Exploring the Science of Pain and Performance with David Wadsworth

David, are there signs that there's overloading or impending injury that athletes should be looking out for?

Like obviously if you're cranking up your training load, we'll call it a really high ramp rate, your risk of injury goes up and there's quite a lot of research across a lot of sports for that. If we ramp it up too quick, it tends to end in tears. If we ramp it up more gradually,

you can get to a high level if you're patient and that works.

Hello and welcome to the Athletes Compass podcast where we navigate training, fitness, and health for everyday athletes. As much as we try to stay injury free, the reality is that many of us of us nurse injuries every year. Research is pretty clear on the positive effect of strength training preventing injuries, but today we want to focus on injury and pain management.

The is that many of us have less injuries every year.

when the pesky injury is about to or has already sidelined us from doing what we love to do. Today's guest, physiotherapist David Wadsworth is going to help us understand common overuse injuries in running, cycling, and triathlon and how to manage

Today's guest, physiotherapist David Wadsworth, is going to help us understand how an overuse

and especially me, is on side on David Orks, and he coached and celebrated performance emoji. Muscular

injuries and especially pain when we are sidelined. David works as the head coach of Accelerate Performance Coaching, Muscular.

and Musculoskeletal and Sports Physiotherapist at Pain Solutions Queensland and owner of Cycle Physio. David was Paul's guest at our sister podcast, the Training Science Podcast, and listen to that podcast as well.

and Muscular, skeletal and sports-busy, I'll what he did. He's an owner of the cycle of busy. David was a call to guest at our sister podcast, the Training Science Podcast, and if you'll listen to that podcast.

about really good informative. So David, can you introduce yourself and what made you introduce yourself to physical therapy and such?

It's really informative. So David, can you please introduce yourself and what made you immerse yourself in the worlds of physiotherapy and cycling and triathlon?

Well, I guess what got me out of high school and straight into physiotherapy, I actually was thinking of exercise physiology and I lived in far North Queensland at the time. And my dad is a scientist and he said, I think he was a bit worried I might not have a job to go to. And he said, if you're interested in sport, why don't you try sports physiotherapy? And that's what got me into it. And then...

This is what got me down to my school on I suggested the mix of sports physiology and public health. I was kind of drawn on that. I was just going to say, you have to be worried about not having a job. You guys are the directors of this school. And enjoy the new schools that are out there. And I just want one thing to say. And then.

Throughout my career, guess, very early on, I did my honors thesis and got some help from a very good sports physio, worked with the Olympic swimming team. And so I a lot of exposure to swimming early on, which is a bit unusual. Most of us do a lot of running sports. And then just through personal interest got into cycling. And there was a bit of a niche there, a bit of an opportunity and pursued that because it was an interest. So I'd had the three sort of individual sports of triathlon that have a big biomechanical sort of

and I found that interesting and that's why I kind of stuck with it.

That's awesome. In your LinkedIn profile, you wrote, I have pursued excellence in treating chronic pain whilst maintaining an interest in sports and human performance. So I am really interested in pain. So let's take a deep dive right into the deep side of the pool and talk about pain, specifically how pain is perceived in our central nervous system and brain.

All

there's broadly speaking two types of pain. One's acute pain, which we're mostly familiar with. So think of a trauma, I sprain my ankle, I break my leg, whatever it might be. We've done some structural damage and the body, there's inflammation, there's stimulation of the pain receptors, which our brain goes, it's like putting your finger on a hot stove and you go ouch, and it has a reaction and...

it's a bit more predictable. We broke this bone, if we put it in a cast, we unload it, it's likely to take this long to heal. We're fairly familiar with that as a concept. Chronic pain's a bit different. Chronic pain, we don't necessarily have a structural damage like a broken bone that we can see. And this can be frustrating at times because most spinal pain doesn't have a label, the diagnostic label.

90 or more percent of it is non-specific, meaning if we do an MRI, we're not getting a stress fracture or a disc blowout, but we still have pain. And so the model for approaching the diagnostics and the treatment needs to be different. If we apply an acute trauma model to a chronic pain model, it doesn't really work too well and our results are quite poor. And so the way that we approach that is quite different.

and it's so frustrating because most of us experience that chronic pain and sometimes the dreaded label, non-specific, up when we go see experts. And then we walk away from the appointment and think like, is it all in my head? And then the frustration comes off them because what it means to us.

