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Eoin Everard is a physiotherapist with a PhD in biomechanics, and is a sub-4 minute miler and two-time Irish 1500 m national champion. In this interview we discuss staying injury-free in running and triathlon, biomechanics, and training interventions to improve running performance.
In this Episode you'll learn about:
- Injury prevention strategies for runners and triathletes
- Why triathletes typically experience tendon and joint injuries, and rarely muscle tears
- How to work with a physiotherapist, including how to find the right physiotherapist for you
- Running biomechanics, and whether you should focus on improving your running form
- How to include plyometrics and strength training into a triathlon training program
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- I am a physiotherapist in Ireland with a PhD in mechanics and the relationship between movement analysis and injury.
- I develop a wearable device that gives us awareness of our back position for exercising correctly.
- I also do lectures in Ireland.
- I ran at a national level for 20 years from a running background. I won national championships five times, and I ran for Ireland over ten times in disciplines like the 1500m to 10000m cross country European Championships in Lisbon.
- Then, I ran a sub. 4-min mile and sub. 8-min 3000 m and sub. 14-min for 5000 m.
Triathletes' trend of getting running injuries
- If you compare a triathlete to an athlete practising other sports, they do not get muscle tears. (Rarely happens)
- Therefore, we have hints for why triathletes get injured. We extend our muscles to the passive structures of the body (e.g. Achilles, knee, hip…).
- There are essentially three types of systems that help us take the load. The first is the passive system: ligaments, tendons or joints. The second is the active system, which is the muscular system. (Muscles take most of the load). The last is the control system, which is the nervous system making the muscles switch on at the right time and making sure we have good mechanics.
- As triathletes and runners run in a small range of motion, the muscle can get lazy.
- Therefore, we overload the passive structures of the body because the muscles are not doing their share of work. So, two aspects allow the injuries to occur. The first is the lack of variety because the same movement patterns lead to the same tissues being loaded. The second is the inactivity of the muscular system, which means the passive system gets overloaded and causes breakdown.
Preventing passive system injuries
- The first step would be variation. I think coaches like the Scientific Triathlon are crucial to getting the most out of your physiology and training and from an injury perspective.
- People who do not have a coach tend to revert to the same training type. Novice triathletes might always do the same thing, so the same tissue gets overloaded, and the range of motion is also the same.
- Therefore, you must add some variety to your training (threshold, changes in surfaces, shoes and doing running strides)
- I like uphill strides on a slight incline. I recommend those because they increase the range of motion of the strides. Joints are like oil fluid that, by moving it through the range of motion and lengthening the muscles, allows the joint to move healthy.
Activation of the muscle system
- The second aspect is that our muscle system is lazy, so you need to wake it up. And you do that by strengthening the muscles.
- Sports pilates or gym work is where you can work well the muscles. Athletes should not be afraid of heavy lifts or feeling the muscles burn.
- It might be a shock for triathletes initially because they do not go to the gym often.
- We sit 8-10 hours per day, so it will take more than a 30s stretch to rebalance your body.
- I do Pilates once per week, but it takes 20 minutes of Pilates to start working the muscles correctly. You have to wake these things up. They are lazy because we sit much of our time.
- Therefore, it is not a stretch that will wake up the body.
- If you do a proper warm-up, your stabilizers will be much more activated, so they will be ready to take the load.
- All injuries that triathletes have come from passive system overload. (SIE joint problem that causes the muscle to get overloaded and get strained)
- The first exercise I would do to wake up the muscles is the single-leg deadlift. You stand on one leg while slightly bending the knee we are standing on, and you bring the other leg back as far as you can.
- You want to keep the lifted leg aligned with your body. The crucial mistake I see is that you have to start lowering the body when the back leg starts lifting. Initially, you might be only 10/20º from a vertical stand, but that is ok, and it is better than people folding their back, and they will not doing the movement correctly.
- The single-leg deadlift works all the posterior chain muscles that tend to weaken. Moreover, it works on balance and in that standing position.
- I would do sets of 10 reps. And you should feel the muscles burning and stop when you cannot do much more repetitions.
- Anyone with calf, chin and Achilles injuries should do this as the primary exercise.
- Many people do calf raises, which are acceptable in specific cases but the calf because of the range of motion, the calf gets overloaded.
