The Sports Physical Therapy Podcast
The Sports Physical Therapy Podcast
Working with Runners and Endurance Athletes with Chris Johnson - Episode 24
Running injuries are extremely common to see in just about any physical therapy clinic.
Just like anything else, there are some things you need to know to take great care of these endurance athletes.
In this podcast, I’m joined by endurance athlete specialist, Chris Johnson. We talk about common running injuries, returning them back to their sport, and how you can build a niche practice working with these athletes.
Full show notes: https://mikereinold.com/working-with-runners-and-endurance-athletes-with-chris-johnson
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On this episode of the sports physical therapy podcast, I'm joined by Chris Johnson. Chris is a physical therapist that specializes in the care of runners and endurance athletes. He's the go-to physical therapist in my eyes in this area. And he has a ton of resources online to help you work with these athletes as well. In this episode, we're going to talk about running injuries and starting your own niche practice, working with endurance athletes, just like Chris.
Mike:Hey Chris, thanks so much for joining us on the podcast today. How's everything?
Chris:Oh, it's going great, Mike. I, uh, I was really looking forward to this when you reached out. Um, easy decision to come on the.
Mike:I love it. So, uh, Chris and I have known each other for a really long time now. We started texting 10 years ago. We just, we just found that out cause we were, we were, uh, uh, just texting again and I, I scrolled all the way up to the top of our thread. But Chris and I have known each other a long time and it's been really awesome to see you. Grow and really develop this niche that you're building. So, um, you know, really happy for you, Really great to see your success and, um, you know, having you on, I think we will share some good knowledge bonds for everybody. So thanks again for coming on.
Chris:Oh, of course. And, uh, you're, you're a much bigger influence on me than you probably realize. So, um, I, I follow everything you do like a hawk and, uh, you know, I've tried to model my stuff after a lot of, uh, a lot of what you've done and, uh, yeah, I have a lot of respect for you, brother.
Mike:Awesome. Well, that's good to hear. That's daunting too. I know. I feel like a lot of pressure to, to continue, but but no, I love it. But, um, what, what I've loved about you, Chris, I think since I've met you to be honest, is you've spent your career, which has been a great career, but you spent your career focusing on running injuries and working with. Um, and that's probably not even fair, right? Because I think, you know, we'd like to say running injuries I think just cuz we're lazy. But you work with endurance athletes, which encompasses way more than running. Um, but you know, I want to dig in a little bit to that cause I know a lot of people share this interest as well. So a lot of people wanna get into this s niche, but why don't we start with that and, and talk about that a little bit. Like what got you started specifically in working with runners and endurance athletes?
Chris:Yeah, I thinking, I think being told that I would never run again and, um, I, I got my start playing. I, I grew up playing baseball. I was a left-handed pitcher and ran into some shoulder issues, um, and then went to. Tennis, which was a n horse sport. But, um, I was diagnosed with a, an osteo, an OCD lesion when I was right around 15 years old. And that was the first time I heard those words. And I think in hindsight, that's when the journey really began. Uh, so, but yeah, I mean, I started when I, when I went up to New York to work at the Nicholas Institute of Sports Medicine with Tim Tyler, Mount mc, Mike Malanney, and that crew. I was doing a lot of just general outpatient ortho, you know, seeing a lot of post-surgical cases. Um, but it was during my time in New York that I started getting back into running and then started to niche down.
Mike:Wow. So you're running, you're running probably from things in New York, right? So it was probably a necessity that you had
Chris:a hundred
Mike:not, I'm not a big fan of New York City clearly, but I'm from Boston. So that's, that's, that's, uh, that's normal for us. But, um, yeah, you know, I, I love hearing stories like that, right? Because, you know, it always goes to that, that catalyst in your life that says, like, Why, why am I gonna. Why am I gonna get involved in this? And I think that's super important. Um, I feel like any person I know like yourself, that is big into endurance sports and, and running, you almost have to be maniacal, right? There's, there's a, there's a bit of a passion behind it. Um, Were you always like that? Like, tell me a little bit about that. I, cuz I just like learning this sort.
Chris:Yeah, no, I never did a lot of distance running when I was younger, but I always relied on my running abilities to gimme a competitive advantage in sport, whether that was soccer. Tennis, uh, baseball. I mean, I sort of dabbled in everything. Um, running away from my older brother who used to rough house with me. I mean, it was a survival mechanism. When I was at parties in high school, when I was at parties in high school, if there was alcohol there, they used to call me lickety split because I'd be out the door and I'd be like a mile or two down down the road, probably like this guy wasn't at the party. He looks like he's out for a training session.
Mike:Was it? Was it because you had all the alcohol? Did you run away with it? Is that what you're doing? You were
Chris:No, No, no. Not at all. I was a pretty, I was a pretty tame, Pretty tame adolescent.