Mm-hmm.

even if our brain perceives the pain, that's okay. That's usually neutral, but it's the frustration and the painful emotions, anger even, it comes from what we associate that pain with. A lot of athletes, okay, so now I have this issue that I have to deal with. What do I do with my race?

For example, so how do you go about like talking to your patients and athletes about how to manage that, you know, the emotions and the chronic pain?

That can be really tough because you're desperately wanting to do one thing, but your body is saying, hey, better cool our jets a little here. We've injured something and it's not letting us do exactly what we want. And particularly if it's a really big goal that you've been working steadily and steadily towards, it's very hard emotionally to let go of that. So I think one of the skills mentally is being able to adapt and reset, which is not easy to do.

We all have different emotions with different traumas that can create things like anxiety, it can even create some depression. And so being mindful of that and I guess if you can get good diagnostics and work out how long would this process to get better take and be reasonable in your estimate, then it can give you bit of confidence if you know it's not long term.

If it is long-term, you, you know, it's very helpful to know early on, maybe you broke your femur and it's a 12 month recovery. It's pretty handy to know that straight up. And that's a bit of an extreme example, but a sprained ankle, garden variety, and if you're used to doing some rehab and you've been through injuries, that might be a three week problem, not so mentally tough to deal with. And then you're going, well, what can I do?

Mm-hmm.

If I can't do X, what are my other options that I can do to make some progress? What can I do each day to make the injury get better as fast as physiology will let it? If you overdo it, you can make it go slower, but you can't beat the pace of natural healing. So it's just understanding that process and going, how can I help you be empowered to speed it up as much as your body will let it?

Mm-hmm.

figure out those projects as you are doing

them.

What are some of the things that you do with patients that help that process?

What are some of the things that you do with patients that help that process?

I guess you're getting into the big management side and I kind of divide it. If we put diagnostics is a really key part, but if you divide it into manual therapy or manual medicine, if you like, and you divide it into exercise therapy and you're trying to work out with manual therapy, if you have what's with some roadblocks to you getting better. So let's say you're dealing with a hip problem.

Yeah.

getting better. let's say you're dealing with a hip problem

And one of the parts is you've got a weak gluteal muscle. And I'm sure most athletes out there have heard about weak gluteals. It's a very common thing to be thrown at. Or maybe a tight hamstring. They're two super common things. one of the jobs is to go, is there something that's inhibiting the gluteals from contracting normally? Okay.

and one of the parts is probably the luteal muscle. So a muscle that folds out there and goes down the luteal is very common in the front. There may be a tight hamstring into the cervical. So one of the jobs is to go, is there some way to continue your luteal attack in the lower body?

Is there some sort of dysfunction that is holding you back? And that's one of the concepts with chronic pain or your gradual onset things is dysfunction.

some sort of dysfunction that is holding back and that's why the concept of chronic pain and gradual symptoms is dysfunctional.

That's where something's not working right, but it's not structurally broken and showing up on your scan, okay? So it might be that your nerve's irritated and it's not allowing your glute to function properly. Maybe the artery's irritated and your blood flow to the glutes a little bit less. Maybe one of your

That's where something's not working right, but it's not structurally appropriate. So it might be that you're too irritated and it's not allowing you to function properly. Maybe you are too irritated and you want to hold it against you and you're less likely to.

joints is irritated and that's inhibiting the gluteal. And we know that happens if your joint's inflamed. So can we do something about those issues? And it's just diagnostically working out, is it one of those? Is it two of them? Is it 10 of them?

is irritated and that's a big deal to you. I know that kind of is a big deal to you. So can you do something about those issues? And it's just got an obstacle working out. Is it one of those two that's intended

on treating them? And then you can sort of go into the exercise side and go, okay, weakness is a problem. It was strength exercise for the new tears. One of the...

and treating them. And then you can sort of go into the exercise side and go, okay, if weakness is a problem, can we do a strength exercise for the gluteals? One of the

two big mistakes I think that happened in my profession with that is you don't remove the inhibition on the muscle that you're trying to get working again. Okay, because very hard to say to someone, contract your glute, but your nervous system is kind of holding you back a bit.

two biggest mistakes I think that happen in my profession with ADC back and the initial muscle and trying to get working again. On timing it's very hard to say to someone, you're trying to work, but you know, it's just in time or in fact.

