Episode 210
Ep. 210- We Told You To Stop Sprinting Into Injury — How I Layer Speed Without Tanking Your Tendons + Low-Dose Ionizing Radiation Treatment
In this episode:
When I sat down with John J. Davis we dove deep into how to get faster without turning into a walking injury notice. John kept swinging back to one deceptively simple split: physiological training load vs. biomechanical load. Translation: your heart and energy systems might be able to handle more, but your tendons and bones? Not always. We geeked out on the two injury levers — volume and intensity — and why triathletes must respect the difference between biking all day (fine) and running all day (your tendons file complaints). John offered practical coaching gold: keep some quality at the targeted speeds (don’t let it drop to zero), manage the ‘‘volume of quality’’ (total meters at a pace matter more than rep length), and extend speed by making the pace last longer rather than constantly shaving seconds off shorter reps. He also schooled us on cadence (low cadence = overstride = trouble), how shoes/surfaces mediate internal loading, and why tinkering with someone’s gait is a delicate, rare move. His philosophy is delightfully unsensational: build endurance, scale race‑specific workouts backward from the goal, and reframe goals as we age instead of chasing impossible past PRs. We cut straight to the chase: we wanted to figure out how to get marathon‑fast without turning our legs into paperclips, and John J. Davis delivers a practical, sciencey playbook on building endurance, managing the quality‑vs‑volume tradeoff, and lowering the injury risk while you chase faster paces. I nerd out with John about the mechanical load vs physiological load distinction — basically, ramp mileage and intensity carefully, mind the volume of quality work at a given speed, and don’t pretend changing rep length magically makes you invincible. We also answer a listener’s weird but excellent question about low‑dose ionizing radiation for joint and tendon pain: yes, there’s legit European data that it relieves osteoarthritis and chronic tendinopathies in older adults, but it’s not some offseason hack for middle‑aged athletes and carries the usual “radiation” caveats. Along the way we riff on cadence, gait tweaks (don’t mess with perfectly working quirks), how to extend speed into longer durations, and why recovery and tissue repair deserve more respect than your ego. Jeff and Juliette pepper the chat with listener feedback, race gossip (Ironman Florida theatrics included), and blunt common‑sense coaching pearls — this one’s for runners who want to train smarter, stay healthier, and still go fast.
Segments:
[8:33]- Medical Mailbag: Low-dose ionizing radiation treatment
[34:54]- Interview: John Davis
Links
Transcript
Certainly there are people where if they were like a elite college runner back in the day and now they're 50 years old, are they going to be breaking that college mile pr?
Speaker A:Probably not.
Speaker A:But you can recontextualize what your goals are.
Speaker A:You can pivot to a different event or a different set of events.
Speaker A:Quite often I see people like that who are like, okay, like I had, I had my wild young days ripping it, tearing it up on the track or on the roads or whatever.
Speaker A:And now I have this new set of goals.
Speaker A:And so if somebody really like, and first of all, it's quite rare that I see someone where like, they're really, I really think they're like capped out in terms of like capabilities in there in whatever they're doing now.
Speaker A:But if somebody is like the, the conversation is often, let's find new goals, let's find new things to train for.
Speaker A:Maybe that's doing ultra races, maybe that's trail running.
Speaker A:Maybe that's you want to qualify for Boston now in your current age division.
Speaker B:Hello and welcome once again to the Tridoc Podcast.
Speaker B:I'm your host, Jeff Sankoff, an emergency physician, triathlete, triathlon coach and a multiple Ironman finisher coming to you once again from Beautiful sunny Denver, Colorado.
Speaker B:This is episode 210 and the voice you heard at the beginning of the podcast was that of my guest today, John Davis.
Speaker B:He's an author, he is a 229 marathoner and he is going to be talking to us about his marathon excellence and his training program that he's developed, as well as his thoughts and experiences coaching marathoners on how to stay injury free as they run in terms of gaining experience, running and increasing volume and speed work, and his theories about how we can mitigate the likelihood of wear and tear in our bodies as we run faster and longer, as we build up towards longer distances and run through the ages as we get older and more experienced in our running careers.
Speaker B:He is going to be joining me a little bit later on the program.
Speaker B:We had a really interesting conversation and I am sure that you will enjoy it.
Speaker B:I have a lot of thanks to give for my listeners in bringing, bringing John to my attention and connecting me with him.
Speaker B:So I appreciate that.
Speaker B:As always, if you have a guest that you think would be great for the program, I encourage you to send it along to me.
Speaker B:And even better, if you can connect us by email, that is the best way to ensure that a guest will make it onto the program.
Speaker B:You could do so by emailing me@tridocloud.com or drop a comment into the Facebook group.
Speaker B:If you're not already a member.
Speaker B:I hope that you'll head on over there.
Speaker B:Look for the Tridoc podcast on that platform.
Speaker B:Answer the three easy questions and I'll gain admittance.
Speaker B:And then send a comment about who you suggest as a guest for a future episode and I will either reach out or if you make the connection, we will have a conversation about getting that person onto the program, especially if they align well with what the listeners want to hear.
Speaker B:And they frequently do when they come from my listener suggestions.
Speaker B:Before we get to John's interview though, we will have a medical Mailbag segment.
Speaker B:As always, it's another listener question today, one from a very prolific questioner, one of my very own athletes that I coach through LifeSport coaching, Justin Rayfiel.
Speaker B:Justin, thanks as always for your ongoing curiosity.
Speaker B:It really helps make the program more interesting when we get listener submitted questions.
Speaker B:This time we're gonna be looking at the notion of low dose radiation therapy specifically to treat joint and tendon issues.
Speaker B:It was a question that I had not heard about in the past.
Speaker B:Those are always the best questions to answer and in the end it turns out there's some pretty good science for it, although maybe not for the population that we are interested in, athletes specifically, but because science was so good, it was definitely something I thought was worth reviewing and bringing to this program.
Speaker B:So we're going to have that conversation, myself and Juliet coming up very shortly.
Speaker B:Before that though, I just want to comment on what we saw this past weekend at Ironman Florida.
Speaker B:Hard to believe that pros are just continuing to get faster and faster every year.
Speaker B:You wonder what the ceiling is.
Speaker B:Magnus Ditli coming off of his disappointment in Kona where he was leading for much of the race, only to have things fall apart as he exited the Energy Lab and cede the race to a hard charging Vincent Louis.
Speaker B:He comes back in Florida just about what three or four weeks later and is able to shatter the previous world record of the Ironman distance and get himself down to 7:19.
Speaker B:Just an unbelievable effort, storming off the bike in a sub four hour time and then able to just charge through the run.
Speaker B:Matt Hanson coming up from behind and able to run a 229 Marathon or 225 think Marathon and able to secure third place on the podium.
Speaker B:Matt Hanson, who we really haven't heard much from in the past couple of years, having just a sensational day.
Speaker B:And these pros, the times that they're laying down in the past we used to see these close to 8 hour Ironman times and now that is barely enough to get you into the top 10.
Speaker B:It's really incredible what we're seeing in the professional fields these days.
Speaker B:The levels of speed, the levels of endurance, the ability that they're able to repeat in and out on the season just in a regional kind of Ironman.
Speaker B:To see this level of quality of performance is just incredible.
Speaker B:What did you think?
Speaker B:Did you follow the race?
Speaker B:Were you gobsmacked by the kinds of times that we're seeing or is it just de rigueur?
Speaker B:Are we just coming to expect this level of excellence day in and day out on the Ironman circuit?
Speaker B:The other thing that I noticed is really the disappearance of the T100 from the scene.
Speaker B:I can't say I'm terribly surprised given that that organization put all of their eggs into the Middle east basket.
Speaker B:All of their funding coming from basically the Saudi wealth fund having a lot of races in that region and of course with the conflict going on in Iran and how that has spilled over Iran's borders into neighboring states, the T100 has really been left with not much they're able to do.
Speaker B:They have a race coming up in Dubai, but one has to wonder how comfortable athletes feel going there.
Speaker B:Obviously for a prize purse they'll probably go ahead, but our age group is going to show up.
Speaker B:I don't know.
Speaker B:We'll have to see how viable the T100 remains going into the next year and whether or not they are going to have to spread out elsewhere and seek other funding opportunities.
