E3 Physio are a Burleigh Heads based physiotherapy clinic dedicated to helping patients overcome knee, ankle, and foot pain. In this episode of the ProActive Podcast, E3 Co-Founders Catherine Ketsimur and Duncan Sanders sit down with Chris to discuss some of the biggest mistakes people make when getting back into exercise.
[Announcer] Welcome to the PROACTIVE Podcast, brought to you by MeMedia.
G'day, world, Chris Hogan coming to you from MeMedia Studio here at Burleigh Heads for episode 131 of the PROACTIVE Podcast. And I have with me Cat and Duncan from E3 Physio, new clients to MeMedia as well. So in case you didn't know, we don't regularly have our clients on the show. Everybody that's been on the show before you has been just a member of the public, and awesome human being, but now we have awesome human beings that are also clients. One of the reasons why we have E3 Physio on today is because they are knee, foot, and ankle specialists. And funnily enough, I've decided to get them on the show so I can get a free consultation on how to manage my getting back into running. And it's been a long time since I've been a runner, been an athlete, that's run around, I generally do other sorta training. And I wanted to talk to you guys about getting back into running. Welcome to the show, thanks, guys.
Thank you.
Hi.
Thanks for having us.
Thanks, Chris.
So a non-athlete for some years, was a soccer player, basically had to stop playing soccer due to ankle injuries, repeated over, I think, almost a decade. So now, you know, a long time after that, multiple decades after that, almost, we're actually, I'm trying to get back into running. And each time I start off it hurts, I have ankle issues, like I was saying to you before, we started that every time I got to run across, even just run across the road at the set of lights, it's like, I can, my ankles seize up and all sorts of stuff. So firstly, what should I be doing? Where should I be starting when I'm that person that wants to get back into running and hasn't done it for a while?
All right, well I might start off, Chris. I think first of all, you need to think about why you wanna run again and what you wanna do. So if you keep the end in mind first, or think about the end in mind, what do you wanna do? Do you wanna be doing a 10k? Do you wanna be running with your kids at soccer? 'Cause they're different types of running, and then reverse engineer, so how long do you wanna do it, in six months time, and then just so you can build up slowly, rather than just going out and doing a 10k, slowly build up half a k a week over the next six months, for example. The maths doesn't add up, but you get the point.
Yeah, okay. And in terms of like warming up, you know, I'm starting from a cold start. I would say I would be pretty warm. I've just walked maybe 200 metres, is that wrong? Am I not warm?
No, no, I mean, the thing is to start gently and go from there, and you actually, if you're not already doing a walking programme, that would be where you'd start most probably, with a walking programme and with some strengthening exercises, 'cause it sounds like your ankles are a little bit dodgy and might need a little bit of help.
Okay.
Yep.
So with that strengthening exercises, I'm specifically focused on my ankles or is that like-
Well, no, it's actually really important that you work the whole chain, from your ankle, knee, hip and back, and that gets back to the old core exercises that everyone talks about. And to be honest, I actually think you need to strengthen your arms too, because some of your arm muscles are very important for your core strength, and your core strength gives you a really nice stable base for your legs to work from.
Okay, cool.
Yeah, so it's a bit of everything, I'm afraid.
No, that's fine, I'm cool with that. So, you know, I'm trying to get back into running and I'm not sure my shoes are cutting it, to be perfectly honest. I do have orthotics that I'm supposed to wear, but they don't fit well into my running shoes, or what shoes I do have to run in. So should I actually be very, like considering, you know, basically looking at some specific shoes for me?
You know what, shoe wear is a bit of a contentious issue. There's schools of thought all the way from the barefoot runners up to super motion control shoes. Personally, I'm kind of somewhere in the middle of that, but you do definitely need different shoes for different people. So you need to look at your foot and there are a few places around where you can go in they can run you on the treadmill, or walk you on a treadmill and give you some advice, but it's better to get someone to look at you than just going and picking a pair of shoes yourself.
Okay. Duncan, I'll switch to you, mix it up a bit. So rise or flat? So no rise shoes, what's your opinion on those?
