GOLD COAST MARATHON SERIES - EXPERT PHYSIO ADVICE, SLEEP MONSTERS & SOME INJURY PREVENTION TRUTHS

[00:00] Welcome back — this is In The Beginning's Wednesday instalment, and today's episode is especially fitting if you caught last Wednesday's with Benita and Bronte. Because we're both broken. We've brought in an expert to help fix us and give some real information on — what are we now, eight and a half weeks out? — what you should be thinking about besides just running. Last episode Benita had a great line about how important it is for coaches to work alongside the other professionals in an athlete's life.

[00:31] So today we're joined by a professional, Britt Kayling. Can you explain your qualifications? — Officially I'm an Australian Physiotherapy Association-titled Sports and Exercise Physiotherapist. I got my title 21 years ago now, so I've been doing sports and exercise physio for a long time. I think I met Courtney back in 2002.

[01:03] That was probably the first time — it was my first international appointment as a sports and exercise physio, with the Australian triathlon team's world junior team, in Mexico for Worlds. You were part of the senior team heading off around the same time.

[01:33] It's amazing to have someone on the podcast who actually remembers things about Courtney, because if I ask him anything he can't recall. All Courtney remembers about Mexico is a place called Senor Frog's and a water slide with an alligator around it.

[02:03] Fast forward — the main thing was we went to an Olympics together, with you as team physio. I was with triathlon back in the early 2000s, then went to work with Australian open-water swimming for a while, before coming back to triathlon around 2008, just after the Beijing Olympics, and followed Courtney and the team through to the London Olympics, then through to the 2016 Rio Olympics as part of the Australian headquarters team.

[02:33] I continued through to around 2020, mostly with triathlon and running, with a bit of swimming thrown in. So you know what you're doing. I'd hope so. The other reason we've got you specifically — there's a host of great physios on the Coast we could have had on, but you're also the director of Gold Coast Physio and Sports Health, which is currently repairing me on a weekly or semi-weekly basis.

[03:05] So you're the perfect person to have on, because a quick update: the calf's not going great. If you listened to last Saturday's episode, I was flying — back running over an hour. Then I tried a light tempo session as prescribed by Benita and it couldn't have gone worse. So now I've got a new programme with basically no running, and I'm regularly seeing Liam Ryan at Gold Coast Physio in Burleigh.

[03:37] I've got dry needling tomorrow. Liam asked me at my last appointment how I go with needles — terrible, I have to lie down for immunisations. He said it'll help, so I've got an appointment straight after we record this. For anyone listening who has no idea what dry needling is —

[04:07] Britt, are we talking trigger-point needling, not the big acupuncture needles? — Dry needling is a form of acupuncture, used more by physios, targeting trigger points — the knot in a muscle — to release tension. The needle doesn't hurt, it's more like a little pinch.

[04:37] You sound scared of needles. — I am. It's the mental side of it that gets me. And when it hits the spot and gives a little twitch — is that meant to happen? — Yes, a twitch. It's more the anxiety before it than the twitch itself, because you know it's coming.

[05:08] I want to come back to some of Britt's achievements and where our paths have crossed over the years — there's a whole other side to her, racing, that I'm going to call "sleep monsters." — You can't just say sleep monsters and move on! — You'll have to wait to find out. But first — we're focused on running here around the Gold Coast Marathon — what's the most common injury that comes in during a marathon block?

[05:42] We don't keep specific stats pointing to one injury, but if I go back to around 2020, through COVID, and around this stage of marathon prep — the next two to three weeks — we'd start to see bone stress injuries come in. I know a bit about that myself right now.

[06:14] A bone stress injury is often a training-load error — people commit to marathon training before their bone health is ready, and start to get bone injuries, which significantly limits training. We'd see those pop up, and through COVID it got to the point of "expect this to be a bone injury until proven otherwise" — that's how common it became. Everyone had too much time on their hands in 2020-2021.

[06:44] The other thing we see now is calf and Achilles problems, from the jump in training load, different shoes, different surfaces, without necessarily the background for it. You've spoken on the podcast before about needing a base before a specific prep block —

[07:15] and I still don't think people get that right, or commit to it for long enough — not enough strength work, not enough of the other training. So we see a lot of knee, Achilles and calf issues around this time, right up until about two weeks out. For people listening who are running their first marathon and have never seen a physio —

[07:45] because they're new to running and haven't been injured yet — we talk about the idea that if you run for long enough, you'll get injured, and that base you mentioned, not being ready for it. Most marathon programmes are a 12-week block. Without asking for an exact number, because everyone's different — how long does that base typically need to be

[08:16] to successfully get through a marathon block? — It's really variable depending on your background. Take swimmers, for example — someone who's been an elite swimmer and decides to switch to running: their body is completely unprepared for the impact loads of running against gravity. They'd need a lot longer — even for a swimmer, I'm talking twelve to eighteen months

[08:48] of some running before their body can cope. For someone doing two or three runs a week who then commits to a marathon, you'd still need a good six to eight months ticking along consistently, weight-bearing, maybe some variability with bike or swimming thrown in, before committing more fully to something structured. Instead, people just begin — "this is a great challenge, my friend wants to do it, I've been doing parkrun once a week and maybe one other run" —

[09:20] and it's just not enough. — There'll be people listening going "oh no." — But there's a happy middle ground, because we're talking about actually running it, not walk-jogging it, which is a different scenario. I'm surprised you said bone injuries — I expected calves. But it makes sense with the bone stuff, because I always think of that as an elite-runner problem, overdoing the volume —