Speaker B:Speaking of funding opportunities, I mentioned on the last program the marriage of convenience between Hyrox and World Triathlon that has continued to raise eyebrows across the kind of triathlon sphere.
Speaker B:We've heard a lot of questioning comments from professional athletes who race in the World Triathlon series.
Speaker B:We've seen a lot of commentary from different commentators questioning whether or not this makes any sense whatsoever.
Speaker B:I continue to wonder myself whether or not this is something that is really just a cash grab on the part of World triathlon who like T100 is in financial dire straits and whether or not this really makes any sense and is going to actually promote triathlon in any way, or if this is really a very one sided deal and really benefits the crossfitters who are finding themselves doing high rocks and is promoting them into an Olympic type of situation.
Speaker B:And if this is going to be to the very major detriment of triathlon as a sport going forward.
Speaker B:What are your thoughts?
Speaker B:I'm very curious to hear.
Speaker B:I know there are several of you who maybe partake in high rocks.
Speaker B:There are certainly several of you who will have opinions on this.
Speaker B:I'm very interested to hear if you think this is a good combination of sports to be together under the world triathlon umbrella or do you think this is potentially a detrimental thing that could bode poorly for triathlon on the world scene, especially on the international Olympic scene in the years to come?
Speaker B:I'd be interested to hear head on over to the Facebook group, leave your comments there and we'll see what the collective group is.
Speaker B:Maybe I'll put a poll in there and ask for people's thoughts on this.
Speaker B:I'm certainly always interested to hear what listeners think.
Speaker B:All right.
Speaker B:That's all I have to say on this Spooky Friday the 13th.
Speaker B:I think we will get right to the Medical Mailbag.
Speaker B:The question today is on the use of low dose radiation therapy to treat degenerative disorders of the joints and tendons.
Speaker B:That's coming up right after this very short break.
Speaker B:Joining me across the camera, across the void is my friend and colleague Juliette Hockman, which can only mean one thing.
Speaker B:It's time again for the Medical Mailbag.
Speaker B:Juliette, welcome.
Speaker B:How are you doing?
Speaker C:I'm fine.
Speaker C:I am hunkered down.
Speaker C:It has been gray and pouring rain here all day.
Speaker C:I feel like I came back from six days on the east coast and when I left it was balmy fall, still gorgeous riding outside, and now it is winter.
Speaker C:Wow.
Speaker B:Is that typical for this time of year now?
Speaker B:Well,.
Speaker C:I mean, it is.
Speaker C:And we are supposed to get a super El Nino in the Pacific Northwest this year, which means tons of rain.
Speaker C:And according to the last couple days, all I was away was photos over text from my husband of him and the dog by the fire.
Speaker B:Is that translating into snow at higher elevations?
Speaker C:I think it's a little bit warm still.
Speaker C:I haven't actually backed up there yet.
Speaker C:I just got back late last night.
Speaker C:But I think it might be still a little bit warm.
Speaker C:But if it just even gets a few degrees colder, hopefully we'll get good snow, which would make my husband very happy.
Speaker B:All right.
Speaker C:Awesome.
Speaker C:Yep.
Speaker C:Yeah.
Speaker B:Well, I wanted to before we get to our Medical Mailbag question, I have had some feedback from a few listeners about a couple things we've talked about over the last couple of episodes.
Speaker B:So wanted to get to that.
Speaker B:One of them comes from listener John o'.
Speaker B:Neill.
Speaker B:And I apologize, John, you wrote to me a little while ago, way back when in our episode when we talked about enervit and lactate gel.
Speaker B:And we, on that episode, we Talked about the 2 to 1 glucose to fructose sugar distribution or whatever ratio.
Speaker B:And he wrote in and he said he lives in Ontario, up in Canada, where they have abundant sources of maple syrup.
Speaker B:And he has made use of maple syrup as a fuel.
Speaker B:And he was asking me about how that shakes out.
Speaker B:And I have used maple syrup, not gels, but maple syrup packs as a means of fueling.
Speaker B:And I really enjoy it because I love maple syrup.
Speaker B:There is pretty good research that shows that maple syrup is a really good source of carbohydrates.
Speaker B:And there it's a reasonable kind of makeup.
Speaker B:The only thing about maple syrup is that instead of 2 to 1 glucose to fructose, it's straight 1 to 1.
Speaker B:So it is a 1 to 1 distribution or ratio of glucose to fructose.
Speaker B:Now, that doesn't mean it's bad.
Speaker B:In fact, I would argue that it's probably really delicious.
Speaker B:And if it's delicious and you're gonna take more of it, then that can only be a good thing.
Speaker B:I would say that you probably don't want it to be your sole source of carbohydrates over a long endurance event, because overwhelming you would risk the potential of overwhelming the fructose carrier, the transporter, and underwhelming the glucose transporter.
Speaker B:Because we've seen in the studies we talked about in that episode, one to one didn't do quite as well as two to one.
Speaker B:And I'm talking about glucose to fructose here,.
Speaker C:Right?
Speaker B:So if you just took maple syrup and you were just leveraging that one to one, you'd be leaving something on the table.
Speaker B:But if you were taking maple syrup as part of a fueling strategy, I think that's awesome and totally makes sense and works.
Speaker C:You know, I used to use maple syrup until about gosh, maybe 18 months ago.
Speaker C:I used to alternate maple syrup and then a more standard gel, like a Morton gel or something like that.
Speaker C:Go back and forth for 70.3 racing.
Speaker C:And I think, I think two things happen.
Speaker C:First of all, I love maple syrup too, but I really like it with pancakes.
Speaker C:Not necessarily straight up.
Speaker C:And I think one thing was it just got so sweet.
Speaker C:And by the end of the two and a half hour ride or whatever, I was like, oh my God.
Speaker C:And then the other thing is, I think it just exploded.
Speaker C:It's quite.
Speaker C:It's so runny that unless you get it just right, it's just so sticky.
Speaker C:And I think after one race, I'D just like, okay, that's it.
Speaker C:But I should go back to it because it is pretty good tasting.
Speaker C:And as you say, it could be used pretty effectively in combination with something else.
Speaker B:I like to use it when I'm on a long run because I'll take it instead of a gel pack when I'm doing my training, and it fits really neatly into anything a gel pack would fit into.
Speaker B:But because when I'm on a long run, I don't mind slowing down to roll the pack up to make sure that I squeeze it all in my mouth and then throw it away when I get to a trash can.
Speaker B:But, yeah, I agree.
Speaker B:The stickiness is definitely a factor.
Speaker C:Yeah, it's hard to manipulate on the bike when it's that runny.
Speaker B:Yep.
Speaker B:Okay.
Speaker B:Another bit of feedback came from Tim Vedder.
Speaker B:Tim is a physician as well.
Speaker B:He wrote about last episode's Baro Shift discussion.
Speaker B:I misspoke, and he called me out.
Speaker B:Thank you, Tim, for doing that.
Speaker B:This probably won't mean anything to you, Julia.
Speaker B:It's only gonna mean something to the physiology nerds like Tim and myself.
Speaker B:I was describing sinus arrhythmia, and I was saying how when you take an inspiration, your heart rate slows.
Speaker B:And Tim accurately called me out and said, no, that's incorrect.
Speaker B:It's the reverse.
Speaker B:When you take an inspiration, your heart rate actually increases and your heart rate decreases.
Speaker B:You.
Speaker C:Know, I knew that, but I didn't want to say anything to you.
Speaker B:You really should have.
Speaker B:Tim would have loved it.
Speaker C:Tim.
Speaker C:Take it, Tim.
Speaker B:And then there was a third piece that also came after last episode, and I can't remember.
Speaker B:I think it was Tim who also mentioned this.
Speaker B:I apologize if it wasn't him.
Speaker B:And I couldn't find where I got this piece from.
Speaker B:But I am interested in your thoughts on this.
Speaker B:I did not talk to you about this before, so I wanna see what you think.
Speaker C:Blindsiding me.
Speaker C:Here we go.
Speaker B:I'm blindsiding you.
Speaker B:I said that Matthew Marquard was the first American across the line at Kona.
Speaker B:Agree or disagree?
Speaker C:He's the first guy from the United States.
Speaker B:That's what I said.
Speaker B:He was the first American.
Speaker B:So Tim wrote to me and said, Taylor technically did finish.