- We often strengthen and overload this area rather than looking at other areas to take the load of that area.
- People might do excessive squats or lunges, but make sure the other chain parts are substantial.
- For swimming, the horizontal lying shoulder abduction, and I could do a video explaining these exercises to people.
- You lie on your stomach and lift the upper back, get your elbows to the side, bring your arms down, and then back up. This movement achieved two crucial points: an extension of the upper back because we are sitting on a desk for an extended period. Therefore, if you do much front crawl, you want to do something that rebalances the body.
- People tend to squeeze the shoulder blades together. However, you should never do that. Bring your elbows to the side as you try to lift the upper back. You do not want to squeeze the shoulders together because a muscle called the rhomboid will be overloaded with that movement.
- When your front crawl, it is crucial that the shoulder blade can move up and down. If you squeeze the shoulders together, they will stick in that position, making the front crawl position harder, causing impingement in the shoulder. So, bring your shoulders to the side, allowing you to activate the right muscles while lifting the upper back.
- The last set of exercises is focused on the core and glutes. In these exercises, we should try to maintain a neutral spine to activate the muscles correctly.
- If people do these exercises twice per week, it would be a massive start and making them until the muscles start to burn.
- The onset of muscle soreness will go away quickly, and the niggles will disappear.
- The last factor would be appropriate load. Do not increase volume by more than 10 % per week if you are in a building phase.
- Then, every fourth week drop the load back to the beginning load.
- Once you achieve a considerable load, we find an acute training load ratio, which looks at your fitness level.
- It is the sudden spikes in muscle load in training that cause injury (more than how much you are doing)
- I mentioned the importance of strides to keep the variety. (running slow, at the threshold, uphill, with strides)
- It helps the joints biomechanically, but it also helps to keep strides or speed work in your block phase. Getting your legs turning is essential if you do a training block of longer spins or cycles.
- If you are in a volume training block, adding 5x200m at a 1500/3000 m pace before or the day after a training session does not take much.
- This approach improves the running economy because you are running quicker, even if that is not the main focus of the training. When you transition to track sessions, you will have the neuromuscular speed of those strides.
- The problem is that most athletes do not do much speed over the winter and try to start doing this as soon as they transition to track workouts.
- It is similar to preparing for Olympic distance triathletes, where you do much more running sessions that are interval based. It does take a lot before the training session starts to do one mile or five minutes at a threshold pace. It will feel slow.
- But then again, it keeps your top aerobic base and keeps your body used to those efforts. And if you are doing your intervals, do not reduce the long run, especially when you are in their peak phase.
- When you transition back from a phase where you have not done much volume, you try to return to the average volume, where things start to break down.
- Therefore, we must keep all the elements we need in the program because it is the sudden spikes in volume/intensity where you are most vulnerable to injury.
- Therefore, having variation in your program's training and strength training will help prevent injuries.
- Then, it is about doing a bit of everything consistently during different training blocks.
- It is not like you have to sacrifice performance to avoid getting injured, but these work hand in hand.
The use of standing desks to avoid sitting all the time
- The most important thing is about changing positions. For every hour you sit, you should be standing for one minute. Therefore, if there is a time when you cannot stand for some reason, you need to stand up and move for 2 minutes after two hours.
- Therefore, if you have a standing desk, sit sometimes to change the position. However, when you are standing, you are activating the muscles more.
- Sit fully back into the chair with your hip as far as possible if you are sitting. Then, grab a towel and put it under the arch of your back. That will help to keep your curve in the proper position.
- People often sit outside of the chair and will naturally recline back into the chair, harming your back and pelvis and causing issues.
Pre-run activation exercises before the run
- People often ask me when it is the best time to do it. There are some benefits to doing some foam rolling before.
- If you are a professional, do some foam rolling around your glutes and hips, and then perform some activation with your glutes with single-leg deadlifts.
- For most of us, at least once a week, try to do some kind of strength training or Pilates type of work. If you can do single leg deadlifts for 30-40 s before going out for a run, it will help.
- However, when I give people the exercise time, people find it hard to do it. Therefore, do it whenever you can.
The volume of the activation exercises
- Assemble a small routine, and you can use bands to make it more challenging. For example, do the back exercise for a minute and repeat it three times. If we accumulate three minutes of that, the muscles will be burning.
