it's pretty severe, by 3 days, 72 hours, it's usually on its way out. And so anything that's kind of sharp or really painful, even the night of, I mean, you'll know you ran or know you did something, but if you stand up the night after a run and you're like, "Ow, that really hurt," there, that's maybe a little abnormal. So not, you have to make an appointment that day, but that'd be a trigger to kind of pay attention to it. Um, and so if things like that don't go away after a week, maybe two, um, might be time to check in. Um, and then certainly if anything is swollen, um, anything is causing you to limp, things like that. Um, limping is a big one for running in particular, because when you're, you're changing, you're not symmetrical, that can immediately load something different and lead to kind of a cascade pretty, pretty quick. And so, so those are— if things are not— I usually, you know, give it a week or two and then kind of check in. I think it can be a good rule of thumb once you clear, okay, this wasn't just from a workout and, and it hasn't gone away kind of on its own or with things that you'd know to be, to be helpful. I will say for a lot of things though, if you— especially more acute injuries, so not always like a running, a lot of things come on over time, but let's say you do a very bad sprain your ankle or pick something up and hurt your back. Often it's uncomfortable, but waiting 2 or 3 days, you know, to get into PT can actually be helpful because if I see you the day of or the day after, a lot of times my exam might be make it worse. And so if we think there's a fracture, we'd want to rule that out. But I think kind of if there's a big acute thing, waiting a few days can be helpful. I'll get people text me and say, hey, I threw my back out 10 minutes ago, can you see me? And it's like, let's wait a few days, see what shakes out, and then, and then go from there. Yeah. So good question.

Yes, very good. Um, I've got one more to wrap up with and Unless we got another one from the panel.

Well, I guess my question would just be for older, older runners. Are there any special considerations for them to think about? 40 and over? 40 over?

Yeah, Jason from New York City speaking, folks.

Um, definitely, yeah. So a couple things that I think about. Um, first, unfortunately, with kind of every year and every decade, we do lose muscle strength. And running doesn't necessarily build that. And you don't— it's a couple percent a year at the most. And so you kind of don't notice it until it's too, too late. And so I think actually, as the older the runner gets, the more priority I would probably put on some of the strength work. For their overall health outside of running, but also to make sure that it's, it's supporting running. And so that's kind of an overarching thing. I want to be careful with that program though, because too many plyometric exercises can be harder to recover from for kind of a master's or a slightly older runner. So doing some strength work, but making sure it's I'm really judicious if at all programming plyometric works. That's number 1. There's been some interesting research on the calf muscle, it's called the calf muscle complex because it's a couple of muscles that even in people who are regularly running, that tends to, for a reason that I actually don't know the answer, but it can actually atrophy or increase faster than some other muscles, and that certainly has a performance effect on running, um, and, uh, and can lead to calf muscle strains, Achilles tendon. Um, there's a guy here that I work with at Flagstaff, and he's— he calls it the old man calf because he's like— he's about 42 maybe or something like that, but it's like all the runners in his age group have strained their calf. And then I test their calf muscle capacity, and even though they're, they're pretty trained runners, doing some calf strength, calf endurance tests doesn't— they're kind of surprised on some of those results. So doing some specific calf muscle training, I usually do that as far from the long run as I can though, because if you haven't done it, it can make your calves pretty, pretty sore. So those are, those are two considerations right off the bat. And then I want to also be careful with the range of motion of exercises. Like, if you search, like, online, how deep should you squat, you'll find a million different, like, very fiercely argued viewpoints. And so my opinion for strength training is we want to train— we don't want strength training causing injury, we want it to support what you're doing, and we want to train in the range of motion that is available. Available. And so sometimes as we get older, the joints do get a little— we can lose a little mobility. We can work on that in other ways, but if I see somebody that it's the first time I've worked with them, they're, you know, 42, 45, and they are a little stiffer, I'm going to choose strength training movements that, that match their range of motion. And that's sometimes harder to get from just kind looking at an online training plan or something like that. And then just knowing that unfortunately as the body ages, I don't think that, you know, 40 to 50 is impacted too much, but we might start to think about overall volume too because your overall kind of ability to recover might start to fade. And that's where we also make sure you're adequately fueled, bring in some tools from a diet dietitian potentially, but potentially looking at some of that overall volume if you feel like you're not recovering. So there's a couple things I think about is strength training, range of motion, calf, plyometric work are some of the, some of the big ones. Thank you.