Speaker C:Oh, okay.
Speaker C:All right.
Speaker C:But I.
Speaker B:Know it's like.
Speaker C:Two different races.
Speaker B:And my response to that was, sure, Taylor ranked higher in the women than Matthew did amongst the men, but given that they are against the same clock on the same course, Matthew did finish almost at, what, 45 minutes before Taylor.
Speaker B:So I was really Referring to Matthew being the first American across the line in general.
Speaker C:Right, right.
Speaker B:And that was not to take anything away from Taylor.
Speaker C:No.
Speaker C:I think people generally know you're talking about two different races.
Speaker C:Even if.
Speaker C:Even if.
Speaker C:Regardless, even time of day.
Speaker C:I just think of the two races as two completely different entities.
Speaker B:Yeah.
Speaker B:And I think that's fair.
Speaker B:But the point was taken, and so I wanted to acknowledge it.
Speaker B:And just in case anybody else was thinking the same thing, that was my explanation.
Speaker B:But I definitely do want to diminish Taylor's accomplishment because of course.
Speaker C:Not.
Speaker B:It was phenomenal.
Speaker B:Okay.
Speaker B:That's what I had.
Speaker B:I think you and I were chatting just before we started recording about the New York City Marathon episode.
Speaker B:Terrible tragedy that took place.
Speaker B:Did you want to just sort of.
Speaker C:Well, I mean, you wrote a really good article for Outside magazine.
Speaker C:Right.
Speaker C:Afterwards, we can talk briefly about your comments about how perhaps whether it was a combination of a misspeak from medical personnel with people just looking for an answer, with the press picking it up too quickly, that the diagnosis might have.
Speaker C:That might have been a bit of a rush to judgment.
Speaker C:And it probably wasn't that you need a full autopsy to really know.
Speaker C:The number one thing is horrible that this person passed away.
Speaker C:That's the biggest thing.
Speaker C:But I do think that the larger point here is not so much what the cause of death really was, but that as human beings, we really want answers quickly because it scares us.
Speaker C:Right.
Speaker C:It scares us.
Speaker C:And we don't want that to happen to us for people we love.
Speaker C:And it's because news happens so quickly and travels so fast.
Speaker C:It becomes.
Speaker C:People want to scoop it even when it's a tragedy.
Speaker C:So I guess the larger message is here.
Speaker C:Hey, people, we don't necessarily take a breath.
Speaker C:We don't necessarily know exactly what happened or how it happened or what the causes were.
Speaker C:You actually have to go through quite a process to figure out in many cases, how someone passed away.
Speaker C:So.
Speaker B:Yeah.
Speaker B:And was it the weekend before we had that awful plane crash in Florida, Their jet that came down and the prop.
Speaker B:Often when there are plane crashes, there is purposely a vacuum of information because the ntsb, or whoever the investigating organization is, does not want to rush to any judgments, because it does.
Speaker B:It takes a long time to figure out what happened.
Speaker B:And the problem there is that in the vacuum, there is this rush to judgment.
Speaker B:Some of the people's comments were just completely not okay.
Speaker B:And some of the people who I follow who are pilots who comment on air things had some really reserved, you know, some commentary that actually made Some sense.
Speaker B:And made me feel better because like everybody else, you don't want to see a plane fall out of the sky without an explanation.
Speaker B:And it felt better to hear somebody give some context.
Speaker B:So similar ideas.
Speaker C:It's funny you bring that up, Jess.
Speaker C:Yesterday on my flight home from the East Coast, I sat next to a pilot.
Speaker C:He was trying to get from A to B for his next flight.
Speaker C:Young guy, super great guy.
Speaker C:We chatted for two hours and we talked about that incident.
Speaker C:And he said exactly the same thing.
Speaker C:He said, unfortunately, the very next day someone tried to determine was out there already saying why it happened.
Speaker C:And he said it was just such a tragedy because they hadn't even had time to look at it.
Speaker C:And again, he gave a very rational explanation of what possibly could have happened.
Speaker C:But we still don't actually really know what happened.
Speaker C:And this is a guy and he's a pilot and he was just this.
Speaker C:Exactly.
Speaker C:Just keep your opinions to yourselves for a little while, would you?
Speaker C:Especially if you're not an expert in these matters.
Speaker C:It's not.
Speaker C:I don't know, just think of the families, think of the people.
Speaker C:There's so many people in.
Speaker C:I don't know, I'm on my soapbox now, but it's just.
Speaker C:Yeah, just hang in there.
Speaker C:Hold on.
Speaker B:For the marathon.
Speaker B:For anybody who doesn't know, Rachel Apa, 24 year old woman, D1 college field hockey player, was running for a charity to raise money for Parkinson's disease.
Speaker B:She Collapsed at mile 24 and was in cardiac arrest, could not be resuscitated.
Speaker B:And just tragedy, no matter what.
Speaker B:But I just feel awful for her family and her friends and everybody who's left wondering what could have happened.
Speaker B:And I surmised in my article, because what happened was the New York Post, of all people, the, you know, paragon of.
Speaker C:Journalism.
Speaker C:Yes, exactly.
Speaker B:Yeah, they came out and they were like, oh, this woman died of rhabdomyelysis.
Speaker B:And their source was the father, the grieving father, who had been told, likely by some well meaning emergency room or emergency department staff, that when probably she was brought in, they did some lab work and they noticed her CK was elevated.
Speaker B:And so this poor, poor, terribly distraught fathers, Please give me something, anything.
Speaker B:Yeah,.
Speaker C:Give me.
Speaker B:The.
Speaker B:The said, look, we really don't know.
Speaker B:But she did have signs of rhabdomyolysis, which is your muscles breaking down, which can happen in a marathon.
Speaker B:And he just latched onto that and he told a reporter and the reporters ran with it.
Speaker B:Irresponsible, because that's very unlikely to have been the cause of death, it is significantly more likely she had some undiagnosed cardiac issue, be it a genetic channelopathy that led to an arrhythmia or something with her coronary arteries.
Speaker B:That is just no way to have known in advance.
Speaker B:The only way we'll know in the end is gonna be an autopsy, which I'm sure will happen, and I'm sure we'll get some answers at some point, but.
Speaker B:And could it have been rhabdomyelysis?
Speaker B:It's exceedingly unlikely.
Speaker B:It's not impossible.
Speaker B:But there's never been a case of rhabdomyolysis that was fatal in a marathon.
Speaker B:So usually if rhabdomyelysis is going to cause a fatality, it's days later, so.
Speaker C:And likewise, we all saw on social media yesterday how in the Santa Barbara Marathon was that Santa Barbara,.
Speaker B:Santa Barbara.
Speaker C:Half marathon on Sunday how all these people ended up in the er.
Speaker C:And of course, everybody is commenting already on why all these people ended up in the er.
Speaker C:And again, it's like, it's just we have no idea why.
Speaker C:So can we just wait until the medical authorities let us know?
Speaker C:They.
Speaker B:May never let us know.
Speaker B:And the reality is, yeah, I was asked to write about that and I told the editor, I said, look, there's.
Speaker B:From what I could tell, there's zero here for me to write about.
Speaker B:So unless there's more information, I got nothing to say anyway.
Speaker C:And I feel like everyone's waiting for this.
Speaker C:Oh, they ran through a toxic plume of something coming out of the sewer.
Speaker C:And that was like.
Speaker C:No, actually,.
Speaker B:Probably nothing like that anyway.
Speaker C:No.
Speaker C:Okay,.
Speaker B:Let's get to our question.
Speaker C:You have.
Speaker B:A question?
Speaker B:It was sent in by a listener, someone who has graced us with several questions.
Speaker C:Many questions.
Speaker C:Yes, from Justin.
Speaker C:Thank you, Justin.
Speaker C:Justin Raphael, one of our life sport athletes, frequenter of many a Northwest not marathon, but event triathlon event.
Speaker C:So we both know him.
Speaker C:He wants to know if low dose ionizing radiation is effective in treating tendonitis and degenerative joint disorders like arthritis.
Speaker C:You read about this somewhere.
Speaker C:Obviously, as we all age, tendinitis crops up from time to time.
Speaker C:Sometimes it can really take us out for a season, especially like Achilles tendonitis or gosh, tendonitis anywhere.
Speaker C:Right?