So if you can make it easy to contract, you're gonna go a bit better. And the second big mistake is if I say glutes to you and you think what pops into your mind is a strength exercise. Are there some exercises that jump to mind quickly?

So if you can make it easy, you train and you can get better. The second big mistake is I say, work is too easy. What you do is a strength exercise, mean some exercises that jump too high.

If I said, give me a glute exercise, I'm sure you could all think of a couple.

Mm-hmm. Yeah.

Clued preaches.

Glute bridges, you could be thinking squats, Romanian deadlifts, you could be thinking lots of things. But the thing I think that matters, I call it load matching. So if you're asking a really high load exercise, maybe it's a single leg deadlift and you're going, hey, we're really going to hit these glutes, but your glute is quite a bit weaker. Your glutes looking at it going, Dave, I can't do that, I'm out. And your butt compensates and the hamstring kicks in or

Yes.

hehe

the entry is here,

your back kicks in or something else does it and you're trying to get the glute to work but it won't contract because the load is too hard.

you get back to the center, there's something else does it, decide that you're to work your way to the fact that it's the lowest you should work

So would you then ask somebody to do like, instead of single leg that lifts, you would take it down maybe to the floor and do glute, like double legs down, glute bridges and build from there towards like single leg glute bridge and then bring the person up and doing

again with both feet down and doing deadlifts and just the progress that way or

the principle, yeah. So the first thing that you do in the clinic is you observe and you go, a well-developed muscle, I always think Arnold Schwarzenegger, bodybuilder, right? There's muscles bulging outwards everywhere. But if you're seeing muscles go the other way and they're caving in, that's not a normal athletic muscle, right? It's atrophied. Then particularly, let's say we're talking glutes still, we've got these giant quads.

that are really athletic and they're bulging outwards and they look great. The glutes should match that. The hamstrings, the calf should match that in a lower limb athlete. But if you've got these giant quads and nothing else, you're going, on, something's not right here. Chances of doing full load quad is pretty high, but a full load glute might not be so high because it's not as well developed. So the first clue is just a visual look.

And then based on what you're seeing and maybe you've watched the walk, run or do some movements, they could have watched a one or a two legged squat. And there's a couple of tests. There's a squat test that we do clinically that you do about five of them on one leg and it gets graded according to whether you can hold your body straight, your hips straight, your knees straight, your shoulders straight. And it's a quick test and it says,

Glutes are highly likely to be a problem or glutes are low on the priority list. And we need fairly quick tests, because if we were testing every muscle ad nauseam, you'd be in the clinic forever, we'd never get to treating it. And suddenly you work out, okay, am I at a lower load? Which could be, I think of low load for gluteus lifting the weight of your leg, which is about 15 % body weight. So that's quite low. And it's not adequate for a runner.

or a cyclist for that matter, but you might be building some sets and reps. And then you go on to exactly what you're saying. Can I manage half my body weight on each leg? Like a two leg drill, like a squat or a glute bridge, hip thruster type thing. And then can I progress it up to one leg?

Mm-hmm

as you're talking about these glute exercises and probably they're a fundamental, it's a fundamental mover, fundamental muscle and whatnot that's in many of these sports that you specialize in, maybe with the exception of swimming. But some of the exercises that we've got in our Athletica platform, I think are on, they're on page in terms of

I are on page in terms of

assisting our athletes in achieving conditioning and those muscles. Are you familiar with seven-way hips?

assisting our athletes achieving the same goals.

Hmm.

Yeah, reasonably. I think they're more lifting the weight of the leg type exercises rather than body weight standing on your feet type exercise.

Mm-hmm.

Yeah,

are. Yeah. So would you say that's appropriate or not really appropriate in the context that you're talking about?

be totally appropriate. I think it comes back to the low match. So what I would look for in the clinic would be if we want, you know, this muscle to contract, does it contract well? Or is it sort of not at all? Or just half half? I want a strong contraction. So if they're doing that exercise, they put their hand on their hip muscle and they go, yeah, the correct muscles working good, then it's a good exercise for them.

don't think doing that exercise, putting the hand on the muscle and that, yeah, the correct muscles will be pulled down into good exercise for

Hmm.

them. And it's a big, problem for everyone. So some people are quite weak and have a lot of trouble getting muscles going. So what looks like a good muscle for one of us might actually be a good exercise for them. it's big problem for everyone. So it's just a question, but the hand on muscle is a good one for them to do it. is.