[09:51] but it's the same thing on a different scale for recreational runners. Injury has what's called a U-shaped association with training load — someone very underdone has a high risk of injury, and someone very overtrained has a high risk of injury too. But someone at a moderate-to-high training load, sustained

[10:23] chronically — over a long period — is protected from injury. So newbies are at risk, and people pushing the boundary are at risk, but there's a happy medium in the middle that's protective. — I'm trying to work out where I sit on that U-curve. — You bounce around every week, depending on what we're talking about. — And that in itself is a risk. We don't actually know that

[10:53] much about preventing injuries. People come into the clinic all the time asking how to prevent injuries — if I had a magic pill for that, I'd be rich. — You wouldn't need the clinic then. — There's nothing I can tell you to do that guarantees you won't get injured. That's not really our role in health — it's about supporting you to

[11:24] stop bouncing between high and low training loads, and finding a happy medium where you continue at a consistent volume — because it's that consistency that protects you from injury and helps you reach your goals, rather than up one week, down the next. — My advice: don't let your podcast co-host talk you into a trail race in Tasmania with

[11:55] two thousand metres of vert and then try to jump straight into a 12-week marathon programme. — But that idea — for people who've never seen a physio — of finding that spot on the curve where you maintain fitness and training while minimising injury, knowing it isn't fully preventable —

[12:25] As you're talking I've got a million questions. Here's one: you said you'd be rich if you knew what to tell everyone to do every week, but for new runners, if you had three things to activate or do before a run to help prevent injury, what would they be? — Every person's different, it depends on your strengths and weaknesses,

[12:58] but as a general answer for a complete beginner wanting to activate before a run — what would three areas or exercises be? — Welcome to Running, presented by Britt Kayling. The biggest one I'd educate someone on is sleep. I know that's not something you do right before a run, but our three pillars for reducing risk would start with sleep — are you getting adequate sleep for what you need, and only you

[13:28] can really work that out. If you're someone who keeps getting repeat injuries and you're always tired, you need to look at your sleep — better volume or better quality. — Never heard it put like that before. — Sleep is the foundation of recovery. The idea of improving performance is that you train to give your body a stimulus, that stimulus causes a positive adaptation that should make you better —

[13:59] but the positive adaptation only happens when your tissues get the recovery to repair. Say you go out and do an intensity session — if your body isn't fully repaired, it can stay in a high-tension state. You then keep training on top of that without full recovery — whether from sleep, nutrition, or something else — and your body isn't

[14:31] back to its normal tone, and suddenly your calf's tight and sore. — That maps exactly to an example: straight off the back of one hard session, I went into breakfast radio and was probably getting about five hours' sleep a night that week. I wasn't rested. — That makes sense. So sleep is one. The second is nutrition —

[15:01] what I often find is people new to the sport, or who've never been around elite environments, will say "I feel like my nutrition's really clean, I eat healthy, not much sugar." Then I ask, does your nutrition vary day to day or week to week? "No, I'm pretty consistent." Does your training vary day to day? "Yes, absolutely." Well, your nutrition has to vary the same way your training does. On a high-training

[15:33] day, you need to fuel for that day beforehand. Similarly, in a high-volume week, or a week where training's ramping up, your nutrition has to fuel that lead-in — because without those nutritional pillars, your body can't repair itself properly. One of the conversations I have regularly — I'm not a sports dietitian, but I work in a team, along Benita's lines, using health professionals around you —

[16:03] and I'll refer an athlete to a dietitian if I think they're a bit under-fuelled. You can be super clean, not eating any sugar, really healthy, but not getting enough volume of food and energy to fuel your sessions. So I'll send someone to a sports dietitian to review the volume of what they're eating — that would be a second big risk factor, particularly with bone stress injuries.

[16:35] Interesting — the first thing once my scan came back positive for a stress reaction was getting bloods done on all my bone minerals. Not directly about nutrition, but checking whether it was actually a nutrition problem, right down to the bone. — Exactly. If you're not fuelling enough — not putting enough total energy in but expecting your body to use energy — where's it coming from? It's going to come from your tissues.

[17:07] When you put it like that, it's obvious. I also want to come back to your third point, but on the idea that Benita, as an expert at Lace Up Running — they're running coaches, they know their stuff — but with the running boom, we're seeing less expert running programmes put out into the world, plus influencers, and a real focus on how you look while

[17:37] you're running. That nutrition angle is interesting — you only have to jump on Instagram to see runners more concerned with how they look running than what they're actually achieving. We probably don't have time today to dig into what those people are eating to fuel their running while also trying to look a certain way. Sorry —

[18:07] and I'd add that it also depends on your age and training status. For me, as a more mature female now hitting perimenopause, my nutritional needs have changed significantly from eight years ago. So the needs I have now are different again to, say, a 24-year-old male. You have to individualise your nutrition to

[18:39] what you're trying to achieve, who you are, your background, and what stage of life you're in. — OK, my third thing — actually, I'm going to make it four — would be having a coach and a programme supervising you, because it's really easy these days to get an AI programme that isn't individualised, and it's hard to listen to yourself and trust your own instincts. That's something I think Courtney's always been a bit better at —

[19:11] upholding his own judgement and going "something doesn't feel right today, I'm changing what I do." — In the past, maybe. — Also, you've met Courtney, haven't you? It's hard, isn't it — if you're having a good week you go "I'll just add a bit extra here," or "I'll add that extra tempo because I'm feeling good." But with a coach — and I love Benita's approach of being a bit conservative and adjusting almost week to week —