Speaker C:And so we're always looking for answers.
Speaker C:We're always trying to figure out is there, particularly if there's a nice quick answer, because these things often just take a really long time to heal.
Speaker C:So is this an option for athletes suffering from either tendonitis or arthritis or other joint disorders?
Speaker B:Yeah, this was not something I had heard of.
Speaker B:And when he asked the question, I was like, oh, pshaw, this sounds rubbish.
Speaker B:Oh my gosh.
Speaker B:I said, pshaw.
Speaker B:That's an inside joke, folks.
Speaker B:Unless you're a wordle player, in which case it'll make sense.
Speaker B:Yeah, I really doubted that this was going to be a thing, but it turns out, lo and behold, it is.
Speaker B:This is a thing in Europe and possibly other places in the world, but it is coming to a clinic near you here in North America as well.
Speaker B:So it turns out that there is a rationale for this.
Speaker B:And when we're talking about low dose radiation therapy.
Speaker B:Radiation therapy is used to treat cancer.
Speaker B:It's never a good thing if you need that.
Speaker B:But when it is done, curative cancer radiotherapy is administered in.
Speaker B:The units for radiation dosage are gray that I can't.
Speaker B:It's a measure of how much energy is transferred in radiation.
Speaker B:And when we do a dose of curative cancer radiotherapy, it is 1.8 to 2 gray.
Speaker B:And when you get low dose radiation therapy to a joint, it is administered in 0.3 to 1 gray.
Speaker B:So it is significantly lower dose than what you're getting with radiation therapy for cancer.
Speaker B:Okay, so what's the point?
Speaker B:How does it work and what's the indications here?
Speaker B:So it turns out that low dose ionizing radiation is quite effective in interfering with the kinds of inflammatory processes that affect the joints and certain kinds of tendinopathies in older adults.
Speaker B:And I want to be clear, when Justin posted this question, I think he was asking more for athlete indications.
Speaker B:I'm an athlete.
Speaker B:I have some sore knee, I have some tendinitis.
Speaker B:This is good for me.
Speaker B:And when we looked at this, unfortunately, we didn't find anything that suggests this has real uses for acute injuries or for returning people to athletics.
Speaker B:What we did find, however, is pretty good evidence that this actually works in older patients who have reasonable amounts of debilitating, not debilitating, but degenerative, like osteoarthritis or other kinds of tendinopathies, which I'll get to in a second.
Speaker B:And there is this whole kind of body of evidence and literature that talks about how radiation works.
Speaker B:And so it actually helps reprogram macrophages, which are a type of white blood cell that are involved in the inflammatory process for these kinds of entities.
Speaker B:It inhibits leukocytes.
Speaker B:So leukocytes are another type of white blood cell involved.
Speaker B:It suppresses cartilage degradation by enzymes.
Speaker B:It attenuates the oxidative stress related to nitric oxide and it inhibits pain by desensitizing neurosensory transmitters.
Speaker B:It down regulates different chemotoxins, different chemical signalers of pain within the joint.
Speaker B:So it decreases the actual mechanism of inflammation and desensitizes your nerves to the pain that's going on from this arthritis and everything else that's going on, which is really cool.
Speaker B:And in the studies that have looked at this, they've been able to show that when you do this, you're actually able to reduce the use of anti inflammatory medications, which can be potentially dangerous for older adults because it impairs the kidney function, it can interrupt stomach issues, cause ulcers and bleeding, it can actually forestall the need for surgery and it can avoid the need for injections into the joint.
Speaker B:So all of those are pretty good things.
Speaker B:And what's it.
Speaker C:But what about the negative repercussions of having radiation therapy?
Speaker B:That is a very good question.
Speaker B:Have we met?
Speaker B:Have we discussed this previously?
Speaker B:No,.
Speaker C:No, we haven't actually.
Speaker B:I'm just throw it.
Speaker C:That way.
Speaker C:Okay,.
Speaker B:So what is it used for?
Speaker B:It's used for degenerative joint diseases, knee osteoarthritis, hand and finger osteoarthritis, hip osteoarthritis and shoulder arthrosis, so frozen shoulders, things like that.
Speaker B:It's used for inflammation where tendons attach to bones.
Speaker B:So plantar fasciitis and heel spurs, something that you've dealt with lateral or medial epicondylitis, which is tennis elbow, Achilles tendinopathy and then chronic hip pain.
Speaker B:And it can also be used for benign conditions where there is hyperproliferation of fibrotic tissue.
Speaker B:Dupuytrain crack contractor.
Speaker B:If you're older like me, and you have this genetic condition where you have these growths of fibrosis on the tendons of your palm or in your feet, they can sometimes be painful.
Speaker B:I have them in my hand.
Speaker B:They're not painful, but they do restrict movement.
Speaker B:So if you're watching a video, you could see I can't straighten one of my fingers.
Speaker B:It's because I have one of these fibrotic nodules on one of my tendons.
Speaker B:This has been shown to potentially decrease.
Speaker B:It doesn't reverse it, but it can slow the progression.
Speaker B:And for people who have keloid, which is an overgrowth of scar tissue, this can actually prevent keloid.
Speaker B:So you asked about the negative repercussions.
Speaker B:The dose is quite low.
Speaker B:So usually this is given in six outpatient sessions of 0.3 to 1 gray per treatment and it ends up being 3 to 6 gray total.
Speaker B:That is equivalent to.
Speaker B:Let me find it.
Speaker C:Three to six gray total.
Speaker C:So that's three cancer treatments.
Speaker C:Radiation treatments.
Speaker C:Because you said they're 1.8 to 2 grays per cancer.
Speaker B:Radiation therapy for cancer is much more than that.
Speaker B:You usually end up with numerous treatments.
Speaker C:Yeah,.
Speaker B:Let's see.
Speaker B:I'm trying to find.
Speaker B:I had a table here that.
Speaker B:This was Sarah, by the way.
Speaker B:Sarah Lopez put this together for me.
Speaker B:I'm trying to find her table.
Speaker B:She explained how many X rays that was.
Speaker B:Oh, here we go.
Speaker B:So the dose of an X ray is basically 0.001 gray.
Speaker B:So a thousandth of a gray.
Speaker B:And you're basically looking at.
Speaker B:If you're looking at 0.3, then you're looking at 300x rays.
Speaker B:It's one of these treatments.
Speaker B:Now the way these machines have been developed is they're very narrow beam and they're really focused on the area, so there's not a danger of scatter.
Speaker B:And that's when we talk about radiation therapy.
Speaker B:Usually we're talking the detriments are from scatter.
Speaker B:So you end up with either damage to the skin from too high a dose, which is not gonna happen here because we're talking about quite low doses, or we're talking about DNA damage and potential malignancy.
Speaker B:Right.
Speaker B:But the latency period for cancer development from radiation tends to be 10 to 20 years.
Speaker B:And because this indication is for patients who are generally in their 60s to 70s, that's not really a concern here.
Speaker B:We're not too worried about.
Speaker B:And again, the doses are not terribly high.
Speaker B:The question then is, what about the efficacy?
Speaker B:Is there research for this?
Speaker B:And in fact, there is really good research.
Speaker B:The European registry experience, which is not a prospective trial, it's a retrospective.
Speaker B:They basically, they have patients that have received this and they look and they say, did it do anything?
Speaker B:50,000 Patients annually.
Speaker B:It's the German Cooperative Group on Radiotherapy for Benign Diseases and they have reported response rates of 60 to 75% across treated osteoarthritic joints.
Speaker B:Pain relief that peaks at six to 12 weeks after treatment and can last as long as one to three years.
Speaker B:Partial responders can receive a second course with equal efficacy.
Speaker B:And in prospective sham controlled studies, they have seen at three months, 44% of active treatment participants getting a reasonable degree of improvement.
Speaker B:Now, there's a non statistical difference between the active treatment and the sham participants.
Speaker B:But this particular study used a different dosing.
Speaker B:So it's not totally clear that the dosing was as accurate as it should be.
Speaker B:But that very large registry would seem to suggest there's a real benefit here and a real effect.
Speaker B:And as I said, this is something that's really been predominantly in Europe.
Speaker B:Just recently in March of this year, the US fda, the Federal Drug Administration, gave clearance, pre market clearance to Siemens, the German medical device maker.