And it's a bit different for everyone. So some people are quite weak and have a lot of trouble getting muscles going. And so what looks like a good muscle for one of us might actually, a good exercise, sorry, may not be a good exercise for everyone. And so it's just a case of put your hand on the muscle. Is it doing what you want it to do? And if it is,

Mm-hmm.

excellent exercise. If it's not, or you're twisting your back because you can't move through the range of movement or that sort of thing, then probably not as good.

What are the primary risk factors for injuries in aging? Endurance athletes specifically like cyclists, triathletes, runners, swimmers.

How can they mitigate the risks?

you

Well,

the number one risk factor for injury across my whole time in the profession is have you done an injury before? So prior history of injury is number one. So if you've that hamstring before, that's a bigger risk factor than any other single thing we can throw at it. And then after that, the research waters are a little bit muddier because you've got to throw a blanket over an enormous number of athletes.

measure an enormous number of possible things like calf flexibility, calf strength, and so on and so forth. So to actually get a cut and dry answer on that is not easy. So consistent things that you could look for in yourself would be, is there areas of tightness or inflexibility like your calf? Or if you're a swimmer in your shoulders, you might notice that by, know, can I get my hands up and

I'm not very good at a streamlined position, but if a swimmer can't hit streamline, they're probably gonna struggle to swim well and they're gonna have a lot more pressure on shoulders, maybe their spine, maybe a higher injury risk. So you have to put it in the context. And I think to be certain, you have to be individual. There's plenty of stories of people making small changes in their technique, whether it's a runner or someone in a throwing sport that has helped with injury.

But yeah, I think contextually, look at strength is probably your number one thing. As you get older, you lose your strength quicker. It's harder to get it back. It's better to maintain it. And you're go a whole lot better if you can keep a certain level of strength. So that would be what I would look for.

David, what's the impact of stress and just, you know, stress in various different forms on injury occurrence? And I think he kind of answered it there with Paul. And I was kind of also like reflecting on my own major injuries. And the big one for me would be a skiing injury as an ACL, or I tore an ACL on a...

on a turn that I kind of couldn't pull out of. But it wasn't like, and you'd think, it's just, you know, at first glance, you think it's just the turning out and the conditions and whatnot that caused that. But if I'm to backtrack a little bit more, there were so many other confounders to that day. We started out at, you know, backcountry skiing at 4 a.m. in the morning. So we were tired. There was loads of stress going on in my own life, in my own world.

And a day or two before I had basically witnessed a class two avalanche that basically I just watched it kind of happen nearby. So psychologically I was very stressed in that moment. So there are all these various different factors that when it kind of came down to it, there was just so much stress in the body. And it wasn't just the turn kind of out of that. It was...

It was a turn plus all these other various different factors that actually caused the major massive injury to kind of, ultimately a massive mistake on my part that I really regret to this day kind of thing. So it's interesting how these injuries actually manifest sometimes, these big ones.

Yeah, you made me think when you're talking about that, a long time ago, they did a lot of research on when do you get injuries and fatigue, whether stress is creating the fatigue or cross-country skiing since 4am and there's different ways you can get fatigue, but most injuries happen at the start of a half or the end of a half if you're in a team sport, if you're at work at the start of the shift or the end of the shift. So in other words, before you're properly warmed up or when fatigue is setting in,

you're much more likely to get hurt. So it's probably a good reminder if you're doing higher risk things, maybe you're in the gym and you're lifting weights, a good warmup's important. Maybe if you're doing high intensity work, whichever format, particularly running, a good warmup is worthwhile so that you minimize the risk of injury at the start of your workout. And then if you're getting really fatigued, maybe you modify the workout. Do you put a bit more rest in? Do you shorten it? Do you go into a lower risk?

Thank

activity if you're worried about crashing or twisting your knee or whatever it might be. So I would look at it that way.

Yeah.

David, back to chronic pain. I interviewed, it was Scotty Livingston and Leave Your Mark podcast and the training science podcast we were speaking. And he's kind of this, he really talks a lot about the importance of our perception of threat in any one kind of condition. And I know we spoke on it briefly, I think in the training science podcast as well that we did.

