Running Resilience

Running Resilience with Greg Lehman – A Review

10 Take-Home tips from Greg Lehman’s ‘Running Resilience’ course.

Most PhysioS have heard of Greg Lehman, but if you haven’t then I’d urge you to check out his work. To NOT know who he is if you are an up-to-date evidence-based practitioner is to be doing yourself and your clients a disservice. I certainly couldn’t pass up the opportunity to attend his ‘Running Resilience’ Course when I found out it was coming to Exeter! So off I went for a 2-day update on all the latest science and research related to treating runners. The great thing about Greg’s work is that it’s not out of reach in that he makes it clinically relevant and relatable to the common man/woman. There are many caveats to the research findings on this course with regards to ‘real-life’ and so what I came away with was a very balanced knowledge base of what the latest science is telling us combined with a whole room full of practitioners ideas, reasons and experience. It also helps that Greg is a really personable chap who also happens to be really funny too (I promise I’m not getting paid for this!) and so thankfully the course was really enjoyable too. Lord knows we’ve all been on courses that are full of great content but are pretty dry, so this was a refreshing alternative.

Apart from the speaker, the other reason I wanted to get along to this course was because I treat a LOT of runners. I LOVE treating runners. But we all know that running brings with it a risk of injury at around 20-30%. So I’m always interested to find out where we are with the latest research into common running injuries, as well as the current hot topics such as gait analysis, footwear, insoles, recovery etc. This course thankfully delivered on all of those aspects but for the purpose of this blog I’ve summarised;

10 take-home tips from the Greg Lehman Running Resilience course.

Please note these are just SOME of my individual observations and reflections from the course and that they are my interpretation of what I have learnt and therefore may differ from what other people may have taken from the same course.

1) There is no ‘perfect’ looking running gait.

So many of my clients are striving for the ‘perfect’ running gait because they may have read an article in Runners World or watched a few YouTube videos about running gait. There are ways to improve your
performance certainly, but if you are simply striving for a perfect LOOKING gait then you may be wasting your time. Don’t forget that what works for one person may not work for another so if you are in pain and not enjoying your running, seek out your Physio for help. Your running style may be influencing your injury rate and this is where your Physiotherapist will be able to guide you with gait analysis and suggest changes to try, but if you are happy with your style and pain-free then why worry? For most people what seems to happen is that your body figures out the most efficient way for you to run without needing any outside help.

2) Your beliefs create your behaviours - for better or worse!

Cognitive restructuring is the idea that you can influence your pain behaviour and experience of pain by challenging your beliefs about the cause of your pain. This is something that is not new in my practice. In my work as a Spinal Extended Scope Practitioner I spend a lot of time working on patients preconceived ideas of the nature and cause of their pain. Runners are no different. For example if you are a runner who thinks that every run should be hard, painful and a struggle then perhaps you are continuing to sensitise yourself to pain? Or maybe you are addicted to hours of painful daily foam rolling in the belief that this is a good thing? Could this be a negative behaviour that sensitises you to pain but is driven by the need to ‘fix’ your sore muscles? Equally the joy of running may sometimes get lost in the constant analysis of your running when you’re out.

Thoughts such as ‘I must clench my glutes’, or ‘I have flat feet and so I will probably always struggle to run’ or hyper-vigilance of which muscles are ‘on/off’, or are you breathing correctly, are examples of potential over-analysing when you’re running that may be unhelpful and need addressing. Rediscovering the JOY of running and NOT over-thinking is the aim of cognitive restructuring in this instance. For more on this topic (it’s a huge topic & a fascinating one) see Greg’s Website (link at the end).

3) Get to know your CADENCE.

Cadence is the number of times your foot strikes the ground in a given time period, usually measured per minute. Because forward movement only happens when your feet strike the ground, it benefits you to get them off the ground as quickly as possible. Your height, weight, leg and stride length and running ability will determine your optimal cadence. Everyday runners generally fall between 160-170 steps per minute, while elite runners strike the ground around 180 steps per minute or higher—with some getting above 200 at their fastest speeds.

Calculate your cadence by picking either the right or left foot and count how many times it hits the ground in 1 minute and then times that by 2. If you have a lower cadence (150-160) you could consider increasing it by no more than 2-5 steps per minute. Give yourself 6-8 weeks to adapt to these changes to avoid overload and injury. Don’t forget that increasing your cadence is
not about your pace but how long each foot stays on the ground for, there is a difference so don’t confuse the two.

