Shownotes

Matt's background

02:06 -

• I’m a physical therapist based in Maryland, USA, with a strong background in treating distance runners, but my expertise extends beyond that. I work with a range of active individuals, including triathletes and CrossFit athletes—essentially, anyone who wants to keep moving and stay pain-free.
• My journey into physical therapy was very personal. I started my practice about five or six years ago, initially focusing exclusively on runners. That decision was driven by my own experience as a competitive runner in track and field and cross-country.
• During my sophomore year of college, I hit a breaking point. I was constantly dealing with knee pain and severe back issues to the point where I had to stop running.
• That was a pivotal moment for me—it wasn’t just about my own frustration but also the realisation that injuries can completely change an athlete’s trajectory. I became deeply motivated to understand why these issues happen and how they can be prevented or treated effectively.
• That’s what led me to specialise in working with runners and endurance athletes. I know firsthand what it’s like to deal with persistent injuries, and that experience helps me connect with my patients on a deeper level.
• At the time I had to stop running, I was still an undergraduate studying Exercise Science and Sport Studies.
• It was a broad degree focused on fitness, which I saw as a natural stepping stone towards physical therapy. I already had a strong interest in the field, so I spent a lot of time shadowing physical therapists, as required for admission into PT school.
• Those shadowing experiences were eye-opening. Some clinics were incredible, using progressive and individualised approaches that truly helped people regain function. Others, however, were frustratingly generic—patients were placed on a stationary bike, given a heat pack, and told to do a few basic exercises without much thought to their specific needs.
• That was an important realisation for me. I saw both the potential of physical therapy when done correctly and the limitations when dictated by insurance constraints or overly standardised approaches.
• I personally experienced PT that didn’t work for me, but I also knew it could work if applied properly. That’s why I was determined to build a practice where I could focus on active people—runners, triathletes, and those who simply want to stay fit—by addressing the real issues, not just checking off boxes in a generic rehab programme.
• For me, effective physical therapy goes beyond just pain relief; it involves analysing biomechanics, improving strength, addressing mobility, and making sure people can continue doing what they love without chronic setbacks.

How Matt overcame his injuries

06:38 -

• Back in college, I had to stop running after my sophomore year, and it was a really tough time for me. I was extremely lean, and we had just finished the Division III cross-country regionals, where I had a terrible race—my knees flared up, my back was in pain, and I just couldn't perform.
• That marked the beginning of a long period away from running. I took a full year off, and since I completed my undergraduate degree in just three years while also doing three years of grad school, I essentially went four years without much running.
• Even after that, when I tried to get back into it, my knees would start hurting after just two miles, making it impossible to train properly.
• I’ve seen this happen to many runners—people who were phenomenal in high school, running 15-minute 5Ks, only to burn out completely in college.
• It’s not just me; it’s a common issue in the running community. For me, the turning point came when I started focusing on mobility. I followed a physical therapist who provided a lot of useful mobility drills and exercises.
• I specifically worked on my quad and ankle mobility, which significantly reduced my pain and allowed me to start running again. At first, it wasn’t perfect, but I could manage four, five, or even six miles before hitting a wall.
• Mobility work was a quick fix that made a huge difference in reducing stiffness and muscle tightness.
• I also realised that my running form needed serious improvement. Initially, I had a poor stride, landing too far in front of my body, which put unnecessary strain on my joints. By working on my form, I started landing closer to my centre of mass, which made a massive difference.
• I also focused on my push-off position, ensuring I used my muscles more efficiently. Hip mobility played a big role here because tight hip flexors can limit hip extension, affecting stride length and overall mechanics.
• The third and most difficult change for me was strength training. I used to prefer running over lifting, but over time, I came to appreciate the benefits. Now, I include barbell deadlifts, squats, Bulgarian split squats, and calf raises in my routine.
• Many runners mistakenly believe that running alone makes them stronger, but that’s not really the case. Cardio training makes you more efficient at that specific activity—swimming makes you a better swimmer, and biking improves your cycling, but it doesn’t necessarily build overall strength.
• Running, in particular, subjects the body to immense forces—each step places two to two and a half times your body weight on one leg. Without adequate strength, those repetitive impacts can lead to injuries.
• At first, weight training was tough because I wasn’t used to it, but consistency paid off. While runners don’t need to bulk up, building just enough strength to handle the physical demands of running is crucial.
• The mobility work and running form adjustments were quick fixes, but strength training was the ultimate game-changer for me. It made running feel easier and far more efficient in the long run.