[19:43] she can check in on how you're going and modify the programme if needed, because most of us wouldn't hold ourselves to that. We'd push through no matter what the ego's shouting at us mid-week when we're flying. That week-to-week thing — when we set up this whole 12-week programme with Benita, I expected a spreadsheet showing all 12 weeks, and at times Benita's said she doesn't

[20:15] know what I'm doing three days from now, because she wants to see how the last session went before deciding the next one. — That's coaching. — That's a real coach, actually being coached, rather than just following a training plan. That's not to take away from online coached-to-5K programmes — they're great and accessible — but if you're chasing a bigger goal, or have a history of problems, having someone supervise and make decisions for you and

[20:47] check in on how you're going is really important — plus it takes away the stress of having to think for yourself. That's the main thing coaching does: left to your own devices, you make dumb decisions. It's the classic "do as I say, not as I do" — even I don't always follow my own advice; I still go and do dumb things. Don't do either. And the fourth thing I'd add is I love having what I call a

[21:20] pre-training routine. This is what we use in elite sport — how does an elite athlete know how they're going to perform on a given day? You can't do something different leading into a race or competition every time. You can't do something different every morning, because then you don't know what to expect from your body. So we should have a little routine before training or before racing — a sequence of stretches, drills or other exercises that gets your body and brain prepared for the

[21:51] stimulus you're about to give it. What that might look like — take that example of the swimmer who's decided to do their first marathon. If they're more mobile in their body structure, with floppier joints, not used to the feel of gravity against the ground, they don't really know where to put their body. They probably don't need more flexibility. What they need is to learn what I call strengthening their Wi-Fi signal — the brain connecting to the body better, knowing where

[22:21] they are in space, so that when they run, they're prepared for those gravity forces. That might mean a sequence of calf raises, some hip stability, some core stability, or drills that prepare them for a better run. Or for someone like Courtney, if he's running well, it might just be a couple of activation exercises through his glutes or calves, or a stretch if his hip flexors are tight —

[22:52] that again prepares him, so when he goes out to run, he'll feel better and find better positions straight away. It's individual to everybody. — I love that. Did you have a pre-race routine? — Of course. It varied over time depending on the week or the gym programme. I used Swiss balls a lot — activating glutes on a Swiss ball. Hard to explain in

[23:24] audio, but similar to hip thrusts or glute bridges, just taken a step further using instability, like a ball, to make it more difficult. That worked really well for stabilisation and activation before racing. Not everyone has access to that kind of setup — when we travelled for triathlon, we'd take Swiss balls to blow up, ergos to ride in our motel rooms.

[23:55] We'd go to the ends of the earth to have everything there that we had at home, to make sure we could activate and get out to race as well as possible. A lot of it came down to your warm-up routine and the timing of it. — But I'm not letting you off the hook that easily, because for our first-time listeners, if I'm going out for my long run tomorrow, what would be three

[24:28] good, broad activation exercises I could do? — The main areas would be calves. When we're running, we're taking six to seven times our body weight through a single leg. Our feet, Achilles and calves have to be really strong, because at the end of the day it's our feet that make first contact with the ground — that's where the force starts. So your calves and Achilles

[25:01] need to be, I guess, two things. First, we want them in a state where they're not too tight and tense — if you're a calf-dominant runner, a toe runner. — Is that a toe runner? — Not always. Sometimes toe runners are strong through their calves and it's not a problem. But if you're known as "the calf guy," someone who always gets tighter calves under load. — That's literally my nickname at Britt's clinic. I walked in the other day after my appointment with Liam and one of the massage therapists called out "calfy runner."

[25:31] So for someone like Liam, it might be some self-massage on the calves to bring the tone down, then some exercises — maybe a sequence of around 15 calf raises, just to connect the brain to firing those calves, then lots of little bunny hops and single-leg hopping. A bunny hop is a small jump across the ground — you don't need many, maybe three sets of eight jumps with a short walk back in between.

[26:02] Again, you're preparing your body to work as those springs against gravity. If that goes well, you might grab a skipping rope for three sets of 20 seconds, or some single-leg hopping — again preparing your body for that impact and release off the ground. The other area is something through your hips and pelvis — glute bridges, single-leg glute bridges, or a little standing wall drill I like to use to get people into the right body position for running.

[26:32] Dr Ben would tell you more about that one — sorry to name-drop, Ben — it can take a while for people to find the right exercise for their glutes, but it's about finding something that works and gets you into a better body position. And the third area would be something like low knees or high knees or A-skips — for people who've done drills before and know what those look like. Again, you're just getting your body into a better position

[27:03] to get ready. So when you walk out the door, it's not "I feel rubbish for the first ten minutes, I can't get going, my hips feel low, I'm running on my toes, my calves are already tight." It's giving your body a stimulus that makes it feel better straight away. It also gives you the chance to notice — "my calves still feel tight after this" — so you know to add a few more calf stretches, or "something doesn't feel right in my arms today,"

[27:34] maybe I need some arm exercises before I go out. It gives you the opportunity to know how you should feel, adjust, and be ready to actually make use of the session when you first step out the door. — This is so good, because despite all my calf problems, I don't think I've ever done this before, and I'd bet a lot of people listening, going into their first marathon, don't have a pre-run routine

[28:06] like that either. — I'd say most don't. And look, it's easy to say "do it," and then in practice you've got a coffee in your hand, waiting on a mate before you run, and the group's already — heading off. — Exactly. But if you can, I think it's great to just pick one of those three pillars and do one exercise before you head out — you can always throw a towel down on the grass and quickly do some glute bridges. It makes a big difference. I know it does, and I'm still someone who doesn't always do it.