- Strength training is a different type of fatigue. I am not expecting people to sweat or suffer, but it is more to experience this different stimulus.
Weekly strength training plan
- The elite runners do the strength training on the same day as the more demanding workouts.
- I worked with the Australian team, and they will do the session in the morning, the gym workout in the afternoon and an easy run in the evening.
- The idea is that you are taxing your nervous system, so you want to tax your nervous system on one day and a more leisurely swim/cycle on the next day.
- Therefore, when you have your hard session, you also do the gym workout on that day.
- If time is a factor for general people, I will do the pilates/gym work after a long run.
- In that way, I would have the other days to recover and not be overloaded with time management between work and training.
- Once you get to a specific level where you have done this for 6-8 weeks, I will not look at massive performance improvements from the gym. I will look into that in a way that helps me prevent injury and keeps me at a general good strength level, and training will bring performance improvements.
- As a physio, I regularly see that athletes are motivated to do this work but do not have the time to do it. Therefore, commit to something you can do consistently.
Additional points on injury prevention we have to consider
- It is only about injury prevention, as these interventions also improve running economy and efficiency for performance.
- Moreover, we have to look at what we can handle concerning load. If you start plyometrics, it can be hard to support initiatives.
- There is a study that looked at skipping. People would skip three to five minutes two to five times per week, and the other group would do additional running in that time.
- People who skipped improved their plyometrics performance: drop jump, countermovement jump, and joint stiffness over a specific period.
- They also did a 3 km time trial and improved performance by 3 %. The people who did only running improved by just 1.5 %.
- People that do hops or landings, especially with poor technique, can have a higher risk of injuries.
- However, skipping is a self-limiting exercise. It means that you cannot skip more than what you can. Therefore, I recommend people have a rope in the car, perform a warm-up again, grab the rope and do three minutes of skipping on an easy day when I finish a run.
- I take a recovery after a minute.
- People cannot even go over the rope 20 times because you hit the rope if you cannot hold it.
- If people do not have coordination, you might not keep their joints stiff as you should.
- It is a stop-limiting exercise because it stops you from doing it incorrectly.
- People who start doing it constantly improve efficiency over 3-4 weeks.
- Skipping is a different way of adding gym plyometric work to training and improving that training variation.
- Many athletes are "functionally dysfunctional". If they do swimming, running and cycling, they do it properly. If they do any other kind of exercise, they might get injured. Even with stride, I do not recommend doing it at 100 %. Strides are more to keep the fast twist fibres moving and range of motion. It should never feel hard and make things worse.
- Skipping is a good exercise because it allows you to do it safely. You do not want to get injured from supplementary training.
- We cannot forget that we get better with swimming, cycling and running. These are things that complement that.
- However, sometimes you can go over the amount of strength training we do. But in these exercises, we have to focus on achieving the minimal effective dose and avoid going beyond it.
- Therefore, we have to progress and overload until a certain point, where we will only maintain that level of volume and intensity.
Focusing on running form and biomechanics
- People should not focus on stride. There was a study from 2018 that divided athletes into two groups: one focused on running mechanics and another focused on their breathing. The last group were only watching TV.
- People only watching TV had better running efficiency than the other two groups.
- This observation also happens in golf, where athletes have better performance if they focus on looking far than on the golf technique. Once you take the focus from their heads, you perform better.
- Your subconscious is much more powerful than your conscious brain.
- Your body has evolved not to overthink while running. If you think about running better than you can, it is a recipe for disaster.
- For example, runners try to run with their heels raised to copy the best athletes in the world that run naturally like that, but they end up with Achilles problems.
- There is probably a reason if you do not have a perfect stride.
- Therefore, people have to work on the building blocks so much more.
- The first block is good mobility. If you cannot move through your knee or hip joint, it is almost impossible to move correctly when you run.
- So, you need to focus on getting movement better.
- There is a joint-by-joint approach where some are mobile, and others are stable.
- The joints that should have good mobility are the ankle, hip and upper back.
- If you focus on mobility, focus on these points.
- If mobility is good, stability and activation of the crucial muscles is the next block. (Hips, glutes and core) The reason is to get a good balance.
- Therefore, we should aim to build core strength in the posterior chain.
- If you cannot hold basic stability exercises, there is no possibility of holding a good running form.