Running form and injuries

11:35 -

• Running form is often overlooked, especially among recreational and even competitive runners. When I was in high school, there was no emphasis on mobility, strength, or biomechanics—just "go run."
• But running, like any other sport, has an optimal technique. Just as there is a correct way to throw a baseball, skate, or take a slap shot, there is an efficient way to run.
• Optimising this not only improves performance but also reduces injury risk.
• Running is all about efficiency. While muscles are actively engaged, the body's fascia and elastic tissues play a significant role in propulsion. These tissues stretch and contract reflexively, helping to conserve energy.
• If a runner's form prevents them from taking advantage of these natural biomechanics, they end up working harder than necessary. This means more energy expenditure and a higher likelihood of injuries.
• One of the most common issues I see is overstriding—landing too far in front of the body's centre of mass.
• When a runner reaches forward with their leg and lands with a heavy heel strike, they are essentially applying the brakes with every step. This constant deceleration means they have to reaccelerate every time, creating inefficiency and increasing impact forces on the joints. Imagine driving a car with the handbrake engaged—you’d feel resistance with every movement.
• The same happens with overstriding. By adjusting a runner’s gait so they land closer to their centre of mass, we can make them significantly more efficient and reduce stress on their knees and hips.
• There is research linking overstriding to knee injuries, such as runner’s knee. In my own experience, I dealt with knee issues while running high mileage in college—sometimes up to 60 miles per week. Looking back, I realise that if I had optimised my form, I likely would have experienced less pain and gotten more out of my training.
• Running is a repetitive motion, and any inefficiency is magnified over time, especially as mileage increases. This is crucial not just for runners but also for triathletes, who accumulate high training volumes across multiple disciplines.
• Running can be thought of as a series of single-leg plyometric hops. It’s a high-intensity, high-impact activity, which is why injury rates are so high. Estimates vary, but around 50% of runners experience some level of injury each year. Among triathletes, running accounts for 70-80% of non-traumatic injuries. This is because poor mechanics lead to excessive stress in certain areas of the body.
• Beyond overstriding, other major running form flaws include excessive hip drop and insufficient push-off. If a runner’s hip collapses too much with each step, it can lead to knee valgus (inward knee movement) and inefficient force transfer.
• Another issue is the inability to generate a strong push-off from the back leg. If a runner’s hips are tight or they simply don’t engage the right muscles, they struggle to extend their leg behind them. Instead, they compensate by overstriding.
• A good way to understand this is to think of a bow and arrow. When you fully draw a bow, you maximise potential energy before releasing it with power and accuracy.
• But if you only pull it halfway back, the shot will be weak and inefficient. The same principle applies to running. If a runner isn’t able to extend their leg properly behind them, they don’t store and release energy efficiently, making every step harder than it needs to be.

Identifying and solving a running form limitation

19:24 -

• Running form issues can stem from various factors, such as mobility limitations, strength deficits, or simply a lack of movement awareness. The best way to identify these issues is through a running form assessment.
• This allows us to observe your mechanics and pinpoint problems like overstriding, insufficient hip extension, or hip drop. However, while an assessment tells us what’s happening, it doesn’t necessarily explain why it’s happening.
• For instance, if you're not getting your leg behind you properly, it could be due to tight hips, or it might just be that your body hasn't learned the correct movement pattern.
• A simple mobility test—such as the couch stretch—can help determine whether hip tightness is the limiting factor. But if mobility isn’t the issue, we need to explore other reasons, like strength imbalances or motor control limitations.
• Once we confirm that mobility and strength are adequate, the focus shifts to retraining movement patterns. A lot of the time, it’s not just about physical ability—it’s about teaching your brain how to move efficiently.
• Think of it like a child learning to walk. My son, who is almost 12 weeks old, hasn’t rolled over yet, but as he develops, he’ll go through trial and error, gradually learning to coordinate his movements.
• Running mechanics work similarly—if you’ve been running a certain way for years, changing it requires consistent effort and reinforcement.
• To correct overstriding or improve push-off mechanics, we use drills and cues to rewire these movement patterns. Marching drills, for example, help reinforce proper foot placement by teaching you to pull your heel under your glutes and land beneath your body.
• Practicing these drills for a few minutes before a run can make a big difference.
• Cues are another powerful tool. A simple but effective one is to imagine running on ice. If you were on an ice rink, you wouldn’t take long, exaggerated strides because you’d slip and fall.
• By thinking about this while running, your body instinctively shortens your stride and improves foot placement. Some cues work better for certain individuals, so we experiment to find what resonates best.
• Ultimately, changing a motor pattern takes time, especially if you've been running the same way for years. However, when mobility and strength are already in place, it’s much easier to focus on refining movement and making small, consistent adjustments.

Common misconceptions about running form

23:46 -

• One of the biggest misconceptions about running form is that people believe they don’t need to change it. Some runners naturally have great form, and when I assess them—often on a treadmill—I find that they’re already moving efficiently.
• In those cases, we might make a few tiny adjustments, but overall, they’re doing well. However, for many runners, there are aspects of their form that need improvement to enhance efficiency and reduce the risk of injury.
• A common belief is that you should just run in a way that feels natural, and sometimes that works—especially if you’re efficient and injury-free. But for new runners, adopting an efficient running pattern can be quite challenging.
• A significant factor influencing this is the type of footwear we use. Modern running shoes, with their thick cushioning and elevated heels, tend to promote overstriding. To clear the foot from the ground, runners often extend their leg too far forward, which disrupts their biomechanics.
• This overstriding isn’t just a running issue—it’s something we see in walking as well. Many people overstride when they walk because their shoes encourage them to land with an exaggerated heel strike.
• That’s not necessarily a problem for walking, where heel striking is normal, but when the same movement pattern carries over into running, it can lead to inefficiencies and potential injuries.
• Beyond footwear, our lifestyle also plays a role. In today’s society, we spend a lot of time sitting, which leads to tight hips and poor movement patterns.
• This makes it even more difficult to develop an efficient running stride. So, while some runners might be naturally efficient, the reality is that most people can benefit from working on their running form—especially given the constraints of modern footwear and sedentary habits.