Mike:That, that, that's, that's awesome. You know, and it's interesting to hear that too because, you know, it, it's just like any, any other hobby or sport, right? Like once you get it, you get the bug right. And I, I think that's why, you know, it's such a good niche for a, for a physical therapist to work with because you, once you have the bug you want. You want to continue and you wanna keep get better and you wanna do everything you can to stay in the game. Right? You don't wanna have to miss any time because that would be, that would be terrible. So, um, you know, really, really great, you know, niche in my mind, I, it's, it's one of the top niches out there that I recommend people get into, you know, with golf and, and, and stuff like that. Cause I just think there's, there's so many people that are interested in running and endurance sports.
Chris:Yeah. And if you end up dealing with a, a running related injury, or you're dealing with pain that interferes with your ability to run, That poses a serious threat to, to someone's wellbeing. And, uh, you know, and people are hellbent on getting back to the sport of running. So, um, you know, if you can get established as a go-to resource in your, in your community or your area, um, you'll never be out at work.
Mike:Right. I love that. That's awesome. Well, let's dig in deep a little bit here. We get a, a wide variety of people that listen to this podcast, so let's start with some of the basics here first. And you know, for me, I don't personally work with a lot of runners. One of our physical therapists at Champion Kevin, he, he does, I think you met him recently at one of your courses that he attended. Right? He loves this sort of thing, so, uh, I try to send him to him. But for me, like what are some of the big running injuries that you see? What are the big injuries that you see with your endurance athletes? And probably more than what do you see, but like why do you think they occur?
Chris:so it's a little bit different depending on if we're talking about someone who's new, uh, or green to running. You know, we may see things like Patel femoral pain, um, ITB pain, not ITB syndrome, ITB pain. Um,
Mike:It's not a syndrome anymore.
Chris:no, no longer syndrome. I, I think the same thing with Patel femoral pain. Um, I'll see plantar fas apathy. I may see medial tial stress syndrome. Um, I would say those are the main things. I'll see some proximal hamstring tendinopathy out here, just because Seattle is very hilly and people will get in trail running.
Mike:That's interesting.
Chris:Yeah, but I, the one thing that's changed since the pandemic is I've just been seeing a whole slew of bone stress injury cases. Um, and those pose a serious challenges because of all the moving parts. With a lot of the, the pros that I consult, um, I'll tend to see more tendon related disorders. These are people who generally tend to be good at using their tendons. Sort of going back to the whole, you know, jumpers, paradox. And I will see some bone stress injuries. I mean, there's a whole slew of bone stress injuries that hit the pro field going into Kona this year. So, um, a couple folks who you likely won't know their name, but Javier Gomez, Astair Brownley, Lucy, Charles, I mean, these are all big hitters. Um, and they're just, they're pushing the needle so much and it's just easy to tip the scales and, uh, once a bone stress injury sets in, uh, it's just, it's gonna take a long time. And most of those were femoral, uh, femoral bone stress injuries. Um, so, and if you get up to the femoral neck, that's a high risk site. So you have to really be visual in how you manage those and be patient.
Mike:Yeah, those are real injuries, right? Those are those, Those are big deal kind of injuries. When you start having bone stress injuries, that's gonna require more than just a little rehab sometimes, right? You're gonna have to have a whole workload modification. Yeah.
Chris:Oh yeah. And you need to have a village in your corner between, you know, uh, a nutritionist or registered dietician. You may need to have a psychologist or counselor in the mix. You're gonna have an orthopedist. Um, Yeah, a lot of moving parts and uh, I would say that, you know, if someone doesn't have their sleep and fueling and just general wellness factors in check, uh, all bets are off.
Mike:Yeah. I, I, I can see that here. And that's, I, I think that's one good tip, right? For the, maybe even the early career professionals that haven't been working with a lot of runners here is don't always assume everything is a tendinopathy. Right. You know, always think like, is is there some sort of bony stress reaction going on too? Because that's something you don't wanna miss, that that probably isn't gonna respond to some of the treatments you do. Right.