Yeah, so I'm totally stuck on calf muscle atrophy.

Yeah, I'll have to dig up the study.

Well, I'm wondering, uh, isn't it true that the calf calf has a very high proportion of Type 1 slow twitch muscle fibers. And like, I wonder if maybe that has to do something, because that's what's— I'm trying to think of what's different about the calf. That's the only thing I can think of that's different. Yeah, tons of slow twitch fibers, I think.

And the calf is just— and Achilles tendon are kind of interesting. Sorry if it's too deep. Runners usually assume that they have really strong calves because that's involved in running, but actually in walking and running, the way the Achilles tendon functions, the fascial systems in the calf, it's more of a recoil. So we evolved with this kind of passive recoil system that allows us to get forward propulsion with actually less activity of the muscle. Makes us more efficient at running and walking than, um, like a primate that wouldn't have— doesn't have— and that's connected to the plantar fascia and the Achilles, right? So, you know, mammals that don't— or if hominids— and there's anthropologists who study like evolutionary anthropology, right? And so the theory is that we adapted that to reduce how much energy you need to use to move forward. And so I have a suspicion it's something to do with that because actually during running, the exception may be being going uphill, but a lot of how the calf works in running is actually in this isometric, so stabilization role, and then this passive recoil.

Spring. Yeah.

Yeah. So I think that's probably part of it of there's actually just less activity in the calf, um, or less kind of true strength work that's happening there.

It's funny, we were talking about earlier— we'll wrap up, um, but like some of the anthropometric differences between, you know, like people from different places. I talked— I told these folks how I, I met a guy in Kenya who was the same height as me. He was an elite middle distance runner, same height as me, same weight, and his legs were 1 foot longer. His inseam was 12 inches. Same height, same, same weight, but like Um, you know, there's, uh, you know, I feel two ways about like genetically focused explanations of like Kenyan dominance and running, but like one thing that has been noticed is a strong correlation between one of the characteristic anthropometric differences aside from like a longer inseam is, um, uh, thinner calves. You know, just less meat on these bones, and it is highly correlated, um, with running economy.

Yeah.

So I think that possibly the atrophy of the calf is adaptive, potentially. I mean, that's— it would make total sense, right? This is like total radical.

Yeah. And they're— but it's interesting, most of— well, I don't know, are a lot of them doing trail running where there's a lot of vert, or most of them actually Mostly on trails. Yeah, yeah. So I just wonder if there's more— so I work with mostly trail runners— if there's more of a calf demand for some of the vert than more of a flatter course. Yeah, but I know a lot of those— the guys, you know, I know some of the Canyon guys will train on mountainous courses. Yeah, yeah, that's interesting of what's adaptive versus But it does seem that there are some measures of cap and strength and endurance that are also linked to injuries, right? So I think sometimes there's a push and pull between injuries and performance, right, as well, of how do we ride that line. And so, but often I'll tell people, if your paycheck isn't depending on running, I probably want to err more toward making you healthy. But maybe a different story if you're, if you're breaking records making a paycheck.

It's also a different story if you're Matthews, Gerald.

Yeah, I didn't need records.

Uh, cool. Um, so yeah, I was going to lobby one about my, my own ultra marathon preparation, but we've talked a little bit offline about that. We'll, uh, you're hanging out for dinner? Yes. Yeah, yeah, yeah, we've got got some eggplant and mushroom raviolis. You know, if you were here, you could be partaking, but you're not, uh, but you could be. So, um, thank you so much for tuning in to episode whatever of Live from Dream Run Camp presented by 80/20 Endurance. And thank you so much, Brian. Yeah, thanks for having his better half for giving us an hour of your time plus dinner.

Yeah, appreciate it. Thanks for having me.