Speaker B:They now have clearance to make new devices that are going to be available in the United States to give this treatment.
Speaker B:And I would say if you have an older relative that asks about this and they don't want to have surgery, they're looking for some kind of relief, they don't want to be taking medications.
Speaker B:I would think this is probably worth a try.
Speaker B:It doesn't seem to have much in the way of downsides.
Speaker B:It's not terribly inexpensive, but it seems like it's going to be covered by Medicare, at least initially.
Speaker B:We'll see if that.
Speaker B:We'll see.
Speaker B:The coverage determinations are still preliminary.
Speaker B:Because it's not available, I would imagine that it probably will be covered.
Speaker B:In which case I would definitely encourage people, if they are in that situation, they have pain from the degenerative osteoarthritis and a large joint, they don't want to have surgery for whatever reason.
Speaker B:This could be something that could provide some symptomatic relief and with pretty minimal downsides,.
Speaker C:But not as of yet any good studies or indications for middle age, middle aged athletes.
Speaker C:Unfortunately,.
Speaker B:I don't think this is going to be for us.
Speaker B:Yeah, this is not going to be.
Speaker B:I think the reason being it's radiation.
Speaker B:And radiation is still, as much as this seems, pretty benign.
Speaker B:I think the reason it's pretty benign is because it's being done in older patients who aren't gonna get through that latency period where the adverse events are gonna occur.
Speaker B:I also think that, hey, it's still radiation.
Speaker B:Radiation.
Speaker B:Radiation is.
Speaker B:Yeah, radiation is still.
Speaker B:If you could avoid radiation, you probably wanna avoid radiation.
Speaker B:But when you're facing the decision between a major surgery for a joint replacement versus some radiation treatment, I think that this makes sense for an average endurance athlete who's having some knee discomfort.
Speaker B:This probably is, you know, then the profile maybe changes a little bit.
Speaker B:And also there's no studies yet to suggest that this is indicated for less significant pain for non inflammatory processes.
Speaker B:So that's to be determined, but interesting all the same.
Speaker C:Hey people, you don't usually hear Jeff prate on and on about this, something like this.
Speaker C:So you may have heard it here first in terms of something that could be a treatment for athletes, for the future.
Speaker C:Another little inside wordle joke there.
Speaker C:Sorry, waiting to use that word for the entire episode.
Speaker C:Anyway, anyway, Justin, thank you very.
Speaker C:That was a great question and we always find something that we've never heard of and particularly Jeff has never heard of.
Speaker C:So that was.
Speaker C:That was great.
Speaker B:Yeah, I appreciate it.
Speaker B:And this was anytime it's something new and we can look into it and especially if it has positive results.
Speaker B:Right.
Speaker B:That's a good one.
Speaker B:This has been a great conversation.
Speaker B:I've really enjoyed it.
Speaker B:And if you have a question you'd like for us to look into, please do send it on ahead.
Speaker B:You can email me@triodocloud.com you can of course head on over to the Facebook private group.
Speaker B:If you're not already a member, I hope that you'll consider joining because over there, if you look for Tridoc podcast on Facebook and answer the three easy questions, we will gain you admittance.
Speaker B:You can join the conversation about things we discuss on the episode, submit your commentary ideas for improvement, and of course your questions for future medical mailbags.
Speaker B:Juliet, always a pleasure.
Speaker B:Look forward to chatting with you again.
Speaker B:I guess the next time we chat it will be Thanksgiving week, so.
Speaker C:That's right.
Speaker B:We're getting into the holiday season.
Speaker B:Looking forward to it.
Speaker C:Looking forward to it.
Speaker C:Yeah.
Speaker C:Great.
Speaker C:Thank you very much and as always, great to chat with you.
Speaker B:My guest guest today is the latest of a string of guests who were referred to me by listeners of the program.
Speaker B:So I am very grateful.
Speaker B:If you have somebody that you think that the listening audience would be interested in hearing from, please do send them my way.
Speaker B:This one is one that I think you're really going to enjoy hearing from.
Speaker B:John J. Davis is a coach, writer and a scientist.
Speaker B:He's been coaching runners from novices to elite field competitors for over 12 years.
Speaker B:He has a PhD in Human Performance and has spoken at international conferences and competitions on the science of running injuries and running performance.
Speaker B: From: Speaker B:Am I saying that right?
Speaker B:Edina.
Speaker A:It's Edina.
Speaker B:Edina.
Speaker B:Okay.
Speaker B:It was one of the two Edina High School which made four consecutive appearances at Nike Cross Nationals during his tenure.
Speaker B:And that I can assure you, as a father of a cross country runner, that's a big deal.
Speaker B:His work has been featured in Runner's World, Running Times and Men's health.
Speaker B: and science of training since: Speaker B:His latest book, Marathon Excellence for Everyone, is your comprehensive guide to modern marathon training, featuring detailed training plans plus racing strategies based on the latest scientific research.
Speaker B:But he's taken just a little bit of his time to join me here on the Tridoc podcast to talk about running training and injury prevention.
Speaker B:John, thank you so much for joining me.
Speaker B:I really appreciate your time.
Speaker A:Yeah, thank you so much to be here.
Speaker B:So you came to my attention because one of my listeners has read your book and told me about your approach to trying to marry this idea of run training with decreasing injuries.
Speaker B:And as we as triathletes know, that's a difficult task.
Speaker B:I always say this about running.
Speaker B:For triathletes, it's like you need to run a lot to get adaptation so that you don't get injured.
Speaker B:And we as triathletes don't run probably as much as we need to.
Speaker B:But at the same time, the more you run, the more prone you are to injury.
Speaker B:So how do you find that sweet spot for runners?
Speaker B:And then how should we as triathletes try to marry that strategy, knowing that we also have to swim and bike?
Speaker A:I think the biggest mental trick for thinking about it is trying to split apart in your head two concepts.
Speaker A:One of them being physiological training load.
Speaker A:So, like hours on the bike or like, however.
Speaker A:How many.
Speaker A:However many, like minutes in certain heart rate zone or certain amount of lactate in your blood.
Speaker A:Physiological training load, that's one thing.
Speaker A:Biomechanical training load, that's something else.
Speaker A:And that's what gets you injured.
Speaker A:If you compare the events in the triathlon, like, you can ride your bike all day, no problem, but you try to run all day, now that's gonna be causing some mechanical problems in your body.
Speaker A:And fundamentally, it's that mechanical load that gets you hurt.
Speaker A:Because when you take.
Speaker A:It's just like taking a paperclip.
Speaker A:You bend it back and forth.
Speaker A:You bend it enough times, it's gonna break.
Speaker A:So the two levers you have for control, like the two biggest levers, at least in running, that you have to control that injury risk, that mechanical load is, number one, the volume.
Speaker A:And I generally advocate actually mileage as opposed to duration for reasons we can talk about for mechanical load, and then, of course, intensity.
Speaker A:So usually, I'm sure you've seen this.
Speaker A:What are the two things that get people hurt?
Speaker A:Number one, they ramp up their volume, their running volume too much.
Speaker A:Number two, they ramp up their running intensity.
Speaker A:So they're doing a bunch of easy running.
Speaker A:They're like, okay, great time to go get on the track and rip some four hundreds or like really crush some hills.
Speaker A:And then they get hurt.
Speaker A:So those are the two levers you have.
Speaker A:Now the tricky thing, of course is they're correlated, right?
Speaker A:That there's often, but not always a tight correlation between the physiological load and the biomechanical load.
Speaker A:Because if you go run 10 miles hard, obviously that's quite a large load in both dimensions.
Speaker A:But I think triathletes should have a better mental machinery for thinking about this because you have such strong intuitions about, like, it's no problem to do a two hour easy ride, whereas two hour easy run, much more damaging to your body.
Speaker B:And I was going to say those are exactly the two things, right?
Speaker B:It's.
Speaker B:I know from my experience as a coach and as an athlete, I am very careful about layering volume very slowly and that I am very wary about increasing intensity too quickly.
Speaker B:I have all kinds of athletes who are champing at the bed.
Speaker B:Oh, I need to do speed work, I need to go faster and I'm like, careful.
Speaker B:And sure enough, it seems to be because I'm careful about layering on the mileage very slowly.
Speaker B:It's always when the speed work starts, that's when the injuries happen.