Chris:Yeah, and I think the main thing to realize for clinicians who are listening is. Tendons have all these tendencies, right? And one of those is tendons tend to warm up. Um, and that's a, a major differe differentiating factor relative to bone stress injuries, which don't warm up. Um, so, and that's my whole practice, is working with people with lower limb tendonopathy and bone stress injuries for the most part. Um, and if you ever are talking to someone and. Vague symptoms in and around of bone. I mean, it's one thing if you have a meial bone stress injury, you can get in there and palpate if someone has maybe a distal fibular bone stress injury, but you know the thing that gets missed a lot. Or these proximal bone stress injuries primarily involving the femoral neck because someone will come in report vague, anterior, proximal, anterior thigh pain, maybe some groin pain. And if you ever hear the diagnosis of a hip flex or strain in a distance runner, it's a bone stress injury until proven otherwise. And the same thing if you ever have a runner coming in with unilateral low back pain and they're indicating or pointing towards like, for and sign, that's a sac bone stress injury. All right? And you see this enough, and I, I think back to the early part of my career where I, I must have missed so many of these. Um, but if you miss. It can be a life altering situation. You know, if someone goes on to to fracture their femoral neck, I mean, AVN replacement, nothing good's happening,
Mike:Yeah, that sounds terrible. So how many times do you see people come into you with these undiagnosed
Chris:All the time. And I, I'm working in a direct access capacity. I don't, I don't remember the last time a physician referred me a patient. So everything's direct access. And, uh, it's funny, there's a doc who, uh, I start sending these patients to if I'm, if I'm, uh, interested in getting imaging for them and he doesn't even question me anymore. He's like, Oh, you probably have a bone stress injury. It took a while for that to happen, but in these, a lot of these patients, Would see me after they consulted an orthopedist or another pt. And uh, if you're not working with this demographic similar to you, it's like you see so many baseball players and pitchers. It's like you just have this sixth sense that if your antenna ever go up, something's up. Right.
Mike:Right. Yeah.
Chris:You have to really act on that. But um, you know, after a while you start seeing the patterns that emerge. And it's really this other constellation. It's a whole constellation of signs and symptoms, you know, and it's basically people who aren't sleeping. They may have a compromise relationship with food. Um, there may be libido issues for women. There may be menstrual dysfunction. Um, guys are losing, they're, they're not getting morning wood and these are really fun conversation conversations to, with adolescent athletes when their parents are, There're
Mike:I'm just, I'm just trying to think if I have to mark this as explicit for Apple Podcast now, or if that qualified. Cause I'm, I'm like well into the three hundreds of. Podcast and I haven't had to hit that button yet. So, Which if you, if anyone knows me, that's a, that's a hard feat. But, um, I like that. That's
Chris:Sorry if I created more work for
Mike:that was fantastic. I like that. That's the first time that's happened,
Chris:but you have to ask these questions, right? And if you don't, you're probably in the wrong hands.
Mike:exactly.
Chris:But you just really have to understand that person's ecosystem. And I would say that a lot of people who don't have those risk factors have been presenting as of late people who grew up playing axial loaded sports, like soccer court sports, you know, not swimming, not cycling. Um, who generally are on top of a lot of these, these wellness factors. But since the pandemic, I think that their lifestyles have changed. Their activity has maybe been dialed back a little bit and you know, folks who'd be like, Ugh, I don't think this person has a bone stress injury. You start taking'em through the clinical exam and some functional assessments and you're like, I think this person has a bone stress injury.
Mike:right,
Chris:Tricky. I, this is what Kevin and I were talking a lot about, uh, over the weekend. So, and he'll get dialed in and he'll be, uh, he'll be a huge asset to everyone in your, in your community and the champion network.
Mike:It just, to me, it seems like if you don't work with a lot of runners, that's gonna be one of those things you screw up. You just because you don't have that intuition, you don't initially want to think that. You're like, No, it's a hip flex or strain. Right. It's, you know, it's almost like it's. The path of least resistance. So it, it's something you don't wanna miss. Um, now I know you work with a lot of high end people, and I know in most people's practices they may have the occasional high end person, but I think they also work with a lot of gen pop people. And maybe that's somebody that's running for. You know, recreation or even just fitness, you know, trying to lose weight or whatever it may be. Or, you know, up here, you know, we have the Boston Marathon and, and there's always people that have never, never run before, let alone run a marathon that are trying to train for this. We start to see all these injuries. It sounds like to me, what you kind of alluded to before was kind of like two ends of a workload spectrum. Where these beginners almost have like this spike in this acute chronic workload ratio. And the pros, the elite level athletes almost just have too much built up chronic stress where it's not so much the acute, but it's more the chronic over time. Um, am I, am I close with that concept? Is there, is that how you kind of think of those things and how do you look at the gen pop population differently from these elite level?
Chris:I mean, I think with, with both demographics, uh, or populations consistency of training, Rain supreme, you know, because if you're not training consistently, you're gonna get side. Line, no adaptations are gonna occur and not, not only that, you're gonna lose capacity in muscle tendons are gonna lose stiffness and bones also gonna lose capacity. And these things take time. You know, it's like the article from Laar Chuck, I mean, basically shows that you're gonna need at least, at least six to eight weeks for tending to start to regain some of its mechanical properties, namely being stiffness, and then bone is gonna lag behind. Tendon and muscle. So, um, so I, I think that with both demographics, you, you gotta get the workloads right in, in how you stagger the, uh, the workloads. But I do think that with a lot of these endurance sports, uh, people become hooked and they, they get addicted and they end up not resting nearly to the extent that they, they. And, uh, I don't know if you've read this Art, this guy Neil's VanderPol who broke the, the world record in the 10 K in the recent Olympics and then the Olympic record in the 5k. It's amazing to look at his training. He basically wrote a manifesto on. Everything. He just put it all out on the line and didn't hold anything back and this guy would train five days in a row, take two days, completely off. Now he was, he was doing crazy stuff during those five days.