It is possible to run faster but maintain your cadence rate (increased power per step rather than more steps). Try using a metronome when out running to help you if you do decide that you’d like to alter your cadence. There are apps available like Nome or JogTunes. You can also try visualisation or guided imagery where you imagine yourself running with a faster cadence and your body should naturally follow suit.

4) ‘What’s in your Cup?’

This is the ‘Cup Analogy of Sensitivity’ and is applicable to ALL rehab not just for runners. If you consider all the things in your ‘cup’ that are potential stressors that could be contributing to your pain. Pain is what your brain produces from its interpretation of a complex relationship of inputs (i.e. tendon pain) and context (i.e. thoughts, behaviours, beliefs). This is why sometimes you can have tissue changes like osteoarthritis but no pain at all. Or you can get a paper cut, which is so innocuous but REALLY hurts!
If you have ever been treated by me in the past then you will know that I remind people that scans that show ‘structural damage’ are very poorly correlated with pain. So you can have changes on an MRI that are NOT related to your pain and this means that structure doesn’t always equal pain or pathology.

Our patterns of behaviour, expectations, lifestyle and psychology all influence our experience of pain. That makes it so individual. Check out Lorimer Moseley’s description of pain in context via his YouTube Video here (link). Pain occurs when all sorts of different components ‘fill’ our cup to the point that it overflows.

The overflowing cup: Build it up or decrease its contents aka: Calm sh*t down and build sh*t back up. Lehman.

What is in your cup that may be causing the pain? Do you have an injury like tendinopathy or muscle tear that may be exacerbated or prolonged because of the other things in your cup? Are you stressed, too tired, not giving yourself enough recovery time? Or maybe you are worried about your injury or fearful about what it means for your future running self? Perhaps your habits are not serving you and your running?

Our aim then is to either
build a bigger cup (strength and correct load) for you so that it doesn’t overflow, or take out some of those stressors inside the cup.

That is the beauty about the cup.  There are a lot of different things we can address to change and manage pain.  Rarely, is there ever one thing that needs fixing.  

“We can either decrease the sensitizing agents or we can build a bigger cup.  This is well illustrated with tendinopathy. You don't change the degeneration/tendinosis dramatically rather you build up the healthy tendon around the tendinosis and now normal loading is no longer sensitizing.  The slow application of load to a person with tendinopathy is probably both building a bigger cup (the tendon adapts, the person might develop modulation of nociception etc) and it can decrease the sensitizing agents (one loads a tendon without dramatic increases in pain and this in turn might increase self efficacy, decrease fear, build resilience, increase hope or even decrease nociception).” Greg Lehman.

5) No SINGLE factor causes injury. Manage the MICRO.

Micro-load management basically means considering the
specific loads relevant to YOU. For example the way your foot strikes the floor when you run, or the kinematics (your motion) when you run, or how your hip/knee/ankle behaves under load. These are all useful things to consider within the wider context of your injury or pain. A good Physio will be able to assess you as a whole person, not just ‘a painful knee’. Because as we mentioned above, you may have a hugely flamboyant running style but never suffer with pain, or you may find that the small change you made recently IS contributing to your injury.

So the concept of micro-load management would be considering the specifics or small details of your running style and changing them up or down accordingly. This assumes that the injury is relating to the runner failing to adapt to the stress/load placed on specific tissues. It’s worth thinking of this as a ‘temporary desensitiser’ to allow the body time to cope. You may then be able to reintroduce the changes that you originally wanted but at a rate that your body can adapt happily to.

Modifying symptoms can be achieved by simply ‘doing something different’. Antony Lo’s voice is ringing in my ears as I type that phrase as he’s a big advocate of finding what works for the individual. That’s what makes Physio so interesting and worthwhile in my book. Once you’ve ruled out any specific nasty pathology it can become a more fluid an adaptable programme for YOU.

Symptom modification;

    The list goes on. By cueing people to work on muscle groups that are not adapting as well as we need them to, one can often change painful symptoms for the better very, very quickly. You can get an entire muscle group stronger and more efficient by doing this. What’s interesting to remember is that the reduced pain may not all be due to the association with load. Context, environmental factors, gait styles and changing cues can all contribute to the management of micro-load.

    6) Train Smart! Manage the MACRO.

    The ability to design a running programme that suits your capacity to load and adapt is key to remaining injury free. But how do you decide which running training programme to follow? What can often happen is that people start their training by doing too many runs a week, running too fast on those runs and not allowing the recovery time required to adapt to the new loads. With the arrival of smart technology, apps and the wealth of information on the Internet, we are seeing more runners following training programmes that may in fact be for elite runners rather than recreational runners. This can lead to problems without you realising it.