[28:40] That's the whole "do as I say, not as I do" thing, because then there are people out there going, "I'll start trying that," and it's the discipline of thinking, if I've budgeted an hour run today, I actually need to treat it as an hour-and-20 or hour-and-15 run, because this pre-run activation needs to occupy 15 minutes of that. — Or it can just be a 65-minute run, you know? It doesn't have to —

[29:11] take away from the run itself. I think a lot of the barrier to doing this — and no disrespect to any industry here — is if you stack up physio, nutrition, psychology, and all the other pillars that go into performance, suddenly you've got half a day of stuff to do before you go running. So it's about working out what works for you, but also that even doing just part of one of those pillars, before you get out of the car, is better

[29:43] than none. If it's your calves, do the calves. If it's glutes, activate the glutes, and you're one step ahead of where you'd otherwise be. If you're getting out of the car, I'd absolutely say do some jumps, or 30 seconds of skipping — think about the position you sit in in a car: bent at the hips, bent at the back, bent at the knees, not putting much force through your calves and feet at all. And then you expect yourself, after maybe a 20-30 minute drive

[30:13] in the morning, to suddenly get upright and work against gravity. That's genuinely hard. — I imagine that matters a lot for people who run in the afternoon too, sitting at a desk all day. I know the single biggest thing that's affected me, going from being 110% a full-time athlete to now being a hybrid of work and everything else while still trying to perform at a reasonably high level, is that I never used to sit down as much as I do now.

[30:44] I put most of my problems down to that — a massive change from 20 years of sitting down mostly on a bike, training, and then lying on a couch, versus now sitting at a computer or a desk. That's the single biggest change in my body since progressing in my career. — Yeah, and there are plenty of people out there who simply can't avoid sitting for their jobs.

[31:14] I think another difficulty for the average runner, the recreational jogger, is not wanting to accept that limitation — the idea of driving to your run and having to think about the position you've been sitting in. "No, I don't want to have to think about

[31:44] the position I've been sitting in — I'm still capable of just getting out of the car and going for a run." I'm 40, and in my head I don't feel 40. I can't really tell the difference — aside from this calf injury — between now and my early twenties. I know there's been fifteen-odd years in between, but I don't feel it. I'm lucky I came out of my amateur

[32:16] football career with the ability to still run and no lasting injuries. But for a lot of people, that acceptance of physical deterioration — like the perimenopause example you gave — isn't something most people think about or accept. — Yeah, our brains sit in a completely different place to our physical tissues. I think what happens is, as a physio in clinic, I have those conversations repeatedly

[32:46] when someone comes back in and says, "but I used to be able to run this pace ten years ago." That opens up the conversation of — well, what else has changed? Sure, we've got the internet now, all this technology, the times have changed. What's changed, and maybe your football days gave you a certain strength in some areas that you no longer retain, so now you have to counteract that. So maybe you don't want to think about it, but that's why

[33:16] you outsource it to us. We have those conversations so we can say, OK, here's what we want to put in place for you, given your body structure, your history, and now your injury history — you don't have to think it through yourself. I'm not asking you to think about how you sit in the car; but if you're someone who feels stiff and off getting out of the car, let's do a few of those exercises before you get out, so you're ready. And that's really our job as health professionals — to guide you on what those

[33:46] exercises should be for you as an individual. — Great, that's amazing stuff. My next question is around proactive versus reactive — when it comes to physio, or getting help in general. I'd also frame it as: at what point do I pull the ripcord and go see a physio? Is that the first port of call for a first-time runner, or

[34:16] what's the process I should follow? — I guess it comes down to niggles. There are a few options — most physios with an interest in running can do a running assessment, looking at video over ground or on a treadmill, testing strength or strength endurance, checking your flexibility as a runner. You don't need to be broken

[34:47] to do that. It lets me, as a physio, put together a pre-run routine for you, or give you things to do at night, addressing weaknesses we've found. So it comes down to how much you're interested in knowing those factors, and whether you've got the time, energy and enthusiasm for a few things that might take 10-20 minutes before your runs.

[35:20] You don't have to be broken. For runners who get repeatedly broken, I'd say this is really important, because one of the risk factors for injury is having had an injury before — having had a calf injury is a risk factor for another calf injury. In particular, the four-week period after an injury is your highest-risk period for re-injury. So for broken athletes, that means

[35:51] you'll definitely react and come in for treatment and an opinion. If you've been broken and think you're fixed, where does ongoing treatment fit in? Again, that's time, energy and interest, and whether you've had a good experience with a health professional — or maybe you're on top of your strength and routines but you still get tight calves. That's where something like massage might come in, but you have to work out how frequently you'd need it to

[36:23] keep that tension under control, the tension that builds up from weight-bearing running loads. The other thing I do is a monthly run-technique clinic. I get a lot of non-broken runners come along who just say, "I heard about you, I want to improve my running." I had a gentleman come in on the weekend doing the 42K at the Gold Coast Marathon who said, "I'm not broken, I just want to see if there's something that will help me get through it better —

[36:55] I just want to be a bit more efficient." — And did you find something specific that helped him? — Yes. The run-technique clinic serves a few purposes. My other physios in the clinic will often send someone down to me — say, someone with a repeat calf or Achilles problem, or a grumbly knee that doesn't stop them running but's bothersome every time they run. They'll send them down and ask me to have a

[37:25] look at them running, do some drills, and try to find something in how they're using that leg that we can change to make the knee less grumbly. So I get people that way, and then I get people who just want to improve their running, or don't feel quite right and want to know if there's something to improve their efficiency. What I'm trying to do with those people — I'm a big believer in running drills. I can send someone to the gym and give them lots of