Mike:Yeah.
Chris:I think that it's such a tough thing to wrap your head around that like, Hey, you need a day or two of rest. Um, and, and I think that both the, the, the pros as well as, um, even Jen Pop, sometimes they get hooked on running and, and they don't afford that, that recovery time. Um, so, and everyone has, has a unique ecosystem, so you need to really understand that stress equals stress equals stress. Um, so, you know, how do you, how do you prioritize recovery? And it doesn't count to just sit in your NormaTec boots. I mean, taking a day off, maybe just going for a walk, um, maybe reading a book. To me, that's what constitutes recovery. Um, but yeah, and I, I think that with a lot of the, the pros, they're, they're producing greater force too, you know, And, and there's a, a tremendous, there's a tremendous pressure for these pros. Their livelihood revolves on them winning. So the stakes are a lot higher, and that's, that's a big difference between, um, pros and gen pop.
Mike:Yeah, so every spring in Boston, I'd say right around April, sometimes May. There's that first day of the year that it goes from 45, 55 degrees and it just pops to 75 degrees and it's sunny that one day and everybody. Goes and takes a jug down the Charles River in Boston. Right. That's just what they do. They haven't done anything for months. They haven't worked out, they haven't done anything. They just start running. Do you ever look at anybody mechanically and say, You know what, You're not a runner, Maybe you shouldn't just be a runner. Your body may not be efficient to be a runner. Does that ever cross your mind?
Chris:Well. I sometimes think that people jump into running prematurely, and not that they don't have, I think everyone has the potential to become a runner, but I think that people don't respect the adaptations that have to occur. And I think for a lot of people it's like news flash. Your running program should start with maybe two to four weeks of walking
Mike:Right
Chris:a walk run, and then bleed into continuous running. Yeah. I think, uh, on a day like that, people are just, they've been so pinned up that they wanna just finally get out. Spring is here.
Mike:I'm gonna exercise Well, I, I kid with the concept, but I, I do wonder though, as a physical therapist, like how much time you spend with people looking at their mechanics and from both ends of the spectrum. Again, so from the elite level at. That's maybe trying to e out just a little bit, Just a one more percent increase in performance. Right. Or from that gen pop population that's maybe trying, trying to train for their first 5K and they're having some knee pain. You know, how much time is a physio do you spend working on mechanics? I always think that's an interesting question to hear from, from different perspectives.
Chris:Yeah, I mean, I, I generally watch everyone run. I mean, if a runner's coming to see me and they're not dealing with a bone stress injury, you know, I'm, I'm probably gonna put them on the treadmill for that first session. Um, I, I also think that with a lot of the elites, they have a running signature that's becoming engraved, so you're not going to, you're not gonna change too much. I think with a lot of Jen Pop recreational distance runners, um, that a lot of the times they adopt a slightly slower cadence that would really then would really be in their best interest. But if someone's training consistently, I'm a less is more guy. All right. I wanna really make sure that they're, you know, for a lot of gen pop it's like, let's have you run on non-con consecutive days. So we know that their collagen, syn synthesis, um, is, uh, is taking place. Um, so, but I, I do watch everyone run and for most people I'll do a qualitative assessment and I find that that's, that's adequate. It allows me to be nimble in the clinic. So, um, meaning I'm looking at a lot of stuff. I'm not looking at forces. Um,
Mike:mm-hmm.
Chris:With certain people. I will look at forces and I'll use something called this Run Easy device, e a s I. Um, and that gives you some interesting metrics. It gives you a symmetry score. Uh, it gives you a media lateral stability and an impact score. Um, just because we, we can't see forces, not like the best coaches, clinicians. We can have an idea, but we can't, we can't quantify the forces. So, um, but most of the time I'm just doing a qualitative assessment and I use the S'S of treadmill analysis as I've dubbed them, which is Strike sound, step speed, surface shoes, slope. Shank meaning lower leg angle, um, and step with. And if you just systematically go down those, you're gonna have a really good, uh, understanding of, of what's going on, what tissues and regions are really having to pick up the slack. But nine times outta 10, I'm pulling that step, right lever because it's super easy. You get someone fixated on one thing. and we'll auto and train to it. And Chris Brahma's research on this is basically like have someone do a five minute gate retraining session and they'll, they'll carry over those kinematics for essentially three months. Um, so he did a nice study with people with Patel femoral pain. Not only did their functional scores improve, but their kinematics changed in and stayed, changed that. Now, after that they were, they were monitoring, but they, the subjects really didn't follow the protocol the way it was outlined. Um, so they basically took'em through the five to 10 minute gate retraining session and the people just ended up monitoring and did great.