But maybe I just find it so interesting if the general concept as I kind of understand is that somehow that brain, your brain is sometimes feeling threat because let's use my context where I've got an ACL injury. It's rehab now and I've had surgery and all that sort of things, but I've always sort of got that in there. even though it should all be good in there, there's this...

something in my brain that still can feel threat around the area. And I'm sure maybe others would know that as well or have that common experience. Do you want to riff on that at all?

I think the first thing is after a reconstruction like that. I've had a shoulder reconstruction many years ago and it's good surgery, did good rehab. It doesn't feel exactly the same. The architecture of your ligament that the tendon they put in is different to the ligament, all these little things and your brain at some level perceives that.

They're like for a shoulder in my context, going back here is quite a dangerous position. And so I've avoided that. And fortunately I wasn't in a throwing sport or something that required me to do that. But I would still avoid that to this day. I would know like a social context to be going swimming at the beach in Australia. And if you're catching a wave and you're surfing along and you get dumped, then you've got to pull your arm in because if my arm stays out, I would have that same sensation you're having.

I'm going show you my content stuff and here is quite a bad position. And so I've recorded that. Unfortunately I wasn't in front row school or something like that before I could do that. But I would still record that to this day and I would know. Social projects without swimming and fishing straight, catching the wave and surfing a lot. And you get dumped and you've got people right there.

of threat and insecurity. I think the way that you mitigate that is through your physical preparation. Like if you're doing good rehab and you're working on the muscle activation and you're side stepping and the various movements, if it's in a skiing context, maybe you're in a team sport context, you've got to sidestep. Maybe it's a collision sport where you've got to tackle people. You have to do quite a lot of rehab and you build the confidence step by step.

physical preparation, think you've learned the rehab and the working on muscle activation and the side step there and the various movements into the skin in terms of the you're going to do the sport, in terms of that side step, maybe to collisions or maybe to tackle people, you have to be more on the rehab and a little bit confident step by

step. And as you build the confidence, your perception of the training that you're doing and the confidence you're going to use, but it's not an overnight.

And as you build the confidence, your perception of threat goes down and you feel more confident doing more things, but it's not an overnight,

it's not what I call a light switch fix where you flick the light switch from on to off. It doesn't work that way. You've got to achieve it gradually and steadily. And that is very helpful. But I don't know that anyone says it feels perfect ever again. It feels a different knee, a new knee, but a good knee nonetheless.

Hmm.

Yeah.

So I wonder as we age and endurance athlete, we keep repeating the same motion. It's always this way, like running, know, biking, swimming. And our, especially like women in perimenopause, our ligaments start to become like old rubber bands, right? And if we don't like...

We forget to have fun. I see, this is with all my athletes. We forget to have fun and we just focus on this motion. We never go this way. We don't climb or balance, you know, balance. So I'm always trying to get my athletes to play a little because I've noticed in my own body that I get stiffer and stiffer every year.

Yeah.

I'm really glad

you brought this up. I think for runners, was that a conference? was a sports podiatry conference probably a decade ago. And it was a bit, it was a great conference because it was quite informal and there was quite a lot of round table discussion. And one of the things that came up on running in particular was statistically speaking in the research, it is safer to play rugby league or rugby union. You get less injured than if you're a runner and we're all going.

Wow.

I don't believe that. just cannot for the life of me understand how that's possible. pretty much every study said the most injured group on the planet was endurance or long distance runners. And we got thinking about this for a long while. And I think someone hit the nail on the head when they said, and it's the one word answer, what do runners do? Run. Just flexion, extension, front, back. There is no rotation. There is no lateral movement.

Yeah.

Most of us runners won't do technical skills work because running fast and running well is a really high skill activity. And if I pop my coach's hat on and you guys can correct me if I'm wrong here, but the three determinants of performance of VO2 max, the threshold or critical power or fractional utilization, whatever word you want to call it. And what's the third one? Economy.

Mm-hmm.

economy.

Now economy, we know in running, if you're running faster, you hit the ground harder and you spend less time on the ground. If your foot spent more time on the ground, you'd be going slower, wouldn't you? you've got this, if you're going to go faster, you're to have to hit the ground harder, which is more force, which is a strength thing. And if you're doing it faster, that's a power thing. know, strength by speed is power. So if you're not doing some strength training and you're training those attributes,

and your economy is also the technique. Am I efficient in my running movement? Am I getting my arms working right? All of that. I think it's unrealistic as a runner to go, well, out of the three big things that are going to help me, I'm just going to cross one off the list. I'm never going to do that stuff.