Look most shoes, it's very individual, so you'd get checked out, but a lot of people now just going more neutral shoes, away from the very heavy supination or pronation shoes and then letting their feet work naturally within the shoe. So the shoe becomes more a cushioner than a correct your foot position. And that's probably where Catherine's saying, then your foot position, knee, hip core stability is what you work on rather than what your feet are doing impacting the ground.
Yep.
Yeah, that's important that you don't let the shoe do all the work. You've gotta do some of the work yourself.
Yeah so, you know, one of those ones with the massive pillow on the heel, that's really good for me, isn't it, to actually like have that support?
The heel strike, yeah. No. That was an old school of thought that you wanted to build up that gap between your heel and obviously when you hit the floor, but the more scientific research is coming out now saying that that shock is actually not good for your body, and that the more natural way of hitting the floor is with your midfoot. So you wanna encourage that. So a little bit lighter on your feet and a little bit higher through your body when you run.
So does that mean we're actually like midfoot, like it's flat, or are you saying we're landing like more ball.
Somewhere, you don't wanna land flat, but it is more on the front of your foot, because as you run you should be almost kind of gliding across the ground. You know those people you can see,
Oh yeah, yeah, yeah, yeah.
They look beautiful, don't they? Yes, I'm not one of those.
Jealous of those people, they're aliens.
Yeah . But that is the theory, is that you gently push your foot through and you roll through from the sort of middle of your foot to the ball of your foot and then project yourself forward from there.
Okay. And so what we're saying there is, you know, that mid-foot strike, when I'm starting out, you know, and I've created this plan, and I want to take off down the street, should I slow it up a bit and maybe focus on my, where I'm striking and maybe even do a shuffle? It feels rather pathetic from my point of view. Like being an ex athlete, it's like, come on, mate, you're just shuffling down the street.
[Catherine] You can do better.
But is a shuffle a pretty safe place to start?
I think it's totally fine, and as Cat was saying before, I think you start with a walk, jog, walk, shuffle. It doesn't matter, it's just getting you back into that motion of running.
Yeah, that's a good point. So maybe even starting out a little bit lighter on my self. Hey I'm gonna go for a jog to the end of the street, which my street happens to be a kilometre long, so it's perfect for, you know measuring how many k's I can do. And then, yeah, walk 100, shuffle 100.
Yeah.
Yeah. There's one really nice app that I like called "Couch to 5k". And it actually just talks you through that process of starting with walk for a certain amount, run for a bit, walk for a bit, run for a bit. And you just basically then gradually swap it over, the walking bits for running bits. And that's a nice way of doing it, if you're worried about doing it yourself and how much you should be running versus walking, use an app.
Okay, good.
And that fits back in with the physiology of our body getting used to things slowly. So you're not overloading and getting an injury out of nowhere.
Yeah okay.
And we know this innately from people post injured. If you broke your leg and you were still a soccer player, you'd build back up slowly. You wouldn't go straight back into a soccer match, but we forget it when we get a bit older and wanna return to how we were when we were 19.
Yeah, yeah, yeah well absolutely.
We forget there's been some years in between.
Absolutely. So I'm getting back into it. I'm jogging along the street and I've chosen this street because it's nice and flat, or is it good for me to include hills from the get-go? Does that matter? Should I be avoiding Hills?
Well, I think again, it goes back to why you're doing this. Are you're gonna go do trail runs, in which case yeah, you need to get into hills pretty early. Are you gonna do a flat marathon? What are you aiming to do? Or are you just running because you enjoy it, and so you wanna go do some pretty paths. I don't think there's any harm in doing hills early on, but as long as you do them slowly and gently and work up the amount and the speed from a very slow gentle run up from there.
Yeah, trail running's where I wanna go with it. So that's my plan. Now I'm down the beach, this is actually, you know, where it's kind of stemmed from, I'm doing my Bronze at the moment, and so that's where, you know, all it's been is a run, swim, run, so you know, it's 200 metre run, swim 200, and 200 metre run, but my ankles are not liking this, and I'm wondering, what am I doing wrong here? Am I starting on that too hard sand, you know, I'm breaking into sprint, I'm not warming up, I don't have a plan, I'm on my toes. Also it's on an incline, so this foot's going, hang on a minute. Should I even be there doing this? Should I be doing this?