Mike:That's awesome. I, I, I, I like to hear some of the things that you use in the clinic as well. Are there any things that you would recommend somebody getting started with a running program, like technology based or app based? What are some of the things that you use every day that you think somebody should, should really look into if they're gonna start like a running clinic?
Chris:Uh, I think that you want something to probably quantify for, I mean, you're gonna need a treadmill or you're gonna need some place for people to run where you can observe them because running is a hierarchical skill. You know, you can take someone through a clinical exam, these functional assessments and have a pretty darn good idea, but you also wanna watch them. Run on a treadmill. I don't use a lot in the way of tech in terms of, I'll just use the iPhone and I'll do slow mo. Um, and I'll use an app called TA Tempo where after you do this for a while, Mike, we had someone on the course over the weekend and someone's like, What do you think their step rate is? I'm like, oh, 1 67, 1 68. And it was on the dot, you know, But for people who, who don't, uh, see runners all the time. Tap that tempo is essentially is, it's a green dot and you just tap it so it coincides. Every time someone's foot hits a ground, you tap it and you'll, you'll know exactly where they fall. Just remember, Go ahead.
Mike:they haven't, they haven't built a microphone version of that yet. They can hear that and automatically calculate that. Right. I feel like they, I feel like they can do that now. right?
Chris:probably is something out there. I'm not familiar with it,
Mike:That's that. But simple is sometimes all you need. And, and I think that's a really good way of breaking it down and having a systemized approach to, to look at those things. I think that's always gonna be more important than fancy tech is that you have a trained eye that's gonna follow the same flow each and every time. Right. And, and those that you came up, that was an impressive list of, of words that began with s by the way. But, um, but, uh, those ss I think that was, um, that was, that was f.
Chris:I'll send you the book I, I wrote, you know, just a book treadmill analysis guy cuz I need to be nimble. Uh, but what's funny though, sometimes I see a lot of people who, who have gone through these very fancy GA analyses and um, and. They're still not better, and they'll connect with me. And sometimes it could be running related, but a lot of the times, you know, someone has them fixated on their running forum when that's not really their issue. So this is why it's important to really just, you know, have a global lens of what's going on with this person from, you know, what their lifestyle is, to what they're running habits are, to what they're doing from a resistance training standpoint to you. Is there a case of incomplete rehab, which you and I know, it's like someone has an ankle sprain, they don't think anything of it, and they plug back in and they develop these subtle compensatory strategies that at some point they, uh, they hit a tipping point. That's.
Mike:well said. I like that. Um, for, Chris alluded to this, and he's being humble about this here, but he's got some great resources about GA analysis that you should check out on his website. I'll be sure to put those in the show notes for everybody. But, um, you know, this is, Anytime you can learn with somebody that has the eye that Chris has, I think is, is really important if you're looking to get into running. But, um, I would say the other area that I think PTs sometimes struggle with and it, and it comes back down, it was just, it's just not things we learn in, in undergrad school, like, like running mechanic for example. But I think the other thing is returning back to a running. Right, And I think sometimes we struggle. I think we understand the concept of workload progressions and walk runs and and taking days off, but what are some of the keys that you would consider when you build your return to running progressions in kind of the more everyday athlete, right? Not so much somebody that's an ultramarathon or competitive athlete here, but you know, the general folk that wants to just get back into running again. How, how do you build those programs? What are some of the keys that you look into?
Chris:I think to really understand the tissues that are involved. So, you know, if you have someone that's coming off of a lower limb tendon issue, um, I'm much more cavalier with runners dealing with lower limb tendonopathy because if I get it wrong, you know, maybe I sensitize'em a little bit, but, Really no harm, no foul. Um, the, the paper that Rich Willie Breen Edwards, Stu Warden, Stu Warden was the lead author, j o s p t 2021. I, I bring this up because this is a really critical point, is if you have someone that's coming off of a bone stress injury that you have to look at, that Return to Run program is a series of controlled bone loading session. And so that person should really slow down. Alright. Um, you know, there, there's a study from Brent Edwards that basically showed that if someone has like a, a tial, um, bone stress injury, that if you drop their speed from 3.5 meters per second, which is a little bit over 10 minute per mile pace, um, to 2.5 meters per second, that that's gonna be a big strike against you. Let me rephrase that. If you go from. Um, 3.5 meters per second, 2.5 meters per second, it reduces the likelihood of a tial bone stress injury by 50%.
Mike:Wow.