Yeah, I noticed when I did the ultra and it was very like there was twists and turns and it was like whole body workout. Like I was sore in my upper body. I'm like, what? But we forget to train like, athleticism and agility like we were when we were younger and how we coach younger athletes. When we turn like 40, it's downhill, but we just keep like singular minded thinking about VOGMAX, VOGMAX.

Bye.

You know, and I think we're missing the point there. we weren't like, especially after 40, we need to play and challenge our agility and ability to move so that we don't grow old and slow. That's my theory anyways.

part of the all-round athletic development. It's not just one bit that you're doing. You're trying to be a reasonable all-round athlete, even if you don't need to be the fastest side-stepper in the world to run marathons, a little bit is a good thing.

Yeah.

Yeah. And if I can, sorry to put my athletic hat on, it's been on the whole time, but the, basically the, the strength and conditioning sessions that we stock talked in there, just to David's point with the importance of running economy, you know, we've got like jump landing, that's in there side hops, side to side, forward and back. And we do try to have at least, you know, hitting your, your plyometric exercise, twice per week in the gym.

And then even like, we call it a strength endurance session on the run, but the idea being that you want to run up and down hills because you get some of that stretch startening cycling, you know, from the muscle contraction going on more so than just like a flat run kind of kind of run and whatnot. just to kind of like, yeah, just to say we're, we're athletic users, listeners.

We're trying to tick that box that David just mentioned.

And you can add those ABCs and little drills as you're running warm up, like walk a little and then do some skips and then you run if you want to save some time.

Mm-hmm.

I was gonna say the warmup is a really rich place to put in something you need to work on. So if you've got a running technique issue, maybe it's your swing phase drive and you're doing those A-skips, do them in your warmup for your run. If you are doing some rehab on a particular injury and there's some key exercises, maybe it's for your calf muscle, do them at the start and use it as part of your warmup and get it in there and then do your run.

or do you ride or you swim? It's a really good spot that doesn't cost you time. You're gonna warm up anyway. Why not use it to work on that economy aspect? Because you're doing it anyhow. You may as well do it with a purpose.

Yeah,

yeah and I think if you pay attention how your body feels, once you start doing those warm-ups you notice how your technique actually is so much more efficient, like you're running, it feels better.

It's like a primer.

Yeah, totally.

driving

the movement pattern you're seeking to improve on. Even if it fatigues over the course of the run, hopefully you can hold it bit longer next time and a bit longer next week until it becomes stored in the central computer up here.

Mm-hmm.

Mm-hmm. found that I've been thinking also about your thoughts here, David, and I'm kind of reflecting back to another podcast that I did a long while back, a training science podcast with Professor Peter Wayan, and he's kind of like the godfather of the anaerobic speed and power reserve. And when he was on the podcast, he likened almost like the, I guess, the run connection phase to

Like similar to like Muhammad Ali when he's hitting a competitor as a punch, right? It's like you're making a punch to the ground. And it's actually that connection. You actually don't have to be like the, you know, a George Foreman kind of thing. You can be that way with just like super powerful and whatnot with lots of muscle mass behind. But you can actually be a little bit more like Muhammad Ali and like, you know, was it?

moves like a butterfly and stings like a bee. And it's like, actually like Carl Lewis was notorious for this. Peter Wan was saying he actually wasn't that strong in the gym. In fact, you'd be amazed at how weak he was. Of course, he was the first guy under 10 seconds for the 100. What he perfected was what you're kind of describing with his technique and how he

Thank

laid a punch to the ground with his lower limbs and that was what kind of made him so effective and so efficient, so economical. And that's what we kind of, we want to work towards that if we want to be amazing runners.

You know, David and Paul, when you guys were discussing on Paul's podcast about some of the chronic pain and you talked about, and I'm going to forget what it's exactly, but you talked about a hip situation and I have a athlete that I work with who has had a niggle in her hip, has had pain and she kept ignoring it and now it's a chronic pain situation and it's debilitating and it's

and see if he's an athlete or a professional. You talked about a hip situation, and I have an athlete that I work with who has had a niggle with her hip, has had pain in her so you have to go around and find a pain situation and set it up for her to get it

done. Some of those non-specific pain issues, which I've

One of those non-specific pains, there's nothing

in the MRI or X-ray that shows up. You two talked about something perhaps with fascia and what are your next steps with this kind of athlete? I what do you do? Do you start manipulating? I mean, how do you go from a niggle that's now a pain to

fixing that and there's nothing specific there.