It's a little bit of an all of the above that one.
Yeah.
Yeah.
That sounds like you need to work on your ankles first.
Yeah.
Sand running is really hard, because the surface underneath your foot shifts. Obviously you put your weight on it and suddenly sand that was there is now over here. So it is actually really tough. And unfortunately, a lot of calf injuries come from sand running when you haven't done it before. So A, working up to it gradually, B, probably doing balance work on your calves, strength and balance work.
There's-
How do you do that?
Loads of different ways. One is just standing on one leg. You could start by just standing on one leg while you clean your teeth.
Oh yeah right.
Easy, and then progress from there. You can get little wobble cushions, foam discs, Bosus, lots of different pieces of equipment that you stand on, and obviously then the aim of the game is just not to fall off. And you gradually work on different exercises that then strengthen your ankle.
How long am I sort of expected to do that for before feeling like it's, you know, I'm getting somewhere with it.
From a control point of view, it should only take a couple of weeks to feel that you're getting improvement, yeah. And then from a strength point of view, you're looking at two to three months. So it's not long in the grand scheme of things. So it's worth taking that time and getting it right before you break out into all these long training runs.
Yep. Okay, so I'm balancing, I'm running and I'm feeling, oh, I'm getting somewhere. What kind of pain or how extreme, you know, how do I explain this? I feel a little bit of pain, should I just harden up and keep going, or do I stretch, put ice on it, or come and see you guys? When do I really need to, I guess, engage you, you know, to help me with my pain issues?
I guess the question is is it a little niggle, and is that niggle getting worse and worse, in which case you need to do something about it. If you have a sudden, very strong pain that might indicate that you've pulled something, then yes, you need to get that looked at. If it's just a little niggle, you go home, you put your feet up, next day it's gone, that's fine, okay. And the other thing is where the pain is. So if it's a sore muscle, again, give it a rest, give it a break and then keep going, 'cause that's generally okay. But some pains like a joint pain or a pain that just doesn't feel quite right, then that's probably worth getting checked out.
So shin splints, are I guess, pretty common. You know, so that pain in the front of the shin, and my calves, man, they're hard as rocks every day, let alone like, introducing running.
Going for a run, yeah.
So should I introduce maybe some massage there? Should I have like super-loose calves all the time, or is it okay to have rock-hard calves?
You'll probably never have super-loose calves. You probably need to be doing regular stretches so they're looser to adapt for your running.
Okay
Yeah, and it doesn't hurt to have a massage on a regular basis as well. Again, obviously it depends on how
It hurts too though, Cat.
much money you wanna throw into it.
Depends if they put the elbow in, yeah.
Yeah, yeah, yeah, yeah.
But you know, if you're a tight person, you're a tight person and that's just how you're gonna be. It's good for your sprinting, you'll have good speed.
I've always been a sprinter, see this is the challenge. This is the challenge, trying to get some distance in. Okay, very good. Getting back to shoes and orthotics. All right, so this is the, should I have my orthotics in my running shoes?
Again, there's probably debate around this. I, my gut feeling, although there's I'm not sure about the evidence, Cat will be able to correct you, is there's enough, the shoes are so well-designed nowadays, you shouldn't have to have orthotics. If they assess you properly and give you the right shoes, you shouldn't need orthotics in running shoes. But Cat might have a different view.
Yeah, no, I mean that's the basic sort of feel at the moment is that you shouldn't need a lot of extra stuff. If you are gonna wear orthotics in your running shoes, you have to make sure you take the current inner soul out and swap it in. But a lot of the thing at the moment is just getting the right shoes for you. And the trend now is to go for those neutral shoes. And then if you need something else, then put your orthotic in, but not going for a control shoe with an orthotic 'cause that's overdoing it.