Chris:Yeah. So, and also understand that, you know, if you have someone with an Achilles tendonopathy, well, we know being on a treadmill. You're gonna shift the loads a little bit more to the calf muscle complex and achilles tendon running uphill. Same deal, right? So when you go to, to reintroduce running, you wanna keep these people on level ground to gently rolling terrain and maybe consider bumping their, their step rate up a little bit if you think that's indicated, which maybe if they're in like the mid to low one sixties, that would be, uh, that would be an instance where you would. Same thing, Rich Willy. Just put something up on Instagram today talking about, you know, if you're coming back after ITB pain or Patel femoral pain, you may wanna start that person on an uphill walking program, uh, on an incline, making sure that you understand their past medical history, if they have a calf muscle complex or Achilles tendon issue, um, before you start to bring them to level ground. And then at the, the last thing you would wanna do is reintroduce hills, because if you're going downhill, Um, that could bias a load towards a patella, femoral compartment as well as, uh, the lateral knee or may sensitize some with ITB pain. Um, with the trail runners that I work with who have proximal hamstring tendonopathy, you know, I'm gonna basically reintroduce hills much later. Right. A lot of these people though, if someone has a proximal hamstring tendinopathy, you don't need to shut them down from running whatsoever. Right? You just need to basically slow them down, keep'em away from hills. And they'll do great because we know when you run faster. If we take an extreme case of sprint, The faster you run, the more the forces shift upstream. When you're going uphill, you're having to produce force from a more flex hip position, and you may introduce compressive forces at that proximal hamstring region or the issue tuberosity. So just put your clinical cap on and say, What's the tissue or region? What are the conditions that may bias load towards that? And just think that's probably the last thing that we should reintroduce. Um, but yeah, most of the time you just wanna be conservative. You could follow, like, you know, the two workout rule where you want people to tolerate a workout, uh, for two consecutive sessions before you bump them up and just gently nudge and people do great.
Mike:Love it. That's some great advice and really good advice on how to individualize that and really think about the specific needs of each person because it, it matters and it changes, and to me that's next level stuff. We can all. Talk about time and duration or mileage, that sort of thing. We can all build a workload progression based on that. But it's that sort of knowledge that I think really puts you over the edge as a running specialist. So, um, you've clearly done an amazing job building this niche, right? You, you're PT that focuses on these endurance athletes. I know a lot of physical therapy. People, I was gonna say students, but even, even early career professionals would love to start building this niche as well. What's some of the advice that you would give somebody that wants to get started in this area?
Chris:I would say it's a great area to, to get started in and I think since the pandemic we've seen yet another boom and running and um, and if there's ever anything I can do for folks who are interested, reach out and I'll do my best to follow up, uh, on messages. But, um, I would encourage you to start running so you understand some of the challenges and situations that runners face. Um, and I think that will really help to foster therapeutic alliance. And I would also say seek out a mentor. I mean, Kevin has been reaching out to me more and more, and I can see his clinical reasoning getting refined. Um, but if you can go and hang out with, uh, a local coach, if there's a clinician in your area that you, uh, that you respect that has sort of niche down with running. I think that's great. Go and watch races. If you know of a nutritionist or RD or a strength coach that works with a lot of runners, just go and loiter, right? And just pick up as much as you can. And I think the most important thing when you're, you're working with runners and clinicians are in a good position, is to really understand where someone is on that injury to performance spectrum. If you think of like the, the Claire Orain article from, um, from Bjsm, I think it was 2016. You know, the, the more you understand where someone falls there, the better, I think the, the better position you're gonna be into really troubleshoot with that person. Um, but yeah, go and go and learn from other people and don't pretend. I, I thought I had a lot figured out when I was younger because I had an affinity to run and, um, I didn't know my ass from a hole in the ground. I would have runners on like a bosu ball, shaking a body blade, blinking their eyes like, you know, the performance demands are predictable, and this is one of the, the important things to remember. It's not rocket science. How we build capacity with runners. Um, and there are a lot of brilliant people out there. And with the internet, I mean, the list goes on and on in terms of folks that you could reach out to who are also so willing to share their knowledge. I don't keep anything a secret. You know, I don't have enough time in the day to share everything I want, but I try and put a lot of stuff out there and, um, I'm not saying it's right or wrong, it's just this is what I've come to Appreci.
Mike:Yeah. That's a great perspective though. I like that. Um, well, another project that you've been working on here that you just recently launched that I thought was really neat was this new community based program that you called Runwell. Uh, and I think it's runwell.com right? Chris? Yeah, so, uh, it really looks impressive. Um, but what I like about it is it's a community for runners too, and not just, uh, professionals like fitness professionals or rehab professionals, but it's for the runners as well. Uh, tell us a little bit about runwell and like, where do you see this going? How do you, what, what's your goals of runwell and where do you hope, uh, to see this in the future?