[37:58] exercises to get stronger, but that doesn't always transfer into better running positions or into your actual running. So we want exercises that are as close to running as possible, that help you improve your running without just more running — that's where drills come into play. They help you find the positions and postures, and build strength in the areas you need, that then feed into your running. What I look at in those run-technique clinics —

[38:28] we know from the research that everyone runs differently, but there are some factors that are still generally better. From working with movement scientists for a long time in elite sport — that's their full-time role at places like the AIS, and Courtney, you've been through that a number of times, haven't you, running across force plates being filmed to find something that might give you a small edge in your running or performance? It's the same idea for me — a movement-analysis scientist or a good physio

[39:00] should be able to watch you and say, "you're wasting time out the back of your swing phase, your leg's trailing behind you — let's try to get your leg through a bit faster when it's on the ground." If you can gain even an extra ten centimetres of stride length by improving the plyometric rebound or spring capacity of your tendons with dynamic off-the-ground drills — imagine getting that extra ten centimetres out of every stride in a

[39:31] marathon. That adds up fast over the distance. So that's the other group I get in the clinic — people who aren't broken but want to improve performance, and figuring out how we support that going forward. When you're talking about those kinds of general cues that most runners would want — lift your hips, or whatever it is — do you use verbal cues for that? — Yes.

[40:02] Would you mind sharing a couple of general ones you like? — We've talked about cues a lot on this podcast, and they don't work for everyone, because everyone reacts differently. Things that work for me don't work for Liam. What was that one cue — driving through the big toe? — I've moved away from that a little, again from working with movement scientists, rather than —

[40:34] I know I've heard you talk before, Courtney, about how when you were first told to think about your running, it — was a lot to take in. — OK, let's just stop there — do you know what I mean? There are cues that work well for me too, but that one felt particularly heavy-handed. These days I try not to make them body cues — "squeeze your glute," "turn this on," "tense there, push your —" I personally don't use that.

[41:05] What I do instead is run some drills, and if something looks really good — the person looks light and floaty when they run — I'll ask how it felt, and they'll say "really good." You video it, show them, and they'll say "wow, that looks easy." That's exactly what we're looking for. So then I ask, what did it feel like — I want a feeling, not an instruction. So

[41:36] does it feel like you're chasing a carrot? Does it feel like there's a fishing line pulling from your belly button? Does it feel like someone's got a skirt around you and they're lifting it up? I try to make the cues about how it feels, rather than push here, hold there.

[42:09] So you're drawing out what they're feeling, rather than pushing an instruction on them. — Interesting. Sometimes with arm carriage too — I won't name names, but I remember working in a triathlon programme with an elite female athlete who'd drop her arms quite low, which would rotate her body. The movement-analysis scientist got her into a better position with her arms higher, which increased the rate of her arm swing — and because your arms and legs work together, her legs picked up the rate too. They then asked her what that felt like, and she said

[42:39] it actually felt like she was taking a photo — holding a camera. So that became her cue: coming off the bike, in the first 400 metres, think about taking a photo. And it got her into a better position straight away. — Individualised cues, that's amazing. — All of this comes with the caveat that it depends on the individual, but I love the idea that everyone, next time you go for a run that feels really good, should think about what made it feel that way, and try to

[43:10] find the cue that led you to that feeling during the run, and hold onto it going forward. — I also want to quickly pick up on the idea of drills, given the running boom we're in — I can picture run clubs picking this up, doing run drills before sessions instead of just meeting at the coffee shop and heading off. Have you seen the ones from Africa and Asia where they do run drills in unison, almost like a dance?

[43:43] That's great content. — There's no reason run clubs shouldn't get into it, since that's exactly what they're after. It doesn't have to be much — you could do six sets of ten-metre drills, one of each type, over about 20 metres, and that's it. The number of ground contacts in that ten metres is enough to make you feel better and start thinking about it. It doesn't need to be a lot.

[44:15] Going back to that arm-carriage example — speeding up the arms helped with cadence. Talk a bit about cadence and running — from the injury side, does cadence have an effect? I'm thinking too slow a cadence means landing too heavy, versus — is there such a thing as too high a cadence? You probably lose efficiency at some point turning over too fast. Just quickly, for the average runner, cadence means the number of times your feet hit

[44:46] the ground — steps per minute. I dislike the idea that everyone should be running at 180 steps a minute. There's no way I could hold the same cadence as someone like Matt Hauser, who has legs up to my chest — there's just no way we'd run at the same cadence, it doesn't make sense.

[45:18] But I have people all the time telling me they read or heard they should be at 180, and they're at 160, and it feels so hard to get there. And I tell them, that's probably too high for you. There is an optimal for everybody, and there is a too-low. The one thing we really know from the research is

[45:49] that if you have knee pain, increasing your cadence tends to help. So if you're at 160 steps a minute with knee pain, try increasing it by 5% and see if the pain improves. Five percent is still a fair jump — ten percent takes you to around 176 steps a minute — so five to ten percent is quite a lot if you're not used to it. That's where running to a song at the right tempo can help —

[46:20] if I'm trying to move someone from 160 to about 168 steps a minute, find your playlist at 168 BPM and run to that. If you can hold it and it doesn't change your knee pain, you can try going a little faster again, another four or five percent. That's the one thing we know from research — knee pain is linked to cadence. Beyond that, there's a happy medium for everybody. Runners who use their

[46:52] tendons well as springs off the ground will generally have a slightly lower cadence, because they get better distance per stride — they're springier across the ground. So their cadence will naturally be a bit less than someone shuffling along the ground. There's no magic number — it depends on whether you're efficient, whether you're having problems, and whether you actually need to change it. Don't change it just because you

[47:24] heard a song or a podcast say you should be at 180 steps a minute. Change it for the right reason. — This is great — I could sit here and pick your brain all day on cadence. The first time I injured this calf, I went to a physio at Paddy Mac Physio in Sydney, the running room — great physio, loved going there — and one of the things Paddy had me work on was adjusting my cadence. And I'd say to anyone

[47:54] out there — if you're getting knee pain and think you need to look at cadence, go and see a physio, a running expert, someone who knows what they're doing. If you just try to change your cadence yourself, it's the strangest feeling — going from a cadence you've never thought about, that you didn't even know you had, to suddenly running at higher steps per minute. It's a very odd feeling.