- Give the body the tools, and your body will use them.
- The last thing is technique. We do some running drills (A and B skips; strides with barbel over the head and keep the bar solid. And this helps all your essential muscles to activate.
- You can work on your stride, but once you start running, do not try to change something when you are running. The most you can do is keep your head steady and focus on looking ahead because that is something you should naturally do.
- Another thing you can do is run barefoot, but do not overdo it.
- In the end, athletes need to trust their body that it will self-optimize with the complementary work. (building the blocks)
- For example, I had a sprinter with a hamstring tear, and he was out for six weeks, but when he got back running, his coach came to me, and he asked what I had to do.
- They had been working on drills for two years, and they had been doing the same things wrong, and after the comeback, the performance was completely different.
- The problem is that they would only focus on the technique without checking the building blocks first. Therefore, he could not do the basic things correctly.
- First, we have to focus on proper movement. And it is what we were talking about the range of motion and technique. Therefore, you want to analyze yourself to understand your starting point.
- Testing your squat or hinge is a good way of accessing if the movement is a limitation.
- Here you focus on yoga and Pilates, and later we focus on your technique to build that foundation.
- The next level is work capacity. (anatomically adaptation)
- That is the ability to tolerate load. You have to prepare yourself for the type of work you will do in the gym.
- With more circuit-type training, you would still do a decent amount of reps (10-20) with some weight. (e.g. I might do a kettlebell swing if I have an excellent hinge to do 20 reps with 20 kgs).
- You could do a split squat (a lunge essentially), holding a 10-20 kg in the hands and doing 15 reps on both sides.
- We do not need much recovery because we go from one exercise to another.
- The goal of these two levels is generally injury prevention. In a session, you have all of these elements in a program.
- The only difference will be the time you will spend on each element.
- The next level is maximum strength. It is the ability to generate force.
- A car will never drive fast if it does not have enough horsepower.
- A 1L car will never beat a 3L car, even if it is efficient. Therefore, maximum strength will help activate the muscle, and it would be the next layer to work on if we were building an athlete from the ground up.
- Once you have maximum strength, we work on strength speed (power endurance), focusing more on the strength element than the speed.
- Olympic lifts and heavy sledges (pushing a sledge or a car) are good exercises to do in this phase.
- Then, we focus on speed-strength, where the emphasis is on speed rather than strength. Focus on how quickly we do the exercise instead of how much we lift. (Lighter sledges or jumps (squat jumps)
- After, you would get to the plyometrics and then speed.
- However, all elements should have these things on them, and then you say which ones you will focus on during training. At the gym, I would focus predominantly on work capacity. It will help stimulate your hormone production, testosterone, especially for endurance events.
- 50 % of the program might on focusing on this aspect.
- I work in blocks. One block is power (strength speed or speed-strength), B-block is maximum strength; C and D blocks would be work capacity depending on how much you need.
- E-block is movement. Every program should have something in each block. So, if I focus on work capacity, I might have an Olympic lift technique or a sledge. Then I would have a vital element (heavy squat or deadlift). If the work capacity is the goal, I could have three exercises in the C block and 3 in the D block. (20 kettlebell swings, inverse roles, split squats, and push-ups)
- A pushing exercise, a pull exercise, a knee-dominant exercise and a hinge exercise in the kettlebell swings.
- The E-block would have some core work and bodyweight exercises.
Strength training periodization
- If we focus on gym performance, we do endurance strength and work capacity during the pre-season. Late pre-season would focus more on work capacity and maximum strength.
- During pre-competition, we focus on maximum strength and power. Instead of 4-6 exercises in the work capacity blocks, they might only do 2-3 exercises or focus more time on strength work (40 % of the time) and power blocks (30-40 % of the time).
- We focus 10 % of the time on power during the early season and 10-20 % on maximum strength, whereas we would spend 50 % of the time on work capacity and 30 % on strength during the late season. We would focus 10 % on work capacity during pre-competition and 10 % on movement.
- In this way, we can express this work in terms of speed or power.
How to work with a physiotherapist
- My experience as a physio and a runner has taught me that you will always find a weak spot if you have a severe injury.
- Therefore, you need to have a management system.
- I was out for 20 weeks due to a hip injury. I know that the hip can get tight if I do a more challenging workout. However, if I do some Pilates and hockey ball work on the zone, I might have to go to my physio.