Yeah. I've heard certain brands can just be, you know, basically fashion brands and some are far more suited to running. So I don't really wanna name names, but one of the features that I found, or was told, was that if the shoe can basically twist like that, then it's not a very stable shoe. Is that, would you agree?
That is true, but it depends on what kind of shoe you want, and if you wan that extra stability versus more mobility, if that suits your foot. For example, also trail shoes, trail shoes are much stiffer and that's because you want that support and you wanna just take some shock and some loading off the foot on the trail. So again, the shoe needs to be right for the person and right for what you're gonna do in it.
And then certain brands might be thinner than other brands. Some people have wider feet, so they lean towards the more Brooks that offer that, or New Balance, whereas other people have narrow feet, so people go into things like Nike, which is seen more as trendy brands now, but they were your traditional running shoes, or revolutionised running shoes with the Nike Pegasus.
Yeah, just had Phil Knight's book lying around.
"Shoe Dog"
It's a great book.
It's a great book.
Sensational. Great, guys. Okay so I'm feeling pretty good, I've got my running going, and I'm managing my pain. You kind of said, if it goes away then after maybe a day or two, or three?
Yeah, a day or two is fine. And as long as it's a kind of pain that doesn't concern you, you know, aches and things are actually really normal when you start running again after a long while. Yep.
Which you'd probably remember from your football days. That normal muscle soreness.
Oh yeah, no, crutches were pretty good sign that, you know, I wasn't really running the next day, yeah.
[Duncan] Shin facing backwards.
[Catherine] Yeah.
Any other tips? What am I missing here? Is there something that I might be missing?
Again, sometimes it's the nature of the pain. So sharp pains, like something stabbing you when you're running, that's not very good, you need to get those looked at, but those achy pains or those sore kind of pains, you know, the type of, you know, when you've over done things is a very different pain to when you've really injured yourself. So listen to your body is probably the best thing. And again, with your running, when you're going back, is having some rest weeks or quieter days where you're not actually just trying to increase, increase, increase 'cause that's when things go wrong.
Yeah.
Yeah, and a lot of the running programmes now are about three weeks they build up the intensity, then have a really low week and then start again.
That's a good idea.
Yeah.
Yeah. I can deal with that.
Yeah.
[Catherine] The quiet weeks, yeah.
Oh no, I think that's true. There was always this, well not always, but when I went plant-based it was, hey, just try it for three days, and if you do it for three days, then try three weeks. And that was quite an easy thing to focus on, versus, oh, this is a three month thing.
Yeah, and that's the hard thing with running, 'cause getting back into it, you're probably looking at three months before you starting to feel comfortable.
Absolutely, yeah.
[Duncan] So you need these little mini breaks and rewards. So rewards are important as well.
Yeah, chocolate cake.
Chocolate cake, yeah.
Or cheese.
Of course.
I like chocolate cake, but I'm only allowed to eat it when I've done those runs, see?
Yeah, that's it, that's it. And not to be too hard on yourself if you miss a run here or there, you know, that's normal that happens.
And then back to what Cat said also earlier, is listen to your body. So if you start a run and you feel you've got a twinge or a niggle, maybe just back right off, see if you can stretch it out, and if you can't, maybe just leave it 'til the next day. 'Cause pushing through, especially starting again, you may as well wait a day, then put yourself out for a few weeks.
Knee pain, we haven't really talked about that. We focused a lot on my ankles, but knee pain. Where does, where does the knee start and finish? Because, no, this might be a silly question, right, but you know, I've got the shin splint sort of occurring and then I've got like that, obviously the knee joint. But if I'm feeling it halfway up the thigh, is that, could that be a knee issue, or is that something else?
It can be, but often thigh pain is related to the hip or the back as well. So if you're getting odd pains in the middle of your thigh, if it's not from the muscle and you can't stretch it out or rest it out, then you probably need to get both your hip, your back, and your knee checked. But usually pain in the body, it doesn't go upwards, if that makes sense.
It tends to go
Maybe I just need to stop.
from the up down.
Just starting swimming or something.