    Obviously the classic Couch to 5K programmes provide a much gentler increase in training but in my experience people do get a bit over-excited and want to do more than their programmes recommend. It’s normal to want to test out your new running skills but always bear in mind that;

    - how fast
    - how hard
    - how soon

    you train will indicate how well you progress through your programme, and how likely you are to pick up injury.
    Many runners do their long run too hard.

    7) 80/20 rule.

    80% of your training should be done in the SLOW zone (slower than marathon pace) and only 20% in the HIGH intensity zone as described by Stephen Sieler (link here).

    The border between LOW and MODERATE intensity is when you
    first have to start breathing harder. So 80% of the time you should be able to chat away happily because you are not breathing hard. I’m fairly sure that the majority of people run faster than this most of the time. Ever heard of ‘Garminitis’? It strikes the avid Garmin wearer who is constantly trying to outdo their last session (though not limited to Garmin; Strava is also included!). Why not try every now and then just going for a run for the pure JOY of running. Really connect with how your body feels as you move it. Something to consider the next time you get out there.

    8) Adaptability is finite.

    Your ability to physiologically adapt to load is determined by factors discussed already. However even if you were to follow the most individualised and science-backed training programme for you, in the correct amount of time and accommodating recovery, sleep, stress etc. There will always be the
    genetic component that you cannot alter. Some people are genetically predisposed to be able to run further, or faster than others.

    Adaptability to load will not continue indefinitely, so at some point you may need to consider what level of running you are ‘supposed’ to do. This will apply more to the elite level than the recreational but with the rise of the Ultra-Marathon/Ironman movement, we are seeing more and more recreational athletes pushing themselves to their absolute limits. You need to sometimes question what the ultimate goal for these people is and how we can support them to enjoy activity without injuring themselves.

    9) Soleus who?

    Most people know where their Gluteal muscles are and why they’re important, but not many people have heard of the Soleus muscle. It’s quite far away from the glutes but it is no less important. The Soleus muscle makes up part of the Triceps Surae complex of the calf. The Gastrocnemius and Plantaris complete the happy trio in the lower leg yet the Soleus gets much less press than the easier to spot Gastroc muscle. The Soleus is a large flat muscle that acts to point the foot downwards. Not only does the Soleus point the foot downwards (push the floor away) but it acts to hold the lower leg ‘upright’ while running which prevents it from ‘falling forward’.

    Strong calf muscles not only supports lots of weight but they also need to transfer energy (hence the size & strength of the Achilles tendon). The reason you should get to know your soleus muscle is that it produces far more force during running than any other muscle group in the lower limb! According to Dorn et al (2012) the Soleus generates significantly more force as you can see below:

    Soleus 6.5 – 8.0 BW force.
    Glute Max 1.5 – 2.8 BW force.
    Glute Med 2.6 – 3.5 BW force.
    Quadriceps 4 -6 BW force.
    Gastrocnemius (other calf muscle) 2.5 – 3.0 BW force.

    Progressing running speed from jogging to sprinting is mostly dependant on the ankle and hip muscle performance. This is probably why you’ll hear so much about Glute Max as a particular muscle to work on. Pushing on the ground at slower speeds is mainly due to the ankle plantar flexors (<7.0 m/s). Above those speeds the hip muscle complex becomes more dominant. Therefore it makes sense to train the ankle planter flexors with isolated strengthening to improve running performance i.e. seated calf-raises. Also slower paced running training focuses on this muscle group strengthening as well which is worth considering in relation to your overall programme and goals.

    Hopefully I’ve made a case for getting to know your Soleus muscle as its quite incredible really. If you’re interested in knowing more about how to look after this muscle group and strengthen it then look out for the next blog that will focus solely on this.

    10) Shifting Stress.

    A substantial review of the literature and research relating to load and running assumes that the runner has failed to adapt to the load placed on specific tissues. By ‘shifting stress’ you can either aim to temporarily desensitize the tissue by altering the load or create a long-term alteration if the tissues cannot adapt to the changes that have been placed on them. Research into various running injuries has applied shifting stress to the following;

      As I’ve already touched on in this blog, there is no recipe or ‘one size fits all’ but perhaps use the shifting stress review as a starting point and discuss your programme with your Physio if you’d like more detailed help with what I’ve covered here.

      Try to remember the following when you next go out running;

      “Your slow is too fast and your fast is too slow.”

      Thanks for reading.