[48:24] It really helps to have a professional standing next to you explaining what's going on and why it's beneficial, because it felt very strange doing it. — I love that — but the thing that keeps coming back, no matter what you talk about with running, is that everyone wants black and white, and it's always grey.

[48:57] It's not prescriptive. — Correct. — Do you have any more technical questions? Because I want to get to the sleep monster. — I haven't forgotten. — First, is there anything else we should be aware of that we haven't asked, eight and a half weeks out from the marathon?

[49:29] Actually, the big thing that comes to mind is illness. We always talk about injury, but illness is the other thing that can derail your prep. We talked about how consistent training loads are protective of injury — that's fine, but if you suddenly get the flu and are knocked out for two weeks, what can

[50:00] you do in that time? Sometimes you can't even cross-train to keep a little load in the system — sometimes you're out for seven to fourteen days. I'm trying to recall the stats, but I think something like 30% of people not achieving their goal is due to illness, not injury. So illness has a higher impact than

[50:30] we tend to give it credit for. So what can you do to reduce your risk, not just of injury but illness? In that week or two before the marathon, avoid putting yourself in environments with thousands of other people, since someone's bound to be carrying something. Wear a mask if you want to, wash your hands more, keep your distance —

[51:01] maybe get your partner to do the school and daycare pickups. Skip the crowded events for a bit. Good sleep in that period too — all the things we learned through COVID reduce your risk of getting sick, and that's really important, because sometimes illness puts you out for longer than an injury would.

[51:32] This is probably not a fair question, but — one thing I appreciate about the experts on this podcast so far is that you're all careful not to speak outside your lane, unlike Bronte and me, who'll happily have an opinion on anything. On training through illness — you said illness can wipe you out from even cross-training. I've got a friend who had gastro heading into a race at Port Macquarie. Do you talk to clients about how to train through illness, or is it always just "rest up"?

[52:04] I do talk to people about it. If you want a simple guide — and the doctors will probably pick at me for this — it's "if it's in the chest, let it rest." If you've got chest symptoms, coughing up stuff, breathing issues, you need to rest — that's something you generally can't push through. If it's in the throat, it's more OK to keep going, though that doesn't rhyme quite as well. Chest stuff you need to take more seriously; anything above that, acute respiratory symptoms that are just in your nose and throat with a bit of a runny nose, not feeling too bad — you'd pull back the intensity but try to keep some aerobic stimulus, whether that's an easy short run, ticking over on the bike, or the cross trainer.

[52:35] You need to modify, because your body's using energy and resources to repair itself. If you then ask it to spend that energy on a hard session, you'll usually end up worse off, and that's often when an upper respiratory infection turns into something in the chest that puts you out for longer. — Can nasal strips fix any of that?

[53:07] No. Courtney's back at it — after two failed run attempts, I've been running with a nasal strip on, and I think that's added to the calf issue. — That is not what's hurting your calf. Why the nasal strip, seriously? — Quick backstory — several people have written in suggesting nasal strips are good. Courtney and I start from the position that you don't see many of them in Olympic marathons or on the track, and we kept getting people asking about them. So last week Courtney bought a

[53:41] packet, conveniently timed for when he can't actually run. I've done my last two runs with these nasal strips on. I feel like an idiot wearing them, and the runs haven't gone well anyway. It's mostly the embarrassment of people staring, thinking "why's he got this thing on his nose." Anyway, we don't need to relitigate that — have

[54:11] you ever run in nasal strips, tried them? — I have tried them, yeah — something new comes out, you try it. The challenge with nasal strips is that the part of your nose that opens up usually isn't the limiting part of your whole airway. It probably works for someone whose nose actually is the limiting factor — great, it'll work for them. But for most of us, the limitation is oxygen exchange at the muscular or lung level, not airflow through the nose. — I had a misplaced theory about lungs being like a toilet, but we don't need to go back into that unless people want to.

[54:43] That's a story for another time — that was my fault, I apologise. Do you have any more technical questions? Because I'm not letting Britt leave without hearing about days gone past — what have you got? We talk a lot about definitions, and on social media different things get thrown around. I want to throw one out there — I had shockwave therapy the other day.

[55:13] What's shockwave used for? — Breaking up tendon tissue, among other things — this was for a different injury. I just threw the name out without really knowing it myself. I saw Liam's face when I mentioned it, because there's a lot of different treatments floating around, and it's probably worth touching on. What are some of the physio treatments — we've talked about dry needling — what else are physios using these days? Just a description of what they are, and your take on which ones are genuinely effective. — Personally, I still use a lot

[55:45] of hands-on massage, different techniques, and dry needling fits into that too, because you're affecting tension in the system. So hands-on work, dry needling, and exercise prescription — the right exercise for the right person. Some clinics use shockwave or ultrasound; I personally don't, because I don't think there's enough evidence for it, other than some evidence for low-dose pulsed ultrasound

[56:16] possibly accelerating bone healing in superficial bone stress injuries — meaning close to the surface. Beyond that, the biggest thing I do is education and advice, tailored to the individual in front of me, based on their life, history, current injury, and what they're trying to achieve. That's the biggest thing — there's no magic pill.