Speaker B:So for you as a coach, I've gotten enough experience that I could talk an athlete off the edge from, hey guys, we gotta take it easy.
Speaker B:We're not gonna start running fast just yet.
Speaker B:But how do you mitigate the likelihood of injury when you start putting in speed work?
Speaker B:Do you keep the intervals short or do you keep the numbers of intervals short?
Speaker B:How do you deal with that challenge?
Speaker A:So there's two things that I try to do as much as possible.
Speaker A:One of them is just never let the training have no quality in it.
Speaker A:Because going from nothing to something is a much bigger ask.
Speaker A:If you're like, I'm just running easy and now I gotta do speed work outta nowhere, sometimes that's not possible, right?
Speaker A:Sometimes taking some time off, getting back into it, like, whatever.
Speaker A:But to the extent that you can keep at least a little bit of faster running in every 10, 14 days, it doesn't need to be constantly or every week.
Speaker A:That helps a lot because it's much better.
Speaker A:People have taken a lot of time off from running.
Speaker A:Know this too, where if you haven't been running at all and then you start doing even a little bit of running quite often, that's quite a challenge to your body.
Speaker A:So that's one thing.
Speaker A:And then the other thing is the key parameter I always keep an eye on is the volume of quality at a specific pace.
Speaker A:So let's say you have somebody that they need to do speed work at six minute mile pace.
Speaker A:I'm always going to ask, okay, in the last three or four weeks, what sessions have we done at that speed and how much total volume?
Speaker A:So it's not so important.
Speaker A:Like the rep length is not so critical from a, a, a biomechanical training perspective.
Speaker A:There's some research on maybe your running form changes and the loading changes a little bit as you get fatigued.
Speaker A:But I don't think that's nearly as big of a driver as just the difference between doing say 10 by 400 versus 12 by 400.
Speaker A:Those extra 800 meters of running are by far a much bigger difference than, than say 10 by 400 versus 5 by 800, same volume of quality, longer repeats.
Speaker A:And you can use that fact to increase the physiological training load while keeping the biomechanical training load the same.
Speaker A: by: Speaker A: by: Speaker A:So yeah, the not letting the volume of quality ever get to zero at a speed that's important for us to do in training if possible, it's not always possible, but try to not let that ever go to zero if we can do it.
Speaker A:And then really keeping an eye on the volume of quality.
Speaker A:And maybe the one other thing to keep in mind is that the relationship between how fast you run and how much mechanical load you incur is not linear.
Speaker A:For example, for tendons, if you double the force and the tendon, the number of loading cycles it takes to get to a certain amount of damage goes up by like 50 or a hundred X.
Speaker A:It's like super exponential relationship.
Speaker A:So that's why you can do some like maybe you do a 90 minute long easy run with your friends on the weekend, fine.
Speaker A:Then you do a couple four hundreds on Tuesday and then you get hurt or you get really sore.
Speaker A:So just keep that in mind.
Speaker A:And you don't want to be like, okay, yeah, I did six kilometers of work at six minute pace and then next week my speed workout's going to be at 5:30 pace.
Speaker A:So I'm going to do also 6km.
Speaker A:That's going to turn out very badly.
Speaker A:So you want to scale down the volume as the speed goes up.
Speaker A:And I wish I could quote some like perfect rule for how to do that, but that's an open research problem I'm still working on.
Speaker A:Unfortunately,.
Speaker B:Something you said in there was really interesting to me.
Speaker B:So as you change the intervals, you don't change the speed, which I thought was really interesting.
Speaker B:I think most people I know myself, when I'm running say a hundreds or two hundreds, I'll tend to run a faster speed than if I'm running a 400 or an 800.
Speaker B:Just knowing physiologically I'm able to run faster at shorter distances.
Speaker B:But you we're purposeful about saying if I'm doing a six minute pace, I'm keeping that six minute pace across the different intervals.
Speaker B:Is there a reason for that?
Speaker A:Yeah, I'm always trying to think about, okay, what's the goal of doing this workout?
Speaker A:I'm trying to provoke some change in the body, right?
Speaker A:So let's say Maybe you've got 10 by 200 meters, classic speedwork session.
Speaker A:You do that workout great, you provoke some adaptation and maybe it's an appropriate workout for you biomechanic loading wise.
Speaker A:So you do that workout, you provoke some change in your body.
Speaker A:Now usually what people do is they're like, okay, great, I'm gonna come back and do that workout next week and the week after and the week after that and the week after that.
Speaker A:I'm gonna try to bring the pace down a little bit.
Speaker A:That works okay.
Speaker A:But often what I like is to introduce a bigger challenge to the body in terms of the physiological load.
Speaker A:So I might have somebody do an equivalent volume, but 300 meters at the same speed.
Speaker A:There's two reasons for that.
Speaker A:One of them is the biomechanical loading thing I just talked about.
Speaker A:But actually the bigger reason is more of a like training philosophy concept where like what are we trying, what are we trying to do in training?
Speaker A:We're trying to be able to take the same speed and make it longer, at least for distance runners.
Speaker A:Different situation for a sprinter, but generally for someone who wants to run a marathon, someone who wants to improve their, their running leg in a sprint triathlon.
Speaker A:It's not that they're not capable of running the speed they want to run, it's that they can't run the speed for the distance of the race.
Speaker A:This is a very like one of my sort of coaching Mentors is this Italian guy, Renato Canova.
Speaker A:He's very big on this idea of extension.
Speaker A:So the thing that's much more feasible is you take the speed and you increase the duration, you can sustain it.
Speaker A:So that's always what I'm trying to accomplish in running.
Speaker A:Even with more conventional workouts like a four mile tempo run.
Speaker A:Often what I like to do with people is just okay, can we do the same speed for four and a half, for five and a half, for six as opposed to do that same workout but make it a little bit faster each time?
Speaker B:How do you determine that speed?
Speaker B:How do you know what that speed's going to be?
Speaker B:Is it a speed that the runner has targeted or is it a speed that you've determined through some kind of testing?
Speaker A:Yeah, so my coaching philosophy is based around this full spectrum percentage based approach.
Speaker A:So if somebody has run, let's say they've run a 5k at 7 minute mile pace, I think I can do the math here in my head.
Speaker B:Do you use like the Jack Daniels formula, that kind of thing?
Speaker A:No, I don't actually.
Speaker A:So what I'm saying, okay, let's say 5, 5K pace, pace, 7 minute miles.
Speaker A:What I look at is okay, if that's 100% of race pace, I look at, okay, what's their endurance like at 5% slower than that?
Speaker A:That'd be about 720 mile pace or sorry, yeah, 7 20.
Speaker C:Nice.
Speaker A:What's their endurance like?
Speaker A:Maybe 10% slower.
Speaker A:So it's about 740 per mile.
Speaker A:What's their speed like at 6 40?
Speaker A:What's their speed like at 6 20?
Speaker A:So I'm starting with a specific race performance and then I'm going out in the directions of, of speed and endurance and trying to ask what are this person's capabilities?
Speaker A:And so very often what I find is someone can run their, their 5Ks pretty good and then if I have them do a longer continuous run, 10% slower, it they gas out four miles or something.
Speaker A:So then now we kind of have a point a foothold where we can start working on increasing that.
Speaker A:Because what you'll find is that if you can Increase your endurance 5, 10, 15% slower than race pace, and by increase your endurance I literally mean become able to run that speed for a longer duration or distance.
Speaker A:You will push down the whole curve of performance, especially if you're also working on the different, the other points on that spectrum, faster and slower.
Speaker A:And the reason I like this philosophy is that it applies to every event.
Speaker A:It's not just, oh, this is the way to train for the 5K or for the marathon.
Speaker A:And then it's totally different.
Speaker A:I use this exact approach, obviously adjusting the workouts, but the this percentage based approach for 800 meters, 1 mile, 5k, 10k, half marathon, even ultramarathon.
Speaker A:And it works really well when you apply this conceptual model.
Speaker A:So that's basically why I'm always trying to take some, some current ability of the athlete and then extend it for longer.
Speaker B:So we've talked about volume, we've talked about intensity.
Speaker B:There are three other things that we've looked at here on this podcast in terms of research that is tied in very much with injuries and injury prevention.
Speaker B:And I'm curious to get your take.