Mobility and injuries

25:56 -

• Mobility is often misunderstood as simply having a good range of motion, but it’s much more than that. True mobility is the ability to move fluidly through a range of motion without restrictions while ensuring that the right muscles are actively contracting.
• For example, you might be able to lift your arm fully overhead, which seems like good mobility, but if key muscles like the serratus anterior, trapezius, and rotator cuff aren’t functioning properly, you could still experience issues like shoulder impingement.
• Similarly, with hip extension, someone may appear to have good mobility when lifting a leg behind them, but if the pelvis compensates by rotating excessively—often creating a "duck butt" posture—then the movement isn’t truly effective.
• There are different factors that influence mobility. Muscle tightness or stiffness, fascial restrictions, and joint capsule limitations can all play a role.
• For instance, if the hip flexors are excessively tight, they can restrict hip extension, making it harder for muscles to contract properly. In cases like arthritis, the joint capsule itself may become stiff, limiting overall movement.
• For endurance athletes, especially runners and triathletes, optimising mobility is crucial to maintaining efficient and pain-free movement.
• When looking at the most common areas of mobility restrictions, three major regions stand out. The first is hip extension, which is often limited due to prolonged sitting. Tight hip flexors can severely restrict the ability to extend the leg fully behind the body, which is essential for running.
• The second major area is ankle mobility, particularly dorsiflexion—the ability to bring the knee forward over the toes while keeping the heel down. This is critical for running, as during mid-stance, the ankle must be able to move efficiently to allow for proper push-off.
• The required range can be significant, especially at higher speeds. There’s even a term for this relationship between hip extension and ankle dorsiflexion: the "Z angle," which represents the optimal positioning of both joints for running efficiency.
• Finally, the third key area is shoulder mobility, particularly for swimmers. The shoulder joint is highly mobile, but it’s also prone to stiffness, muscular imbalances, and fascial restrictions, especially in the trapezius region.
• While muscle tightness, such as shortened lats, can sometimes be an issue, it’s more common to see restrictions due to fascial adhesions or joint tightness.
• Among triathletes, addressing these mobility limitations—hip extension for running, ankle dorsiflexion for push-off, and shoulder function for swimming—is essential for improving performance and reducing injury risk.

Mobility assessment

29:53 -

• The couch stretch is one of the best ways to assess hip extension. For ankle mobility, I often use the box test or wall test. It’s a simple test: you place your hand against the wall, measuring from pinky to thumb (about 4-5 inches), then position your big toe at the edge of your thumb and try to touch your knee to the wall without your heel lifting.
• If you can do this, your ankle mobility is likely fine. However, if you can’t, the next step is identifying why—whether it’s a restriction in the joint, the muscle, or even the Achilles tendon.
• When assessing these limitations, I always ask where the restriction is felt. In the couch stretch, tightness usually comes from the quads or hip flexors.
• With the ankle, it might not even be the calf—it could be the joint capsule itself, causing a pinching sensation in the front of the ankle. If that’s the case, we use hands-on techniques to mobilise the joint.
• If the limitation is due to the muscle or Achilles tendon, then different strategies are needed. It’s crucial to not only check if the range of motion exists but also to determine the exact cause of the restriction.
• Self-diagnosis is possible, and I discuss this in my book, providing guidance on how to identify whether the restriction is in the calf, the joint, or another structure.
• If someone is unsure, they can see a physical therapist for further evaluation. However, with some basic knowledge, individuals can assess their own limitations and apply the right interventions—whether that means stretching the calf, using a lacrosse ball for soft tissue work, or employing joint mobilisation techniques.
• For example, if performing the wall test, the goal is to reach the wall with the knee while keeping the heel down. If the heel lifts, the next step is to determine where the restriction is felt.
• If it’s a pinching sensation around the ankle bone, the issue is likely the joint. If it’s a deep stretch or cramping in the calf, then it’s more muscular, and targeted calf work is needed. In most cases, people can pinpoint their issue with this simple approach.
• To work on ankle joint mobility specifically, we focus on improving the natural roll-and-glide motion of the talus bone.
• When the connective tissue around the ankle joint is tight, it prevents proper movement, leading to pinching and restricted dorsiflexion. A common self-treatment is using a resistance band around the ankle while performing knee-over-toe movements.
• The band helps restore normal joint mechanics by facilitating the necessary glide. This technique mimics manual therapy and is highly effective for improving mobility.

Tips for athletes with mobility limitations

35:34 -

• When it comes to improving hip extension, the couch stretch is both the test and the treatment. It’s one of the most effective ways to address restrictions in the quads and hip flexors.
• Holding this stretch for two to three minutes might feel like the longest two minutes of your life, but it produces great results. You can distract yourself—watch TV, check your phone—because it’s an intense stretch.
• If the restriction is in the ankle, it can be a bit more unpredictable. Sometimes, the stiffness comes from the ankle joint itself, and other times, it’s more about soft tissue tightness.
• A good way to assess this is using a lacrosse ball—if an area is tender, keep working on it. If the restriction is in the calf, static stretching can be helpful.
• Holding a stretch for two to three minutes is boring but effective. However, if the issue is more related to the Achilles, different types of calf raises are needed, which is a separate approach.
• For the hip joint itself, banded hip mobilisations can help. Since the hip is a stable joint, it often presents with tightness. Wrapping a band around the hip and performing lunging thrusts—anchoring the band to a squat rack, for instance—can provide some additional mobility.
• But if we’re talking about the most effective method, the couch stretch does about 80% of the work in improving hip extension. The key is consistency—holding it long enough to release muscle and fascial tightness in the quads.