[56:48] No, definitely not — and a lot of these things come into trend and go just as fast. — Normatec boots? — Yes, we have those in clinic, and it's a bit like heat and cold therapy — probably quite individual. I don't think compression or hot/cold therapies have the physiological cellular effect people like to think they have.

[57:18] We used to think hot/cold helps clear lactate and makes you feel better — it doesn't really do that, but it can make you feel better. A lot of recovery tools out there work because psychologically they make you feel better — Normatec boots make you stop and rest for 20-30 minutes, and that rest itself helps. So if it makes you feel better, use it. But I also have plenty of athletes who feel worse after an ice bath —

[57:50] and if it makes you tight, cold and tense when we're trying to make you feel better, don't use it. It's not the right tool for you. — That's great advice. Can I ask — can I touch on one more thing, following on from what you and Benita discussed last week about strength training?

[58:22] Yes. That's another thing I think about in runners' programmes — when we said a runner has to tolerate six, seven, even up to nine times their body weight landing on a single leg — you could ask, am I getting stronger just from that? Not really, not necessarily. I'm a big believer in strength training to improve that Wi-Fi signal between brain and muscle. What heavy strength training does is

[58:52] allow your brain to recruit more of the muscle — you learn to fire more muscle fibres with heavier strength training. There's also a difference depending on what a runner needs. If you're doing pure marathon training, especially without intervals, you're giving the muscle the same stimulus over and over, so that brain-to-muscle pathway barely changes. When you do strength training, you give the muscle a different, heavier stimulus, and you learn to use it a bit differently, which is healthy for the muscle

[59:23] and everything that makes up that muscle-tendon-bone complex. So I'm a big believer in strength training. I think part of the barrier for a lot of runners is time, or the fear it'll give you bulky muscles — done properly, it won't, and as a distance runner you don't want extra mass to carry across the ground. You need that strength in the tissue to tolerate the repeated forces of

[59:53] running. It should be periodised — I think what Benita's getting at is that during marathon training, you're not chasing gym PBs; your gym work in that period is maintenance, giving your system a different stimulus from the straight-line running you're doing thousands of repetitions of. Outside a major build, that's where you might actually chase gains in the gym — strength in the hips,

[01:00:26] pelvis, and calves, for example — and it'll look a bit different depending on the phase. Always work with a professional who understands what running actually looks like, so they can individualise your programme around your phase, your goals, your injury history and your weaknesses as an athlete. — I'm glad you brought that up, because I was going to keep it separate. If I'm someone listening and thinking, who do I go to for that?

[01:00:56] Because there are personal trainers, and even here on the Gold Coast — are there specific avenues? Would a physio have the right connections to point you in the right direction, or where should someone go? — If you're a runner with specific goals, I think it helps if the physio, or the personal trainer or strength coach, has themselves been involved in sport or running at some point, because they understand it

[01:01:27] better — the frustration of not being able to run, not just physically but psychologically, and how to support you through the whole thing. So the first step, if you don't know where to start, is to just start Googling — Gold Coast physio with an interest in running, or a Gold Coast strength and conditioning coach with a running background. People with that genuine interest will usually show it

[01:01:59] online, or ask around your group of runners who they use and whether they're happy with them and feel understood. It's easier as a runner to go to someone you can talk running with. And I'll say — we invited you on today because that's exactly why I go to Gold Coast Physio in Burleigh. The first time I actually used Gold Coast

[01:02:30] Physio and Sports Health was up at Ashmore, recommended to see Kyle, an incredible runner himself, and it was great — then I realised I didn't have to drive all the way to Ashmore because there's a clinic in Burleigh. I've been going to Burleigh for a couple of years now. That idea of going and talking to the experts — and just quickly on the strength side, I wanted to say, for the average runner who might not have done strength training, that idea Bronte mentioned

[01:03:01] last week about not enjoying the interval running Benita prescribed for her — that's something Bronte's having to work through in this programme. Testing and activating your muscles with something different is something I think will resonate with people, because if you're just running and then try the gym, that's where the change happens. For the average runner who's never done a marathon before, never used a physio before,

[01:03:31] the idea of doing something different is, I think, a really compelling point for people. — Can we talk about the sleep monster now? — Sleep monsters, please, this is great. — Yes, we can. We haven't even properly introduced Britt as one of the best adventure racers in Australia, if not —

[01:04:04] probably not still, these days. — Well, we're not saying "former," because you still are — I still see you out there racing and winning races locally, and everything else. But your real expertise is in expedition racing, adventure racing — expedition adventure racing, right? Mostly the 48-hour races, the 24 —

[01:04:38] 48-hour, though you've done God's Own and a few others. — I've never actually finished a full expedition race — the one we started, I got really sick and we didn't finish. — Was that in your chest? Because if it's in the chest, you should let it rest. — No, actually the adventure racing and the long

[01:05:09] stuff is interesting, because all sorts of strange medical stuff comes up. What had happened was I hadn't slept for 12 hours and started shivering — I remember running with a fleece on at 12 noon in the middle of the day, off Airlie Beach in North Queensland. You get some really weird medical stuff popping up in those events. Which is why 48-hour races tend to be a bit different — you don't get as much of that,

[01:05:40] because in a 48-hour or expedition race you get to choose whether and how much you sleep. And that's the whole idea of sleep monsters — I'll let Britt explain it, since she knows it far better than me. Whenever I think of that space, sleep monsters is what comes to mind. — What is it? Explain it to me. — When I first got, let's call it conned into adventure racing, you don't know anything about it going in. Gary Sutherland is a well-known adventure racer here on the Gold Coast, and he was probably the one who talked me into it.