Chris:Yeah. Well, I appreciate you bringing that up. Um, I, I wanna just start by thanking, um, my. Buddy, my business partner who's become a, a dear friend, uh, Michael Henry. Uh, he's brilliant. He is a, um, he's a, just this design inclined dude who, uh, has a really amazing background. Um, he worked at Red Bull GoPro and Adobe. Um, so I've learned more from this guy. I never thought I'd, I'd learned so much from a 28 year old. But you know, our goal is, you know, there, there's a very underserved, uh, in a, a big population of runners and, you know, a lot of these people are just very fearful about, you know, Taking up running or getting back into running after injury. And they're just working with such misinformation. And I think that the lay press sort of presents in the medical community presents running as this very injurious activity. And you know, I think a lot of that stems from hasty, you know, decision making and training errors. But we want people to realize that they. Have a, a very healthy relationship with running and they can run across their life span and we're trying to give them the tools and resources as well as a community to lean on when the going gets tough, um, that is gonna position, position them to do that. So I've always wanted to, It's like, I, I think you probably share this, uh, you know, this perspective too. It's, I love working with people one on one, but I also feel like I, at this point in my career, I want to, I want to help a big group of runners and, uh, and I have the resources and the knowledge base to really do that. And I, I suppose I have the platform and, uh, and this will, this will go hand in hand with.
Mike:I think that's awesome. And, you know, for, for those that are interested in this sort of thing, I don't think you need to be a runner yourself to get a lot out of this. Right. I think as a physio, uh, therapist, a fitness professional here, being part of this community and just learning from them, I think is, is gonna teach you a ton, even if you're not. An endurance athlete yourself, but you just want to get started working with them. I think this would be a great start. Uh, don't get me wrong, I agree with Chris. You gotta get out there and you gotta do that. But I, I think this is more than for just runners, right? I think this would be a great community for rehab and fitness professionals as well. And, and, um, you know, I, I think it's gonna be really successful. So, uh, so good stuff. Um, I'll, I'll put a link to that in the show notes as well. Um, Chris, before I let. We got a little segment at the end, we call the high five. Five Quick questions, five quick answers. Um, although we'll see, I don't know. I get, I get, um, mixed feedback on calling this the high five, but whatever, uh, it was, it's not as good as the 12 Ss or whatever you came up with, uh, for, for, for years. But, uh, but, uh, five quick questions. First question, What are you currently working on or, or reading or learning for your own ConEd or professional development? What are you doing for.
Chris:I am about to go through another apprenticeship, uh, with a woman who actually had her son go to see you. Life is about relationships.
Mike:Yeah, right.
Chris:Who had some shoulder instability. So, um, she's a brilliant copywriter. She's someone who, uh, I, I went to, um, grade school with. So, um, you know, I've just spent time with her and, uh, I'm going to do another apprenticeship under her with storytelling. But in terms for, for the audience, um, I'm reading, I'm just about to read the Pringles article. P r i n g e l s with, um, Joe Cook and Craig Perham talking about intra tendonous pressure in how we need to start factoring that into the continuum model, um, which is fascinating. I'm currently, um, highlighting anytime I read an article, I highlight it and then I create a Cliffs Notes version of it and then turn into edf. So, I'm reading Peter Malli S'S recent manuscript on physiotherapy management of Achilles Tendonopathy mid portion as well as insertional.
Mike:Awesome, awesome. There's always gonna be things that you can keep learning from, those sorts of things. I love that. But I love the storytelling apprenticeship. I think that's gonna be great in the community. I look forward to, uh, um, reverse hacking that as I see it unfold. I think that'd be great.
Chris:Cool.
Mike:uh, what's one thing that you've changed your. Thoughts on recently?
Chris:A hundred percent knee effusions decision making around knee effusions.
Mike:Oh, tell me
Chris:Yeah. So I used to always think someone has a knee effusion, shut'em down, you know? Um, and this is going off of, um, Lynn Sturgis's paper in J O S P T. Um, you know, I was trained at Delaware. If you didn't know how to grade a knee effusion, they were gonna kick you out of the program, Dr. He would've just kicked me out of his office. I used to assist him a lot. Um, I think that you have to really understand how that knee effusion is behaving. And I, I speak from experience, so, um, I developed a knee effusion sort of out of the blue, and I don't, I don't wanna get into the what I think the reasons why, uh, but if you have someone that has a one plus knee fusion, Don't be so quick to shut them down with running. Obviously I wouldn't go out and put them on a hilly run, but what I noticed is, uh, and I'm not telling listeners to do this, but if I had won even a two plus knee effusion, I would run over to my in-law sometimes, uh, which is not a trivial run. I mean, it's real, it's rolling terrain, but, I would get there, my knee effusion would be completely clear. It would improve. So I would say monitor it. I'm not talking about after ACL reconstruction, after mastectomy, I'm talking about, um, non-surgical situations. But you know, now if you have someone with a knee effusion, And again, just remind people, swelling, inarticulately, you're thinking, you know, there's a few different structures that could cause that, but if it improves over the course of a run, you know, that's a good sign. Monitor it. Teach your patients how to self-monitor that. Now, if it gets worse, it's telling you you're not ready, you know, So I would've a knee effusion, it would improve by the time I got there and it would be fine really the rest of the night. Maybe get a, maybe start to come back. But then it would be back to baseline or a little bit better the following morning. Um, so that's something that I've changed a lot. And, and I would also say one other thing. I had a bunch of things. I'm gonna just simplify it. I used to do a lot of static single leg balance training with the runners that I work with, and I got away from that. I think you need to put runners into motion, which is why I post a lot of those marching videos with the caveat that after a lateral ankle sprain, you know, EW and Tim Tyler, they've done some great studies, um, just looking at. Just simple single leg balance on like a, the pad, um, in an at risk population of high school football players and how that basically almost eliminated ankle sprains. So that would be the one instance where I would say, um, you know, I would tend to prioritize some single leg balance, uh, in more of like a static or quasi static manner.