Speaker B:The first of these is shoes.
Speaker B:We've looked at the super shoes.
Speaker B:We've looked at just regular shoe kind of structure and how they're constructed.
Speaker B:We've looked at running surface and we've looked at strength training.
Speaker B:I'd be interested in getting your thoughts on those three things.
Speaker B:And then if there's something we're missing in this kind of paradigm.
Speaker A:Yeah, the mental model I use is like, okay, the training you do imposes some amount of external biomechanical load demand.
Speaker A:If you're going to run 40 miles this week at a certain speed, that's like just some amount of running that you have to do.
Speaker A:And then that external load gets mediated by your particular biomechanics and which includes like the surface you run on and the shoes you wear, but also your running form, your cadence is a big driver.
Speaker A:So those things mediate that external load into an internal amount of loading that goes into the tissue.
Speaker A:And then that loading going into the tissue is mediated by the properties of the tissue to determine the damage.
Speaker A:So if you have like really strong bones, obviously you can endure much more loading without sustaining as much damage.
Speaker A:Same thing for like stiffer, stronger tendons and then the other piece and this ties into like maybe what an additional thing to think about is, okay, you incur some amount of damage.
Speaker A:How much repair and recovery are you able to do?
Speaker A:So that is where things like sleep, hormonal imbalances, menstrual disturbances in women, nutrition, that's where that comes in.
Speaker A:So I'm always trying to apply this model.
Speaker A:When somebody says, oh, how do shoes affect injury risk?
Speaker A:How does running surface affect injury risk?
Speaker A:How does sleep affect injury risk?
Speaker A:I'm applying this model that I'm thinking about.
Speaker A:Okay, shoes would change your biomechanics.
Speaker A:So they would alter that relationship between the training you do and then what forces are going into your tissues?
Speaker A:And I like this because it helps you diagnose problems more efficiently.
Speaker A:So if someone's like, hey doc, I'm just coming off a stress fracture and I've got these great new super shoes and now I'm back running 100 miles a week, what you're like, whoa, wait a minute.
Speaker A:I don't think the problem is the shoes here.
Speaker A:Let's talk about the training volume.
Speaker A:Whereas if someone is like, I just keep this area, my foot, like my arches, like really hurt and like I'm really not running that much, then maybe you're like, okay, can we look at what's mediating the load and going into that part of your foot?
Speaker A:So having that like, okay, the training volume, the external load, the internal load, the damage, the recovery, that's always how I think about that.
Speaker A:And maybe that would plug into your last question of.
Speaker A:I do want to encourage people to think more about the recovery, the repair, the tissue repair side, because I think that's like long term, what determines are you ascending or descending in your ability to tolerate amounts of training?
Speaker B:Yeah, and we talk a lot about the importance of recovery, especially for older athletes, and how much that can really affect just your overall trajectory of training and your ability to avoid injury.
Speaker B:So what does training look like with you when you're dealing?
Speaker B:Because I deal with multi sport athletes so it's easier to shift things up.
Speaker B:So if you do have a running injury of sorts, you can switch to biking and swimming.
Speaker B:But if you're dealing with a unisport kind of focus and you talk about the need for recovery, you talk about the need to have volume.
Speaker B:So how do you operate with runners?
Speaker B:Obviously it's going to vary based on age and skill set, but just in general, what's your approach and philosophy?
Speaker A:Yeah, at a very high level, obviously I'm a big fan of aerobic development.
Speaker A:So I want to bring people's volume up over time.
Speaker A:I really want to work the endurance end of that spectrum of speeds to much greater extents.
Speaker A:Not neglecting the speeds, but putting more emphasis on the endurance.
Speaker A:And then what I'm always trying to do is like for some, some athlete comes in, they have some particular set of properties, they're training for a certain event and I want to look at, okay, how do we develop this person's endurance for that particular event.
Speaker A:So for example, like I coach some 800 meter runners.
Speaker A:Endurance for them looks very different than improving endurance for a marathon runner.
Speaker A:And also thinking about like, what is the long term trajectory of this athlete because maybe somebody comes to me and like, like they run the 5k now, but like probably based on their strengths, in a few years they'll be a marathoner.
Speaker A:So I'm always trying to think about how do we grow this athlete's capabilities.
Speaker A:And then so that's like starting from now, it's like we're growing this athlete's capabilities, particularly on the endurance side.
Speaker A:And then also like for the events we're training for, I try to start from the end and work backwards of like I have some athletes doing Bronx 10 mile in a little under a month.
Speaker A:Okay, 10 miles of running, relatively flat course in and I work backwards of okay, if we can do like this, this race specific workout and by specific plus or minus 5% around race base within those last key maybe month or so of training before that, we'll be really set up for a good race.
Speaker A:How do we get to the point where we can do those race specific sessions?
Speaker A:We got to build up to them now.
Speaker A:So we kind of have this like growing your capabilities now on one end and then building towards where we need to be in terms of race specific workouts.
Speaker A:Now I know there's a very general response to your question.
Speaker A:So like in practice, like what does two weeks look like for an athlete of mine?
Speaker A:Might be like a Kenyan style progression run, starting really easy and then like working down to a pretty fast pace like maybe last mile and a half close to LT2 as one workout for a week.
Speaker A:Another one might be maybe like K repeats at around 10k pace or more of a classic like LT2 session.
Speaker A:Sometimes I'll have people do a continuous run a little bit slower, maybe kind of physiologically call it roughly halfway in between LT1 and LT2 every few weeks.
Speaker A:I like to have people do what I call a long fast run.
Speaker A:For most events, not so much for like mile 800 meters, but 5k and up.
Speaker A:Usually we're going maybe 15 to 20% slower than the speed of the race and we're doing it continuously and we just try to increase the distance of that over time.
Speaker A:Again with that kind of extending endurance idea.
Speaker A:Maybe that's something that's different that I do is that I have different workouts on kind of different cycles in terms of how often they come around on the calendar.
Speaker A:A session like that, the long fast run, it might only be every three or four weeks that we do it and then we really recover well afterwards versus some people, they kind of have the magic week that they like copy and paste every week.
Speaker A:Usually we have some sessions like more classic threshold work or like a progression run where you can do it every single week.
Speaker A:Other stuff, usually stuff that's like longer and faster or shorter and higher intensity, comes around less often.
Speaker A:Maybe every 10 days, two weeks, three weeks even, sometimes just once a month.
Speaker B:And are days off packaged in there somewhere?
Speaker A:Oh, it depends on the athlete.
Speaker A:It depends on the athletes.
Speaker A:If I have one guy doing over 100 miles a week right now, his day off is 5 miles, super easy in the morning, 5 miles super easy in the.
Speaker B:Afternoon.
Speaker B:I.
Speaker A:Have other people who are running like five days a week and they take multiple rest days every week.
Speaker B:Okay, how much do you work on form with your athletes?
Speaker B:Do you believe that it's possible to change gait?
Speaker B:That it's important to change gait?
Speaker B:When there are really fundamental issues, because some runners come to you and you're like, wow, just beautiful gait.
Speaker B:And then there are other runners that, that really need to work on where they land, where they take off, things like that.
Speaker B:So how much do you work on form with runners?
Speaker A:I would say rarely, but not never.
Speaker A:The biggest thing, I've done quite a lot of biomechanics research.
Speaker A:It is definitely the case that how you move affects the loading in your body.
Speaker A:And the tricky thing is that generally people are optimizing, at least like locally, they're choosing how to run to optimize their efficiency.
Speaker A:And so if someone's healthy and they haven't had injury problems, unless something's really weird, I generally don't mess with it because basically it almost guaranteed that at least short term, if you change their gait, you're gonna make them slightly less efficient.
Speaker A:But if someone has a lot of injury issues or they have like quite a.
Speaker A:The one thing I really check for is having quite a low cadence at the speeds they train at.
Speaker A:And now I'm building out this whole infrastructure of cadence testing specifically to address this problem.
Speaker A:Because if you just say, oh, what's a low cadence?
Speaker A:Depends on how fast you run.
Speaker A:Because if you run at 10 minute mile pace versus 6:30 pace, you cannot compare cadence between those two athletes unless you standardize on speed.
Speaker A:But I'm building data from athletes I have now to be able to say, okay, at this speed, you are in the bottom 10th percentile of runners in terms of cadence.