- As an elite athlete, I would go to the physio at least once a week to maintain my body.
- We work as a car, so we need to service our bodies.
- If you are not seeing improvements in niggles for three weeks while working with a physio, start looking for another one.
- Sometimes, the injury might not suit a specific physio, but it can be great with other ones.
- If there is no management system developed where you do not receive exercises to do, it would be a red flag for me that the physio is not trying to prevent issues from happening.
- Of course, some athletes/people do not want to do exercises and only want to visit a physio to ensure no problems are developing.
Looking for a physio
- Maybe check reviews on a particular topic. For example, I only work with the lower back and legs. I am not good with shoulders. Therefore, I get more reviews on that type of work.
- Physios specialize in specific areas, so you have to look for the best options.
- Moreover, some athletes might know the best physios for specific issues.
Reluctance to see a physio
- It is a massive problem because you will not have to listen to the screams if you listen to the whispers. An excellent example of this is knee pain.
- This problem is often the knee cap being slightly tilted outwards, and it grinds the femur and the bone underneath.
- If a triathlete comes to me, we can release the muscles on the outside, give an exercise, and that problem will go away.
- I have seen people dealing with that pain for more than a year. However, the joint has gotten ground, so you now hurt the cartilage underneath the knee cap. (which is much harder to fix)
- It is not customary to have this type of pain if you train a lot.
- If you had a car, you would not drive that car up and down the country without servicing the car.
- Therefore, I would strongly recommend people to get an appointment with a physio or get a massage and make sure everything is ok.
Takeaways from this discussion
- The first is to remember that the passive structures get injured.
- Therefore, we want to activate those muscles with the gym or sports Pilates.
- Secondly, a well-structured program adds variety and avoids overloading a particular spot.
- So, having strides and some skipping combined with good training plans are good examples of things you can implement to address this topic.
- I have had a coach for years, and we can train the same amount correctly or wrongly, and my time is precious.
- If you are doing strength training, look over the blocks and include each element in training. However, focus on the ones you want.
Run training tips
- The Lydiard model where we do endurance work during summer is something I believe is worth it.
- I believe the Norwegian success comes from this approach to training, where they add more endurance work during this period, while others focus only on short, high-intensity efforts.
- I was lucky with good groups, and they do those consistent sessions. They do not do special sessions, but they can do consistent hard training daily.
- Moreover, do not limit yourself until you have tried something within reason. People said I should not train with my actual coach, and I started training with him. And he did not prescribe hard sessions, but the consistency of hard sessions was tremendous.
- For example, Australians apply these strategies as well.
- People below you think those training sessions do not work because they are too complicated.
- Therefore, sometimes look at what people from the next level are doing and try and see if you can manage it.
- You may break down, but you may see more potential than you thought.
Rapid fire questions
What is your favourite book, blog or resource?
I do not have a favourite book, but I like podcasts like this one. However, a book that helped me much was Awareness: The Perils and Opportunities of Reality by Anthony de Mello, J. Francis Stroud. It gave me a better perspective on life.
What is an important habit that benefited athletically, professionally or personally?
Discipline. Doing the little things correctly is something that I benefited from during my career. For example, people say they do not have time for naps, but you can arrange meals differently and get time to sleep during the afternoon. You need to have the discipline to sleep on the bed instead of scrolling on the phone, where you lose 10 minutes.
Who is someone you have looked up to or who has inspired you?
Coaches have made a significant impact on my life. I ran competitively since my teen years, and my coaches gave good perspectives on how hard we needed to train rather than training hard only one time. (Importance of consistency over time)
LINKS AND RESOURCES:
- Eoin's website, Instagram and ResearchGate
- Eoin's book (free): Get to the line in the best shape possible
- Video: Key exercises for triathletes and runners to stay injury free
- Eoin's physiotherapy clinic website
- Back Aware Belt website
- Injury prevention and rehabilitation with James Debenham, PhD | EP#209
- Injury prevention and recovery methods for triathletes with Nate Koch | EP#114
- Jump-Rope Training: Improved 3-km Time-Trial Performance in Endurance Runners via Enhanced Lower-Limb Reactivity and Foot-Arch Stiffness - García-Pinillos et al. 2020