Static stretching

37:59 -

• Static and dynamic stretching serve different purposes, and it’s important to understand when to use each. Static stretching is not meant to warm you up before a run; instead, its primary goal is to lengthen tissues, improving mobility and efficiency.
• If you’re extremely stiff, doing a static stretch before running—like the couch stretch—can be beneficial as it helps you access a better range of motion.
• However, static stretching doesn’t raise your heart rate or activate your muscles, so it’s not a traditional warm-up. Over time, you may not need to do static stretching as frequently, but if you have a sedentary job or travel often, increasing its frequency can help. The couch stretch, in particular, is excellent for relieving lower back pain.
• On the other hand, dynamic stretching is specifically designed to prepare your body for movement. It activates your nervous system, raises your heart rate, and gets your muscles ready to perform. If you have a minor issue, like a tight hamstring, dynamic exercises can help by priming the muscle.
• The key difference is that static stretching actually sends a neural signal that relaxes the muscle, temporarily "turning it off," which can inhibit muscle contractions. This is why static stretching before a sprint—or even distance running—is generally not recommended, as it can reduce force production.
• However, if you’re extremely tight, I might still suggest a brief static stretch before a race to ensure you can access a full range of motion. In such cases, the benefit of improved efficiency outweighs the downside of slightly reduced muscle activation.

Structure mobility programs

41:23 -

• I recommend holding a stretch for at least two minutes to see meaningful tissue changes. Two minutes is the minimum effective dose, but if you want to maximise results, doing it twice a day is ideal. Think of it this way: once a day makes you a "B student," while twice a day makes you an "A student"—and who wouldn’t want to be an A student?
• With consistency, you'll start noticing progress quickly—sometimes within a couple of days. Take the couch stretch, for example: if you're doing it correctly, with your knee flush against the box, wall, or couch, you'll see that your range improves over time.
• You’ll be able to get higher and higher, and eventually, you might even feel the stretch less, which is a clear sign that your flexibility is improving.
• At a certain point, once you've gained sufficient mobility, you won’t need to stretch as frequently. I personally still do it about once a week to maintain my quad health, but for most people, once you've reached a good level of flexibility, you can scale back to two or three times a week.
• You'll know when you reach that stage because the stretch will feel significantly easier compared to when you started.
• If you're running, timing your stretching is important. If you're feeling really stiff, I don’t mind doing static stretches beforehand, but generally, once you've regained flexibility, it’s best to avoid static stretching before a run because it can reduce muscle activation.
• Instead, opt for dynamic quad stretches—something like grabbing your foot behind you and moving through the range of motion dynamically. Save the longer static stretches for after your run.

Common misconceptions about mobility

43:30 -

• In running, there's a common misconception that mobility is not essential. Many people believe that since running involves limited knee movement—about 15 to 20 degrees of knee flexion when the foot hits the ground—it doesn't require much flexibility. However, I would challenge that belief.
• While it is true that running doesn't demand extreme mobility, having adequate mobility, especially in the hips, is crucial for efficient movement and injury prevention.
• When we talk about mobility, we're considering the range of motion our body can achieve in certain movements. For instance, in a neutral standing position, our hips allow us to swing our legs forward and backward like a pendulum.
• If our hips are tight and we can't fully extend our leg behind us, our neutral position shifts, affecting our gait. This limitation can lead to overstriding as the body compensates for the lack of hip mobility, which, over time, may cause discomfort or injury.
• In running, this lack of mobility may force a runner into inefficient postures, leading to overcompensation. Essentially, if we don't have full range of motion, it negatively impacts our natural body mechanics, which in turn affects how we run.
• The same concept applies to strength training, particularly in deadlifting. If your hips or back are tight, you may struggle to maintain a neutral spine position while lifting, which could lead to back pain or injury.
• So, while not all areas of the body need extreme mobility for running, it's essential to have proper flexibility in the ankles and hips.
• Without it, our body mechanics are altered, which could lead to compensatory movements and, eventually, injuries. It's also a key reason why deadlifting with tight back muscles can be risky—without proper mobility, you're more likely to lift with a misaligned spine, potentially leading to back issues.

Strength training

47:10 -

• I think a common misconception with running, especially among runners, is how they approach injuries like knee pain or stress fractures. For example, I worked with a youth runner who’s going to run Division 1 next year.
• She’s really excited, but she came to me after having a stress fracture in her hip, which is a pretty serious injury. There are a lot of factors that can contribute to a stress fracture, but in her case, rehab included a lot of strength training.
• We focused on strengthening the bone because loading the bone properly is how you build bone strength. It’s not running that helps with bone density—running actually isn’t great for it.
• Strength training, on the other hand, is fantastic for bone density. It helps heal stress fractures by making sure we’re loading the body in the right way to encourage the bones to become as dense as possible.
• During her rehab, she also did a lot of cross-training, which is important to maintain cardiovascular fitness when you can’t run. Yes, she lost some fitness because she wasn’t running, but cross-training kept her endurance and cardiovascular systems in good shape.
• In these situations, you have to keep the heart and lungs engaged, even though it’s not a substitute for running. Cross-training doesn’t solve the problem of the injury, though.
• If you want to heal from a stress fracture, you need to load the body correctly, which means doing strength training.
• A lot of runners think that just cross-training will fix their injuries, but that's not enough. We need to load the body in specific ways, forcing the muscles, tendons, ligaments, and joints to adapt.
• For instance, when I have someone do goblet squats, I tell them it should be a 10-rep max. By the time they reach ten reps, they should feel pretty exhausted. If they don’t, then we haven’t used the right weight or dosage, and that means we’re not creating the right stimulus for adaptation.
• Strength training has so many benefits. It allows your body to handle the impact forces that come with running, which can be two to two and a half times your body weight on one leg with each stride. That’s why it’s so important.