And maybe start, David, I loved how you described fascia. Tell everyone what fascia is first and then get to Paul's question. Yeah, because it's an interesting one. Not everyone would know about it.

Good. Good.

The fascia is a really interesting structure and it envelops everything in the body. So the easiest way that everyone will know is if you've got a joint of roast beef that you're gonna cook for dinner, it's the white shiny stuff around the red meat is one type of fascia. So everyone's got that picture in their mind. So every muscle in the body is covered in fascia, every artery, nerve, lymphatic.

or venous vessel, even your bones have a covering around them. So it pretty much covers everything. And if you look at it on that joint of roast beef, everything's interconnected. So all of this fascia interconnects through the body. And like every structure in the body, there are nerve receptors in the fascia that sense what's going on because that's how our body gets the feedback to adapt. So if we want to run and we want things to get stronger, we need a way of sensing that input.

that impact load, the stretch, the contraction, whatever it is. And one of the ways, you know, in that neuromuscular system is the sensory receptors. And that might potentially give us a way of saying, hey, we need to upregulate this to make it stronger, better bone density, thicker tendon, whatever it might be. Now, within the fascia is a structure called the fibroblast. It's a little cell that makes the white.

collagen fibers that you saw on the roast meat. And those fibroblasts have been shown to respond to mechanical stretch, like stretching things. So if you put load into that fascial structure around the artery, the nerve, the muscle, whatever structure it is, they're gonna detect what's going on. So one of the ways that this could go wrong in terms of developing pain in a hip,

And there's probably a chronic load thing, which would be a postural overload of that fashion. Or maybe they're on the bike and their handlebars are too low and their torso is coming down and closing the hip angle up and it's pinching at the front. So it's a repetitive motion thing. Or it might've been, we jerked our hip in some sort of movement. Like instead of twisting the knee when Paul was skiing, or maybe you slipped on wet ground, you twisted the hip a little bit.

And those cells sensed it and they went, bang, I've got to protect whatever it is I thought was getting injured, the muscle, the joint, the nerve, whatever it was. And so they convert to what's called a myofibroblast, which introduces tension in that fascia. And that traps inflammatory cytokines, which are the chemicals that cause inflammation. And if nothing gets those cells to relax and the fascia to relax, that keeps the inflammatory cytokines there,

gets us ourselves to relax in the question of the last that came to people that we can solve and to

pitch to us in the question. And that's not as political or political as be. That's what our opinion states until there's something to the question of ourselves to let you know and allow the structures, whatever is the word, the muscle in the question, to let about it. So that is what serenity in question.

perpetuates the inflammation. And that's known as peripherally maintained pain. That's why the niggle stays until we do something to get the fascia and those cells to let go and allow the structures, whatever it is, the nerve, the muscle, the fascia to move better so that it's not surrounded in inflammation.

That is a really hard concept. It's about a 28 page paper I've tried to summarize. hope it makes sense. It's a tough one to get your head around.

Heh.

But imagine that you just can't get the inflammatory chemicals out once things are locked. Most of my patients will say, I've locked it up. I've locked my neck up. I've locked my back up, my hip up, whatever it is. And people, that's that tightness we talking about before, Marjaana, something's not quite right. It may not hurt yet. But if I keep loading that structure, one of two things happens. Either it does get sore or I compensate for it higher up the kinetic chain and I start locking other stuff up. And the last thing left moving starts hurting.