Speaker A:And we know that both, like from a biomechanistic argument and also just like empirically in the literature, people who have a lower than average cadence do seem to have a higher injury risk.
Speaker A:And that's just because it's the same reason why, like, if you go walk for a couple miles, it's like fine.
Speaker A:But if you go run a couple miles hard, that's much more loading in your body.
Speaker A:It is less injurious to take a certain amount of load and split it up into more steps, each of which is a lower amount of.
Speaker B:Loading.
Speaker B:Right.
Speaker B:And when you run at a lower cadence, you tend to over stride, heel strike, all of that stuff.
Speaker B:So.
Speaker A:Yeah.
Speaker A:And it's all coupled together.
Speaker A:Yeah.
Speaker A:And so cadence is an unusually good intervention point where people tend to be pretty good.
Speaker A:Obviously, like the watch is measured and it's quite an accurate measurement on the watch.
Speaker B:Yeah.
Speaker A:And you can get empirical data on it.
Speaker A:Now more advanced, sophisticated stuff is, is much more rare.
Speaker A:And that's generally something I would do like in collaboration with a clinician of some kind where they have some particular injury, they're seeing a PT or an orthopedist or whatever, and we can kind of put two and two together and be like, okay, you're doing this really weird thing and it's that good biomechanical reasons to think it's aggravating this tendon that you're having issues with.
Speaker A:But I generally am not like, hey, let's just go tell everybody how to run.
Speaker A:Because there's, you know, this.
Speaker A:People are quite variable in terms of just like literally the shape of their bones, the joint range of motion, the relative lengths of their legs and the subject compartments of their legs.
Speaker A:It's very unlikely that there's just one way that's like ideal for everybody.
Speaker B:Yeah.
Speaker B:And we know in triathlon there are two, two Canadians, Tamara Jewett and Lionel Sanders, who have really very non traditional running styles.
Speaker B:But Tamara, especially amongst the women, is one of the fastest women runners out there and just never looks comfortable.
Speaker B:She's just got, she's all over the place.
Speaker B:And I've talked to her about that and she's, gosh, I've heard that many times.
Speaker B:But she's, I don't know, it just works and I, you can't, you can't argue with that.
Speaker B:How much do you focus on when you do look at form?
Speaker B:I always think about this for myself because I feel like the lower half of my body, I have decent form and the upper half of my body is awful.
Speaker B:How much do you think the upper half of the body contributes to running efficiency or takes away from it?
Speaker A:So there's some really cool research on this that essentially like the role that your upper body has.
Speaker A:Why do you move your upper body at all.
Speaker A:When you run, why do you not just run with, like, there aren't your arms crossed?
Speaker A:There's research on this that people do.
Speaker A:If you make people run just, like, with their arms crossed or held above their head, they run a little bit less efficiently.
Speaker A:Not a lot, but a little bit.
Speaker A:And there's really cool biomechanical modeling studies on why people move their arms.
Speaker A:And the reason is you're essentially offsetting the rotational inertia that's getting transmitted up your body from your legs.
Speaker A:So for the same reason that, like, if you're like a.
Speaker B:Gyroscope, it's.
Speaker A:Exactly.
Speaker A:Yep, yep.
Speaker A:To the.
Speaker A:When you swing your legs, you're inducing all this rotation in the rest of your body and your arm swing and your torso swivel is offsetting that.
Speaker A:So I am.
Speaker A:If I see somebody doing something really weird with their upper body, I'm gonna try to look and see, like, is there something funny going on with their lower body?
Speaker A:Maybe there isn't.
Speaker A:And that.
Speaker A:And they're just running upper body weirdly for, like, some, like, individual, quirky, biomechanical reason.
Speaker A:The example I love is Usain Bolt, world record holder on 100 meters.
Speaker A:He spends about 14% longer on the ground on one leg than on the other.
Speaker A:And probably a relevant factor is that he has scoliosis and his spine is all twisted weirdly.
Speaker A:And so to the extent that he does asymmetric or, like, weird things with his upper body, I would really not want to mess with that.
Speaker A:No, definitely not.
Speaker A:Tons of injury issues.
Speaker A:Because even if his upper body was doing some weird, like, kind of asymmetric thing, maybe it's offsetting intentionally something in the lower body.
Speaker A:And again, like, I'm sure you see this in the clinic all the time.
Speaker A:Asymmetries are really common, even in, like, healthy runners.
Speaker A:It's, like, quite common to have one leg a little bit longer than the other or, like, a stride that just kind of, like, bounces left, right, a little bit differently.
Speaker A:And it's not.
Speaker A:There isn't a clear relationship in the research between, oh, you have a longer leg or you have an asymmetric stride.
Speaker A:Therefore, you're more likely to get injured on this side.
Speaker B:Last question.
Speaker B:To wrap things up.
Speaker B:This has been a great conversation.
Speaker B:I've really enjoyed it.
Speaker B:But as a coach, when you start working with a runner, do you feel, listen, we're all limited somewhat by genetics by age.
Speaker B:My son, much faster runner than I ever was and will continue as he gets older to become just faster.
Speaker B:But do you ever Start working with a runner, understanding that, hey, there's a ceiling.
Speaker B:Or do you believe that everybody can get significantly faster than they are?
Speaker B:Now, clearly a beginner runner can get a lot faster than they are.
Speaker B:But let's face it, not everybody can be, I don't know, Kipchoge.
Speaker B:Right.
Speaker B:There's just going to be that genetic.
Speaker B:There's going to be, there's going to be things that restrain us into our lane.
Speaker B:So what determines our ceiling besides genetics?
Speaker B:And what do you go into your relationship with each runner thinking, I, I can make this runner into X, Y or Z?
Speaker A:Yeah, that's a good question.
Speaker A:I think you certainly.
Speaker A:There are people where, if they were like a elite college runner back in the day and now they're 50 years old, are they going to be breaking that college mile pr?
Speaker A:Probably not.
Speaker A:But you can recontextualize what your goals are.
Speaker A:You can pivot to a different event or a different set of events.
Speaker A:Quite often I see people like that who are like, okay, like I had, I had my wild young days just ripping or tearing it up on the track or on the roads or whatever, and now I have this new set of goals.
Speaker A:And so if somebody really.
Speaker A:And first of all, it's quite rare that I see someone where like, they're really, I really think they're like, capped out in terms of, like, capabilities in their, in whatever they're doing now.
Speaker A:But if somebody is like the, the conversation is often, let's find new goals, let's find new things to train for.
Speaker A:Maybe that's doing ultra races, maybe that's trail running.
Speaker A:Maybe that's, you want to qualify for Boston now in your current age division.
Speaker A:That's the nice thing about Boston and these other races.
Speaker A:Like, the older you get, it doesn't necessarily get harder if you stay healthy and fit for your age.
Speaker A:So trying to recontextualize, like, what are your goals and what are you trying to get out of running, that's one of the things I always ask people is like, you know, tell me about why you run, why do you train, why do you compete?
Speaker A:Like, what are your personal motivations?
Speaker A:What are your personal goals?
Speaker A:And I think at a really high level, like, I think people, people can always find some goal or some objective that's worth pursuing.
Speaker B:That's an awesome way to sort of frame things.
Speaker B:And I can't think of a better way to end this conversation.
Speaker B:It's been a fascinating one.
Speaker B:John J. Davis is a co writer and scientist.
Speaker B:He's a PhD in human performance.
Speaker B:He is a widely sought speaker and an author.
Speaker B:I will include links for where you could find him, where you could find his book, and how you can connect with him if you're interested.
Speaker B:That will all be in the show Notes John thank you so much for taking some time and joining me today to have this fascinating conversation on the Tridoc Podcast.
Speaker A:Glad to be here, really enjoyed it.
Speaker D:Hi, I'm Sam Sankoff and I'm the proud editor of the Tridock Podcast.
Speaker D:The Tridock Podcast is produced by Jeff Sankoff, my dad, along with his amazing interns Cosette Rhodes and Sara Lopez.
Speaker D:You can find the show notes for everything discussed on the show today as well as archives of previous episodes@www.tridockpodcast.com.
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Speaker D:The Tridoc Podcast will be back again soon with another medical question and answer and another interview with someone in the world of multisport.
Speaker D:Until then, train hard and train healthy.