Runner's strength training program

50:27 -

• Running is essentially a single-leg hop, performed repeatedly with alternating legs while you fall forward. It’s essentially a dynamic plyometric exercise. When considering strength training for runners, it's crucial to focus on exercises that mimic this motion, although they don’t have to be overly specific.
• The calf, particularly the soleus muscle, plays a pivotal role during running. This muscle is responsible for the repetitive loading during each step and has to endure significant force — up to five to eight times your body weight while running, and even three times during walking.
• The soleus is the powerhouse of running, capable of going on for long periods, and requires specific strengthening. It’s important to note that while running uses the calf, it doesn't make it stronger. Running stretches and contracts the muscle like a rubber band; if the muscle isn't strong enough, chronic tightness and injuries occur.
• To address this, calf raises, particularly bent-knee variations, are highly effective in strengthening the soleus.
• In addition to the calves, the hamstrings are the second most used muscle group, especially for distance runners. Hamstring curls and single-leg exercises, such as kick-stand deadlifts and Bulgarian split squats, are great for strengthening the hamstrings and improving running performance.
• The Bulgarian split squat, in particular, has many benefits: it mimics single-leg movements, provides a stretch for the quads, and improves balance while strengthening one leg at a time.
• In terms of strength training frequency, for most runners, training two to three times a week is ideal. It’s important to balance strength training with running, so it doesn't interfere with performance.
• When working with a marathoner, for example, it’s often recommended to do strength training twice a week during peak training, with a gradual reduction as race day approaches.
• Strength training should start heavier in the off-season and taper down as race season approaches. For the typical runner, dedicating 40 minutes to an hour per session is ideal.
• Plyometrics also play an important role, especially when it comes to maintaining bone density. These exercises, like hopping on and off a curb, should be performed before running to maximize the bone density response.
• Doing plyometrics after running can lead to a diminished response due to an inhibitory effect on bone cells. Incorporating plyometrics before running allows runners to improve bone health while preparing the muscles for the load of running.

Foot overview

57:19 -

• Personally, I have flat feet, and I’ve been told time and again that I need to wear specific shoes to correct it.
• I was always skeptical, though. Whenever I tried the recommended shoes, they never felt like they were solving the problem. I’d go to the store, and they’d say, "You overpronate, you need this shoe," but even after wearing them, I never felt that they addressed the issue.
• My flat feet always seemed like a barrier, especially when it came to running, and I’m sure they contributed to my knee and back pain over time. I now realize that when my foot collapses too much, it impacts the entire chain, making my knees cave in, my hips drop, and my back suffer as a result.
• For me, foot health is vital, particularly for runners and those who are very active. The feet are the first part of the body that hits the ground, so they need to do their job properly.
• However, the shoes we wear often force our feet into positions that aren’t natural. Take, for example, shoes with a curved forefoot rocker or cushioned heels—these can actually cause more harm than good by deconditioning the foot.
• The design of many of these shoes squeezes the toes together, and over time, they prevent the foot from activating and functioning optimally.
• While I’m not anti-Hoka or any other specific brand—I know some runners who love them and perform incredibly well—I do believe that, if we’re going to wear shoes like this, we need to make sure we’re also doing the work to activate and strengthen our feet from the inside.
• In my case, as someone with flat feet, I’ve found that many people in the same situation are told they need to wear certain types of shoes, but they just don’t feel comfortable in them. They can be bulky and heavy, which isn’t ideal.
• The good news is, you don’t have to follow this conventional advice blindly. It doesn’t matter as much whether you have high or low arches—it’s about activating your arch.
• In more developed parts of the world, we often see extreme foot types, with some people having very high arches and others having very low ones. In societies that haven’t gone through this process of shoe dependency, you’ll see a more natural variation of arch types, with people generally able to move better.
• For those with high arches, we need to activate the arch so it can act as a shock absorber. If the arch doesn’t function properly, it’s like trying to mountain bike on a road bike—it just doesn’t work. On the flip side, if you have flat or hypermobile feet like mine, the key is learning how to stiffen the foot.

How to work the foot

1:03:00 -

• In my new book, I'm focusing on the benefits of transitioning to barefoot-style shoes, which can significantly improve foot health. A simple change like switching to a minimal shoe, even just for walking, has been shown to enhance arch strength and activate important foot muscles, including those responsible for moving the toes.
• Specifically, muscles that control the movement of the pinky and big toes, as well as toe flexors, become stronger. This occurs because barefoot-style shoes allow for more natural foot movement. The key is not to scrunch the toes but to press them down, promoting muscle growth.
• The research around this is fascinating, with studies indicating that the surface area and volume of these muscles increase over time. Barefoot-style shoes, with their wider toe boxes and less cushioning, provide the necessary conditions for this improvement.
• They allow for greater foot mobility, which triggers an important process called the "tie rod mechanism."
• This mechanism is simple to understand: when the foot hits the ground, the toes are supposed to spread out, causing the forefoot to widen. This signals the brain to activate the muscles in the arch, stiffening them to support the body during movement.
• However, wearing traditional shoes that squeeze the foot can inhibit this natural process, limiting the ability to activate the arch muscles.
• By using shoes with wider toe boxes and promoting toe spread, such as with toe spacers, we can improve the foot's natural mechanics. I also focus on the importance of working with conditions like bunions or tailor's bunions, which can be addressed by strengthening the arches and promoting toe mobility.