[01:06:10] It started with — we need a, because the premier category is a mixed team, you need at least one female in a team of four. At the time I started, the bigger races were teams of four and the shorter ones were teams of three. So they said we needed what they used to call "mandatory gear" — which I never found offensive, because at the end of the day I could keep up with them

[01:06:42] just fine. — Absolutely, and it was funny, because in my first 48-hour adventure race, I ended up pushing one of the guys up a hill on the mountain bike — so "mandatory gear" definitely held her own through the first 24 hours. It's the ultimate compliment, honestly — sorry, keep going. Anyway, I never took to it lightly. It started with, "we need an extra, we need a new mandatory gear — would you come and race with us?" "Yes, I will." It started as a two-hour race, and I still remember the gun going off and the guys heading straight for a trail up ahead — and Gary and Brett went ninety degrees sideways straight down into a gully, off-track, no trail. I'm thinking, I came from triathlon, I raced triathlons, and you want me to go straight down through the bush? Anyway, we got through that event — about two and a half hours, went well, we won. Then they said the next one's in three weeks — how long? Eight hours. So I went from two and a half to eight hours. In we went, got through the eight hours, won that too, and then they said we're taking you to Sydney for

[01:07:15] the 24-hour. I had no idea how to do a 24-hour adventure race — do you even sleep? Yes, you sleep, you get some rest. Not knowing the guys well enough yet, we got to Sydney, did the race, it took 16 hours, and we won that too. So they said, right, we're doing GeoQuest, the 48-hour race, in July — and my first race with them had only started in January. Six months. In six months I'd gone from a two-hour race to a 48-

[01:07:46] hour race — and do you sleep in a 48-hour race? Yes, definitely, expect a couple of little naps. "Oh, cool, I can do that." By the time we were 24 hours in, we weren't sleeping. So they'd just call it "two days" — you just don't sleep for however long the event takes. Hence sleep monsters — especially in the longer races, there are usually hallucinations and strange things that happen in the middle of the night, funny things

[01:08:17] that happen around 2am. Do you remember any of them? — When we were down at Kanangra, I remember — I thought Liam was going to have a hallucination. — No, I can't remember her name, one of the Salomon runners down there who'd done UTMB, talking about a hallucination she had in the middle of the forest — she thought she saw an old woman off to the left, and it was actually a rock, and for a moment she couldn't remember where she was or what she was doing. It took her a few minutes to realise, "oh, right, I'm in the middle of UTMB, this is a

[01:08:49] race." I never had too many, but I remember Craig, who I used to work with, telling us about a kiosk he saw in the middle of the bush, selling soft drinks, and thinking they should go get one. — Cream donuts, apparently. — There's a small part of me that finds the idea of experiencing that quite appealing — that level of weirdness. I'd love to

[01:09:19] experience it, even if I'm not sure I want to go through what it takes to get there. — I think what I love most about it is that it's a team thing — you're doing it together, whether it's two, three or four of you, and especially through the longer races, everyone goes through a bad patch at some point. When you're in yours, someone else is OK and helps get you through it. You end up with this team — not always happy, but a team — that gets around the course together, and there's

[01:09:50] something really cool about finishing that way. And there are places I've been that I have this picture of in my head that I'd never otherwise go to, or find again. I particularly remember one race — I couldn't even tell you where it was — where we had a section on foot and a little stuffed toy dog appeared beside us on the trail, out in the bush for hours, and this little dog

[01:10:20] followed us around the whole course, and it wouldn't have got home without us. — Was there actually a dog, or were you hallucinating a dog? — Very fair point, very fair point. But things like that — you get experiences you just wouldn't get any other way. We haven't gone to that extreme, but we've talked before on the show about the appeal of the next level of this running boom. The boom was kicked off by COVID and people being unable to get to their usual gyms — suddenly this door to

[01:10:52] running opened up for a lot of people, and then the marathons. But the next evolution, the next step, is this experiential thing — what you were describing about running as part of a team, part of a community. It's the stuff you just can't replicate with any other kind of exercise. Hyrox is starting to bring in that team aspect, but you're not going to find a stray dog following you around a Hyrox course in the middle of nowhere. You might, though, find one

[01:11:22] following you at the Gold Coast Marathon. — Let's get everyone through the Gold Coast Marathon first, and then if you still want a bigger challenge, we can talk adventure racing. — This has been amazing — Gold Coast Physio and Sports Health, thank you, and shout out to Liam and Mark, who I've also seen at the Burleigh clinic. I don't love having to go in, because it means I'm injured, but I do genuinely enjoy the sessions

[01:11:54] when I'm getting treatment, and along with Benita, this is the team getting me there. I don't know if a sub-three is still on the cards — we'll talk about that another time — but I'm still chasing a PB. — They'll get you to the start line in the best shape possible, and then it's on you. — Fair enough. You're off to a massage right now? — Tomorrow I've got dry needling. Maybe I'll get Liam to take a photo of all the needles in my stupid calf so we can share it — never done that before.

[01:12:25] Britt Kayling, an absolute pleasure — director of Gold Coast Physio and Sports Health, thank you so much for coming in and sharing your wisdom. — Very welcome, it's been a pleasure.