So the diagnostics for that, I'm assuming cyclist Paul would be, know, is it a bike fit issue or is it the rider? And then if it's the rider, where in the kinetic chain is locked up? So the sort of thing that we do now is we would motion test everything, obviously the hip and the lower extremity, but we might look at all of the different spinal levels from the top of the head down to the tip of the tailbone and go, what's locked up? Because if you're sitting on a bike and you're sitting crooked,

because my neck's crooked, maybe my shoulders are that way and my hips are that way and it's down the chain that's the problem. And I won't know that until you have a look and you go, maybe you get in there and you go, it's just L3, L4, that innovation area of the hips, problem, but maybe it's not, maybe they're under load from elsewhere. And so it just depends where the restriction is. And then you go, okay, if it is L3, four, is it sympathetic nerve or is L3, four locked up because the hips irritated and the labrum.

reacted or the hip flexor reacted. And so you're just looking at what are all those possibilities and trying to problem solve it. And typically with the more chronic pain, if it's one of these, I've just locked myself up. There's a whole list of them. You your body handles one little thing pretty good, but if you've got 20, 50, a hundred things, my term for it is death by a thousand paper cuts.

One paper cut's not a big problem, but after a thousand of them, you start bleating out and you've got a problem. And most people get that. So you're looking for these little things and trying to work out what's the most primary, what's secondary. And you treat the primary ones as best you can tell first. And we've got some ways of doing or testing for that now that we didn't have 10 years ago. And we're starting to develop that. Is it perfect yet? Probably not, but it's better than it was and it's getting better all the time.

you

Thank

you.

So David, you know, we've talked a lot about manipulation. We've talked about a lot about things that you do as a

What about strength training? Is it better to, to strength train specifically for a sport, for the movements of a sport, or is it better to do a full body kind of workout or kind of a combination of what

in order to prevent injury.

I think there's a little bit of a training history or age dependence there. So with young athletes, I always think long-term athlete development, all-round athlete, and that takes a couple of years in the gym, just very gently learning how to move and allowing particularly adolescents, their bones and their discs and tendons to tolerate that load and adapt. So you don't need to do anything heavy when they start. If you've got a big...

training history behind you and lots of years in the gym, you might be doing it somewhat differently. A lot of the strength coaches where I work anyway will say it's about a 10-year process to build a great athlete in the gym and from there on in its maintenance. if you started when you're 15 and you've done a couple of years of adapting and you're probably reaching a peak maybe when you say mid-20s, after that they're often lifting to maintain that.

rather than, I mean, the sky's not the limit. You just can't keep going to infinity and beyond with these things. So what you may need to do in the gym might be a little bit different. In terms of sports specific, I don't particularly like sports specific straight up. And Marjaana was already talking about that. Just running flex extend, flex extend, same with cycling. You lose all of this stuff laterally or rotational wise. you're a lower body athlete, you only lift your lower body.

the top half of his way, and the other side, the top and the bottom. I'm not saying the top half has to be amazing as a runner, but the bottom half, and the front, and the rear, and the side. So I would intend to still be talking about an overall comment, advice, and I'll be talking about your runner and a cyclist, and the torture arms, but I think it's probably the most important part of the value, which is probably...

the top half withers away and we got this imbalance between the top and the bottom. I'm not saying your top half has to be amazing as a runner compared to your bottom half, but I think you need a little bit of something. So I would tend to steer you towards a little bit more of an overall program. The bias might be towards your legs if you're a runner and a cyclist rather than towards your arms, but I think totally neglecting half of your body in the gyms probably, first of all,

you're not going to able to squat very well without

some strength in your back and shoulders, right? And it's going to ultimately impair that sport specific, but your bias might be a bit different because your context is specific to lower body rather than say an upper body sport like shotputting

Thank

If you could give one piece of advice to an aging endurance athlete who is worried about injury, what would it be?

Don't just run.

Yeah.

Thanks

A little bit of technique work in your warmup maybe, a little bit of strength work. Do things that aren't just legs, flexion, extension. Do some other stuff. Have some fun with it and embrace the variety and you'll probably find you'll go a lot better. You'll be a little punchier, a little quicker, a little less injured, having a good time. It's not gonna harm your performance one bit. It's probably actually gonna help.

Well, David, thank you so much for joining us tonight. We really appreciate your time.

Thank

Thank you for having me. I

really appreciate it.

That is all for this week. Join us next week on the Athletes Compass podcast. Ask your training questions in the comments or on our social media. When you finish this episode and love it, we appreciate it when you take a moment to give us a five-star review. For more information or to schedule a consultation with Paul, Marjaana or myself, check the links in the show notes. For David Wadsworth, Marjaana Rakai and Dr. Paul Laursen

I'm Paul Warloski and this has been the Athletes Compass Podcast. Thank you so much for listening.