Start all over again. But you know what, all the exercises that you'd be doing for your ankle, they're gonna help your hip and your knee anyway.
Yeah.
Yeah, groovy. I like the Bosu Ball idea, the balancing, the standing on one foot when I'm brushing my teeth, it sounds to me that's where I need to start, is actually do some balance to build up my ankle strength. And then back to the foot pain. Where's the most likely place that I might start to feel pain in my foot? What seems the most common foot-
Well, one of the most common problems with runners is the plantar fascia.
Okay, well all know where that is, right?
It's a big band that goes from your heel to the base of your big toe, okay.
Yeah, underneath.
So straight underneath your foot, yeah, underneath your foot. What most people say they feel first is heel pain. So your heel hits the floor and ouch. And a lot of them will get morning pain. So they get up in the morning and they're like, ooh, ooh, ooh, you know, creeping around because when their foot's on the floor it's sore. Then it warms up, feels better, go for a run, same thing the next day. So that needs to be sorted out, because again, if you're not running properly because your foot is sore, that affects everything else. But that's the most common thing we see for sure.
And that's more of a style thing, and possibly shoe thing is it?
It's a loading thing.
Loading.
Loading.
So you've probably done too much too quickly.
Oh.
Yeah, or you've changed your running too quickly. It's something that's changed quicker than your body has adapted.
Gotcha.
Or we see people, out of the blue, mix up their training, so they'll go and do a cycle, or a long bike ride and then go back and do a run the next day. Yeah.
Or that afternoon.
Oh so I wanna do a triathlon this weekend. You reckon I can do it? Without any pain?
We'll see you on Friday, We'll see you on Monday.
Yeah, we'll see you before you do the triathlon, you're not going. Rightio, good one. Anything else, guys? Anything else to add?
Not for me.
I would just say, you know, if you wanna get back to sport, get out there and do it, but just do it sensibly, take your time and make sure you do all those other things that help, you know, the strength work and the stretching as well.
Yeah.
And I think from what we see too, a lot of people get scared of little pains and I think they've gotta realise it's slightly normal and natural. And if you're not causing more damage, some people just do accept they have some pain, and build back up slowly, despite pain, as long as it's been cleared and you know it's nothing sinister or causing more problems.
Yeah, that's the kind of thing that, you know, I know I'm gonna feel pain, and I'll probably push through the pain, and then I'd be like, oh, have I done too much here?
That's where some guidance can be good, just so you know it's not something worse, it is just normal.
Yeah, you're better to get something checked early and you know, maybe come in just for one appointment, get it checked, have a review, have a set of exercises and not let it get to something that keeps you out for weeks.
I'm sure it's not just running that's gonna cause all this too.
No, not at all.
There's plenty of stuff, you know, it could be working on a construction site and fell down a hole.
Exactly.
You know, roll my ankle. So for sprains and things like that, are people coming to you for those as well, sprains?
Yeah, sprains and strains of all different sorts, you know, a lot of people just fall downstairs or put their foot in a pothole the wrong way. So there's a million different reasons, it's not only sporting injuries.
Yeah. And when I'm trying to determine whether or not I've done an ACL or, you know, a meniscus tear, are most people, are they going GP, physio, then ortho, is that sorta how it plays or does it?
It really varies. Some people will come to physio first and some people will go to GPs first. The tests that you do in the clinic are actually fairly accurate for the knee, not for some other joints, but for the knee they're pretty good. And then, you know, you can advise people then we'll, I think you need an MRI. But again, a lot of people will go to their GP first and sometimes they get an MRI without any physio at all. But there's no reason, even if you have an injury like that, why you can't start some physio, because even if you end up having surgery, you've got a headstart on rehab.
And then some people we see actively choose not to have surgery, even though it's indicated, because they just don't wanna go through that. So then you really are working on conservative management,
Yes.
long term.
Yeah, one of my mates did both knees really young and just built up his quads to, like supersize quads and calves, yeah.
Yeah.
Which is perfect, unless-
Yeah, so not everything needs surgery, but always if you're in doubt than an opinion from a surgeon is a good idea, but you just don't have to have surgery.