Mike:Now, have you gotten rid of single leg balance or do you just Dee. Since it's just a small piece of the program.
Chris:Uh, I haven't gotten rid of it, you know, but I, I've turned that into more slow motion marching because I do wanna make sure that someone has that. Postural stability. I mean, freeing back in the early 1960s was talking about this stuff, you know? Uh, yeah. So I, that's an emphasis with a lot of the, the videos that I put out and, you know, so I, I think it has its place, but runners need to be put in motion cuz they get bored pretty quick.
Mike:Awesome. What is one of your favorite pieces of advice that you give students, uh, when you work with them?
Chris:Uh, what I, I'm gonna bite off my friend Joel. Joel said, Well, a couple make. 10 year plans. All right. You know, so when I got outta school, I said, I'm going to immerse myself in trying to refine my clinical reasoning to the nth degree. I did not go right out into my own practice, and that's, that was why I stayed at Nsma as long as I did. You need to get your clinical reasoning dialed in, and you have to be keeping a journal of what you're seeing in the clinic, and you could just scribble down one word, one phrase, one sentence. Keep a clinical journal and that way you're gonna start really identifying patterns that you're seeing.
Mike:That's, that's brilliant. And, and that was more than one piece of advice, even just within the same piece of advice. That's how good that was. So, um, I love that. That was great. Uh, what's coming up next for you, Chris? Where can we, uh, where, where are we gonna see you? What projects are you working on?
Chris:Oh, I'm trying to simplify, man. I mean, I'm gonna be, uh, deep in the weeds with, um, with Runwell. Um, You know, I. I, I'm teaming up. I, I team up with Nathan Carlson. We do a course called Bones, Tendons, Weights and Whistles. We drag Rebecca McConville in there, who's a brilliant registered dietician who wrote the book called Finding Your Sweet Spot. She specializes in, um, really managing, helping athletes manage energy. Um, and I'm also doing a lot of teaching with Jay Dacher, who wrote the book Running Rewired Mobile Board. Um, and it's just fun. You know, I, I feel like I'm starting to hit a point, um, maybe at the, I'm at the beginning, maybe I'm at the late stages of my fluid intelligence, uh, period of life and starting to step into crystallize intelligence. So I just, I want to. Give everything back that I've learned from all of the people who, um, who made it a priority to teach me. Lynn Snyder, Mackler, Dr. Ax, um, Mal McCue, um, all the, and I excluded other people. Um, not by, not by intention, but I have been so fortunate over the course of my career and if I can just pay it forward and, uh, You know, and help other clinicians who are looking to niche down working with runners, because I think when runners get injured, it's not as simple as a running related injury. I think that that becomes a soci, a societal injury. Um, and when a runner gets injured, that's gonna impact their family, their friends, their employed, they're employer and their colleagues, as well as their c. If we can, if we can address it and conceptualize a running related injury like that, um, the world would be a better place.
Mike:That's awesome. I love it. How do we find out more about you, Chris? Where do you wanna send everybody to learn more?
Chris:Uh, my website, uh, chris johnson pt.com, as well as the Graham, uh, at Chris Johnson, the pt. Um, and I would say the best place to learn from me is, um, my newsletter. You know, it's, uh, I, I spend a lot of time on my newsletter. And I also have the Runner's own podcast that I did with Nathan. And, uh, we try to have candid chats with people and, uh, you know, just open, open some doors for folks.
Mike:That's awesome. Yeah, so if you're interested in these endurance athletes, be sure to head to Chris' website, check that stuff out. Obviously we talked about runwell.com, but um, really head to Chris' site cause I think there's, um, a bunch of different avenues you can take care of from learn from his newsletter or his podcast, but also some of the things he has brewing and some of his courses, um, you should definitely check out. So Chris, thank you so much for sharing this with everybody. That was awesome. It was good to catch up with you, man. Thank you so.
Chris:Thank you so much, Mike. Keep up the good work and, uh, yeah, you're an impressive dude, man. People, people ask me, how do I do it all? I say, you know, ask Mike Ryan hole that question. Yeah,
Mike:It's good, Good teams around you, right? That's what it always comes down to, Awesome. Thanks Chris. Take care. I'll see you soon.
Chris:Thanks, brother.