Wide shoes

1:05:58 -

• In my experience, I believe in finding a balance between barefoot-like shoes and more cushioned options, depending on your needs and comfort level.
• I’m a big fan of shoes like those from Altra, which tend to have a wider toe box, offering more room for the foot. They also have higher stack shoes, providing more cushion, which can be great for people who are not yet ready to go fully minimalist but want to enjoy the benefits of a wider toe box.
• For those who want something in between, I recommend shoes like the Altra Escalante, which has a minimal stack height. On the other hand, I sometimes run in my Paradigms, which don’t have any drop and are very minimal in terms of forefoot lift, offering little curvature or twisting of the shoe.
• These provide a solid middle ground—offering the benefits of a wide toe box while still being cushioned enough for comfort.
• If you're looking for something more minimal, I do wear Xero Shoes, which are essentially barefoot shoes with no cushion at all. While these are fantastic for building foot strength, they can be a lot for people to handle, especially if they're not used to running in shoes that offer no cushioning.
• This can be a tough transition for many, particularly if you walk on concrete for long hours, like nurses do. For them, barefoot shoes might not be the best option.
• A good alternative for those who need a bit more cushioning but still want to feel close to the ground is the Peluva toe shoe. While it’s not as minimal as the Vibram FiveFingers, it does offer a little cushioning, making it a better option for people who need something more comfortable for extended periods of standing or walking.
• It’s a great shoe for those who can’t quite manage barefoot shoes but want something that still respects the natural shape and function of the foot.

Foot strength training at home

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• I am a strong advocate for toe socks. I find them beneficial because they allow my toes to move independently, providing space between each one.
• This is important, as it activates the foot muscles and promotes better foot function. I was introduced to toe socks by a 79-year-old patient who had undergone two bunionectomy and had fused big toes.
• He swore by them, and after trying them myself, I quickly understood why. While initially strange, the experience of feeling your toes spread out is incredibly refreshing, and it makes the feet feel more active and engaged.
• Though I’m not aware of any specific studies on the benefits of toe socks for foot activation, based on personal experience and observations from my patients, I believe they help.
• When combined with shoes that have a wider toe box, the toe socks allow for better toe spread, which supports the arch and overall foot health. The wider shoes and toe separation help the foot's natural mechanisms, like the tie bar mechanism, to function better and activate the arch.
• Now, when transitioning to barefoot shoes, it's important to meet certain requirements. The easiest step is simply changing to a different shoe. In my recent book, I discuss a system where your foot doesn’t need to be perfect to begin walking in barefoot shoes, but we should check some foundational boxes.
• A simple exercise I call "toe yoga" can help with this—can you keep your forefoot on the ground while lifting your big toe separately from the others? Can you do this without the foot wobbling? These exercises don’t have to be complex, but they help differentiate the big toe from the others, which is crucial for arch activation.
• It’s not about advanced exercises like picking up marbles, but about basic control of the toes.
• Another key factor is ankle mobility. Traditional shoes with heel lifts offload the Achilles, so when transitioning to barefoot shoes, you need adequate calf strength and mobility.
• This transition will be more successful if you have good ankle mobility and foot strength, so performing exercises like pressing your big toe into the ground or balancing on one foot can help.
• I believe that barefoot shoes can be beneficial if you’re ready for them. While I enjoy running in barefoot shoes, I don’t do it all the time—sometimes my foot just doesn’t feel ready, and I’ll switch to a more supportive shoe.
• However, walking in barefoot shoes and performing foot strengthening exercises simultaneously can greatly improve foot health.
• Whether you have a high or low arch, working on strengthening the foot muscles and wearing minimal shoes will bring great benefits over time.
• In addition, doing mobility work, such as rolling your foot on a golf ball, can help activate the intrinsic muscles, particularly if you have a higher arch.

How to evaluate the feet

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• In my new book, I discuss a few key tests that are excellent for assessing foot strength and mobility, which are essential when transitioning to a barefoot-style shoe. One of the easiest and most effective tests is the calf raise test.
• I ask people to perform calf raises while holding a 20-30 pound weight on a slantboard, doing the exercise with a three-second up and three-second down tempo.
• The goal is to complete 20 repetitions. If someone cannot complete the full set, it indicates their calf strength may not be at the desired level.
• Over time, tracking progress in this test is a great way to gauge improvements in calf strength, as it should gradually increase, ideally reaching 20 reps.
• Another valuable test I use is the toe yoga test, which serves both as an exercise and an assessment. If someone struggles to differentiate their toe movement at first, I encourage them to practice releasing tension in the foot, strengthening the big toe, and focusing on control.
• With consistent practice, you should notice improvements in toe yoga. It's not just a test, but also a progressive exercise that helps build foot strength.
• For glute strength, I often incorporate the single-leg glute bridge test. This test evaluates whether someone can hold a hip thrust without letting the hip drop.
• Since the glutes and hips play a significant role in foot mechanics, this test helps assess whether there are issues with hip strength that might be affecting the foot.
• I also use a simple test to measure the strength and control of the toes. By placing a piece of paper under the big toe and asking someone to press down on it, I check if I can easily pull the paper out.
• The goal is for the person to press their big toe down firmly enough that there is resistance when I try to pull the paper away. I also check the other four toes to ensure there is no scrunching. The strength of the pinky toe might be a little weaker, but it should still offer some resistance when pressing down.
• In some cases, I’ve used a device that can measure the amount of force the big toe and other toes can generate. This device provides a quantified reading, but it does come at a cost.
• When a more affordable solution is needed, I rely on the paper test, which can still offer valuable insights into foot strength.