Beautiful.
Yeah.
Guys, thank you so much. That was a free consultation from me, for me, sorry, from E3 Physio. You can find them at E3physio.com.au. There are at Burleigh Heads on the Gold Coast, actually just two doors away from our office, thank you very much. And a beautiful little studio there. Thank you so much, guys. Really appreciate your time. And also find them on the socials, E3 Physio on Instagram, Facebook, and what's the running group that you guys are part of?
Oh, that's the Good Times Running Club. They're fantastic. They run from Tallebudgera Creek, outside the, don't know what that surf club is called, but near the-
Tallebudgera Surf Club.
Tallebudgera Surf Club, yeah
Yeah, run from there a couple of times a week and it's a really lovely, supportive club.
It's a really social club, it's great.
Groovy, and, favourite running shop to get shoes from.
The one at Burleigh.
Yeah, The Running Shop.
The Running Shop?
I think it's actually called The Running Shop, isn't it?
Yeah. In James Street.
Down James Street.
James Street, that one.
Oh, legends, beautiful.
Yeah, they're very good. He's got the treadmill set up and loads of kind of personal knowledge and advice.
Great, and I'll give a shout out to Sporties Warehouse as well, one of our clients, a huge range of shoes there too.
Yeah, perfect.
Thanks, guys.
Thanks, Chris.
Thanks, Chris.
Cheers.
[Man] Can you just quickly ask about barefoot running?
Okay.
Well done.
Oh god, contentious issue.
Yeah, barefoot running. All right, I was, I nearly did that earlier. So those barefoot shoes or just running barefoot, what are your thoughts?
Oh, whether one is better than the other?
Well no, just-
I think you need to take a step back first of all and think about barefoot running. If people approach it, they have to approach it really slowly. Barefoot running was great for our business because we got a lot of injuries,
Oh my god.
Like, people getting into CrossFit, just because you're not used to it. So I think it's building up really slowly. And then whether you go the shoes or barefoot straight, the shoes are just a little bit of preventing you getting stuff in your feet, I suppose,
Yeah, yeah.
as well.
Yeah, the shoes are more just to protect you from burning your feet, and things like that.
Yeah 'cause skin's really tough, hey?
The thing is, when people build it up properly they do, they get really tough feet. And you know, being barefoot for some part of each day is actually very good for your little muscles in your foot. So you shouldn't actually wear shoes all the time, but it's gonna be a personal choice as to whether you wanna run without shoes. Like everything, build slowly, yeah.
And also we're running on concrete nowadays, which is pretty punishing for your feet. So barefoot might be great for soft sand or grass, but concrete, maybe not so much.
That's a good point. Something that we didn't raise. When I'm running, should I be sticking to the path, the road, or find grass at every opportunity, like what's gonna be the lowest impact?
Well, as far as impact goes, grass is better, however, it's the unstable surface. So it's a bit of a catch 22 in that if, for example, like yourself, you're having any ankle problems, the grass might be quite hard to start with and not so safe for you, so you'd be better on a really nice, lovely, straight concrete path and then progress to the grass. But if you were having impact based problems where you were getting sore and you were stable enough, then I would go onto the grass. If you really wanna work hard, then you go onto the soft sand.
Yeah.
Yeah.
But making sure I've got that stability right.
Yeah, get your stability right first, yep.
And you back off your k's a lot when you start soft sand. You just do a little bit, much less than you are on the road.
Yeah, I'm fine with that.
And build it up. Yeah.
Soft sand running's hard.
[Duncan] Yeah, really hard.
Burns the calves too, 'cause you tend to be
You have to push.
stabbing. It changes your actual foot angle too.
Yeah, it does.
You can't mid strike, or anything like that,
No.
You just,
No, no, no.
end up almost doing a ballerina move, straight into the sand.
Yeah, and that goes back, I think, to the first point of what you wanna achieve. If you want to run on trails, do you need to be training on trails. If you wanna run on the road, you run on the road. If you wanna be out running on the beach, then you train on the beach.
Beautiful.