Core strength

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• When it comes to running, a key aspect that often gets overlooked is the role of the core, particularly the rotational movements involved in the motion.
• Running isn't just about moving forward; there’s significant rotational force in play, particularly in the hips. In fact, lateral forces, those that push you out to the sides, can account for about 15-20% of your body weight.
• If these forces aren't managed properly, it can lead to excess sideways motion, such as a "head bob" to one side, which can cause imbalances and potential injuries.
• Strengthening the core in all planes of motion, particularly in side-to-side and rotational movements, is vital to limit these compensations.
• Anti-rotation exercises, like side planks, are essential, but simply doing front planks isn't enough. The most important core movement for running efficiency is rotation, often referred to as the "spinal engine."
• When we run, we need to rotate—not just bounce or move forward in a linear fashion. If you observe someone running efficiently, you'll notice a fluidity in their movement, which is a product of proper rotation.
• A helpful cue for optimizing running mechanics involves focusing on belly button rotation. When one foot lands, the belly button should rotate toward that side of the body. This helps promote counter-rotation, a necessary component for fluid running form.
• It's not just about strength in the core but knowing how to apply that strength to optimize rotation. Strength exercises, such as banded movements or stability ball exercises, can help build this necessary foundation.
• To integrate rotation into running, it's essential to train the body to use its core muscles, especially through specific running drills. A simple yet effective drill involves holding a PVC pipe in front of you while walking, with the focus on rotating your body to ensure your belly button moves with each step.
• By limiting arm movement, you force the body to use its core to generate the necessary rotation. This helps isolate the core's role in the rotational movement, as opposed to relying on the arms to initiate the motion.
• This rotational movement also involves stretching and contracting the fascia system, providing "free energy" that makes running more efficient. Properly trained rotation offers a significant advantage in running, reducing the effort required for each stride.
• The challenge is integrating this strength and mobility into running form, and this is where the belly button cue becomes particularly useful. By learning to rotate from the right place in the body, particularly from the spine, you can optimize running form and efficiency.

Core strength exercises

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• One of the key things to practice is the "belly button cue." Start with simple movements—just walk while focusing on this cue. Once you are comfortable, progress by placing your arms behind your back or holding a very light object overhead.
• You can gradually increase the weight, similar to a method used by Dr. Mark Cucuzzella, a highly knowledgeable physician in running.
• He recommends holding a lightweight metal rod, like those found at hardware stores, and progressively adding weight.
• The more weight you hold, the more your core has to work to stabilise and control rotation, making this an effective way to strengthen your core while reinforcing proper movement patterns.
• A great way to train this is by walking on a treadmill with a weight overhead, as long as your shoulders can handle it. Walking outdoors is also an option, but I personally prefer using a treadmill for better control.
• Essentially, once you've mastered the belly button cue while walking, you can start to challenge yourself by adding resistance.
• Beyond this, I’m a big fan of moving in and out of planks rather than just holding a static position. For side planks, instead of remaining still, I recommend slowly lowering your hips and then bringing them back up in a controlled manner.
• Another variation I like is incorporating rotation into the side plank. You can hold a light weight at your side and, while maintaining hip stability, open up your upper back to add rotation.
• Similarly, in a front plank, you can use a resistance band attached to the side and rotate your torso while controlling the movement back down.
• The key takeaway is to introduce movement into your side planks by adding a band or a weight. Running requires movement, not just rigid stability, so while anti-rotation exercises are valuable, they should be balanced with counter-rotation work.
• In running, the upper body rotates in one direction while the lower body rotates in the opposite direction, so training this counter-rotation is crucial.
• One of the easiest ways to integrate this into training is by modifying traditional side planks to incorporate rotational movements.
• Since many people are already familiar with side planks, adding rotation is a simple yet highly effective way to enhance core engagement and dynamic stability.

Triathlon considerations

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• When it comes to running, one of the most important biomechanical factors is optimising the Z-angle—essentially ensuring maximum hip extension and ankle mobility.
• However, in cycling, the body remains in a fixed position for long periods, which limits hip extension and encourages a rounded posture in the mid and lower back.
• I often describe cycling as “active sitting” because, if you visualise a cyclist’s position and then stand them upright, they’re essentially still in a seated posture.
• This extended period in a flexed and rounded back position presents a challenge when transitioning to running, especially in triathlon.
• The first priority when coming off the bike should be counteracting the effects of that prolonged position. The back has been stiff for the duration of the ride, so it’s crucial to introduce movement and rotation immediately upon starting the run.
• A simple but effective mental cue is to focus on rotating through the midsection—what I call the “belly button cue.” This helps reintroduce mobility and allows for a more natural running form, which is particularly valuable when taking on a 5K, a half marathon, or a full marathon at the end of a triathlon.
• Mid-back mobility is absolutely essential, and it’s not just an issue for triathletes—many runners suffer from tightness in this area too.
• There are multiple ways to address this, but one of the most effective tools is a “peanut,” which is essentially two lacrosse balls taped together.
• Placing it along the spine and applying pressure helps to mobilise the thoracic region more effectively than a standard foam roller.
• In addition to mid-back mobility, hip extension is another key area to focus on. The seated position on the bike often results in tight hip flexors, which can restrict a runner’s ability to extend their stride effectively.
• However, cueing hip extension is not as simple as just instructing someone to push further back with their leg—it’s not always intuitive. Instead, I find that arm positioning plays a major role in influencing lower body mechanics.
• One of my favourite cues is keeping the arms close to the body and ensuring the elbows drive back behind the torso. When the arms move in this way, the legs naturally follow, improving both cadence and push-off efficiency. This approach is particularly useful for triathletes, as it helps to overcome the stiffness that develops during the cycling portion of a race.
• For immediate, in-race adjustments, I recommend focusing on that belly button cue to ensure the back is moving fluidly, and consciously keeping the arms tight with a strong rearward motion to improve running form. Outside of racing, incorporating mobility exercises such as thoracic spine work with a peanut and hip mobility drills—like couch stretches—can significantly improve post-bike running performance.

Overrated and underrated concepts in injury rehab

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• Cross-training is overrated when it comes to addressing injuries. While it can help maintain cardiovascular fitness and some level of metabolic conditioning, it will not resolve knee pain, mobility issues, or poor running form.
• If you’re dealing with an injury, simply replacing running with another activity is not the solution. You need to identify the root cause of the issue—whether it’s related to running technique, mobility limitations, or strength deficiencies—and address it directly.
• This often requires loading the affected tissues properly rather than just avoiding running altogether. If you're injured, don’t just turn to cross-training as a way to work around it—seek professional help, diagnose the problem, and take steps to correct it.
• On the other hand, one of the most underrated tools I’ve found for foot health is the Barefoot Science insole. I don’t get paid by them, though I do have an affiliate link, but honestly, I recommend them because they work.
• These aren’t orthotics; they don’t force your foot into a specific position. Instead, they use different levels of spacers inside the insole to provide tactile feedback to your foot, which helps activate your arch. Over time, this stimulation causes the foot to engage naturally, strengthening it and making it more resilient.
• For example, I personally have a hypermobile foot, and using these insoles has helped create more stiffness in my foot structure, which is beneficial for support and efficiency.
• But they’re not just for people with flat or hypermobile feet—if you have high arches, they can still be useful because they encourage your arch muscles to engage dynamically.
• It’s similar to how a rock mat works, where standing on textured surfaces activates foot muscles, but in this case, it happens inside your shoe with every step you take.
• This is something that most foot health influencers don’t talk about, and I believe it deserves more attention. The research behind tactile cueing and how it stimulates foot function has been around for a long time, yet these insoles remain relatively unknown.
• I had the chance to speak with Lance, the owner of the company, before he passed away recently, and it was clear that the science behind this product is solid and has been for years.
• One of the issues with minimal shoes is that while they allow for natural movement, they don’t provide varied sensory feedback—you feel the same rubber sole with every step.
• When we’re actually barefoot, our feet constantly experience different textures and sensations, which helps activate and strengthen them. These insoles replicate that process, making them a fantastic tool for improving foot function.
• Yes, they’re a bit pricey (around $90), but every person I’ve recommended them to has reported great results. If you’re serious about foot health and want to take things to the next level, I highly recommend trying Barefoot Science insoles.
• It’s not about selling a product—I only back things I truly believe in. Along with tools like the Mobo Board and minimalist shoes like Xero Shoes, these insoles are one of the few products I consistently recommend because they genuinely help people improve their foot function.

Key take home messages

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• To improve running form and overall movement efficiency, I highly recommend focusing on hip and ankle mobility, particularly achieving proper hip mobility with a strong Z-angle position. This alone can solve many biomechanical issues.
• One crucial but often overlooked cue is the belly button cue—most people don't pay attention to their rotational movement when running, but being mindful of how your core rotates can make a significant difference.
• Another key aspect is foot activation. Start engaging your foot properly by pressing your big toe down and incorporating exercises like toe yoga to build strength and control.
• In terms of strength training, the Bulgarian split squat is the single most effective exercise you can do. If I had to choose only one movement to perform for the rest of my life, it would be this.
• It not only builds lower-body strength but also allows you to incorporate a calf raise by pumping your calf up and down while holding the position.
• So, if you're looking for an 80/20 approach—maximising benefits with minimal exercises—start with these five key elements:
  • Hip and ankle mobility
  • The belly button cue for better rotational awareness
  • Activating the foot properly (big toe engagement, toe yoga)
  • Bulgarian split squats with a calf raise
  • A structured approach to movement efficiency
• These foundational principles could make a massive impact, possibly even beyond what we usually expect—maybe even 120% of the results from just these focused efforts.

LINKS AND RESOURCES:

• Matt's website (Alpha Project Phyzio & Performance), Instagram and Youtube
• Built To Run - Matt's book