How to Prevent Injuries in Ultrarunning with Alicja Partyka and Zbigniew Waśkiewicz | Koopcast Episode 110

trail and ultra runners what is going on what's happening welcome to the first episode of the KoopCast for 2022 i hope your year has started off with a bang i hope that you're starting to get all of your races and events and goals lined up for the year mine certainly has it's been an incredibly busy season over the course of the past six weeks i'm really excited about the next several guests that we have lined up on the KoopCast the first of which is going to touch on a topic that i've touched on a lot in trail and ultra marathon running and that is this subject of injuries how to prevent them and the overall injury rates make no mistake that i think that we are doing a pretty bad job across the entirety of the community of preventing and treating injuries particularly repetitive stress injuries and we can't do enough to try to unravel the mystery of why these things start to occur and so on the podcast today i brought on the lead author of a narrative review that i happened to find in september of last year the title of which is the consequences of training and competition to the musculoskeletal system in ultra marathon runners and this was in frontiers and physiology in september of 2021 i have the lead author of that paper alicia partica and i have her

advisor zibi on as well to discuss what this whole compilation of literature that we could find in ultra marathon runners what it actually says about how we can prevent them what the root causes of this are in the first place and practically what can athletes do from a training perspective from a cross training perspective from a strength training perspective to try to stay on the right side of the injury line i would encourage all the athletes that are listening to this podcast to go back and and also listen to this this series of three podcasts that i did with my three favorite physical therapists that i work with which is john chow jessica layman and nat collins that i did several weeks ago that is a treasure trove of information on how they view their physical therapy practice and getting athletes on the right side of the line but one of the things one of the themes that will certainly emerge throughout the course of this particular podcast is that simple solutions are always the best ones that's true in training and that is certainly true when we start to look at the body of literature that exists that relates to injury rates and injury prevention in trail and ultra marathon runners so keep that in mind as a theme throughout the course of this podcast there's the initial ramble i'm going to get right out of the way here's my conversation with alicia partica and zibi all about injuries in ultra

marathon running tell you alicia like you you you tackle you're trying to tackle a pretty big bull right and what i mean by that is is all runners are injured and it's a problem it's a problem that's plagued the endurance community ever since the endurance community was a community and i've said on this podcast a number of times that we quite frankly we suck at it we suck at being uninjured if you look no matter how you slice and dice it and you know the data way more more than i do the injury prevalence rate in my mind when i look at it analytically i'm like this is unacceptable as a community like for 50 anywhere between 50 and 70 percent of people getting injured in a year for a particular sport that's just not i don't view that as an acceptable outcome now i don't profess to know what the answers are right and that's what we lean on good folks like you and the physical therapy therapy community and things like that but i appreciate you trying to tackle it because it is such a big one and it makes a big difference for athletes in terms of their overall outcomes because training availability is such a big part of success at the end of the day and in terms of sports so so to start out with i appreciate you tackling it i realize it's not a it's not an easy it's not an easy answer and it's not one that we're going to come up with some sort of like lightning bolt at the

end of this podcast and say oh well if everybody just took the blue pill you know instead of the red pill then everybody would be fine it's definitely definitely not going to be like that but but before we get into this i want to get a little bit of background just on your research group and your team and the university and i think zivi you might be the you might be the the person to to answer this can you kind of just give the audience just like a general overview of the university there and the sports that you're working with and some of the research that's that's getting conducted there so first of all jason thanks that you invited us here and uh it's a pleasure that it's very nice that somebody noticed our paper which is not so common in uh in everyday life so uh thank you very much for inviting us and uh well um i am from the university or let's say university is a big word because it's a small university small school academic one but it's uh focused on physical education and sport and physiotherapy also and my interest in the in the ultra marathon or also marathon was as always it happens but it was accidental i i was running i was running a lot but then i started to run marathon then my friend professor started making a perfect research and then when i took part for the first time research looking at these people running 24 hours well it was the day when everything started and then i don't have a great team big team in university um we have a four or five person researching in the ultra marathon from a physiological point of view and i'm me particularly i'm just also

researching the motivation of the ultra marathon marathon so that is uh let's say the background and we have a nice laboratory nice research center which helps and what is more important the most important thing i have like 10 12 marathon runners which are always keen to make a research so when i'm inviting them just to make 24 hour run in winter in summer anytime just you know just just call me and i already let's say in a couple of days and they're coming and you know what doing you know punishing them and uh running so so that's nice and thanks to them they would not heard about it because they are let's say they don't even don't speak english because uh in poland the group of ultra marathon runners are mostly not educated and just like you know normal everyday people so i think let's let's start with this maybe it's so hilarious that you mentioned that because everybody that i've brought on in this podcast and most people have this kind of like cross bridge between studying some of the more traditional endurance sports like cycling and marathon running and they kind of cross into ultra and one of the points that they always lament is is like we can't find subjects that will want to run on a treadmill for 24 hours or 12 hours or whatever the protocol is is because a the subject pool of people that can actually do that starts to starts to dwindle down pretty quickly but b even the subject pool of people that can do it the ones that want to do it even get whittled down anymore even more but it's so it's good that you've got enthusiastic group there that you can constantly poke poke poke and prod oh it's just ethical a little

just they they have also some um some relations with us because we help them also in training i mean to give them results we help them you know just you know the measuring all the stuff just helping them with the diet uh so you know it's a kind of a both-way relationships and mutual interest let's say but uh but it's not so easy just three times per year coming to laboratory making some you know so hard stuff it's it's absolutely not easy and uh thanks to them you know it's possible yeah okay so we're gonna dive into a narrative review excuse me a narrative review paper alicia that you wrote on injuries in ultra marathon running and as i as i mentioned during the onset this is something that it currently plagues the endurance community and i think it's going to continue to plague the endurance community and so to so to tackle it from this big broad narrative review perspective i think it's quite a monumental task because a the the the scope of what you're looking at is so broad but also but also b within an ultra marathon context the the data you know i'm gonna let you speak to this in a second it's it's kind of thin just because it's uh and what i mean by that is is there haven't been a lot of really controlled studies or even observational studies on ultra marathoners as a whole that we in a very robust fashion that we can look at and draw some some conclusions and so you're trying to do that so i appreciate that i appreciate the effort despite some of those um some some of those uh limitations so to start out with like what what first off what

prompted you to do this like because you probably knew the situation going in that you were going to be faced with some of these variables like what motivated you to start to to tackle this narrative review in the first place i cannot deny it was a tough task to do but uh my motivation was just a curiosity because like it happened to me that i i'm a runner and it happened to me to be a part of the organization group of the ultra running race i was volunteering there and it was by chance what uh i was quite surprised that such people can do that and they are still alive and they are just still doing that for several years without any injuries which would stop them from doing that so as i'm a medicine student i started reading the uh some stuff some looking for some resources uh and in fact i was surprised how many i found um and by time i um just read too many of them and because of that i decided not to just keep it for me

i decided to write a paper just to share it with the others so it was an innate curiosity based off of you observing this silly sport where people can can somewhat appear to continue to locomote and perform even after hours and hours and hours on end um i think you just touched on one of the things that i initially want to talk about is is that one of the things that comes through in the paper that we're starting to see we're starting to see this theme emerge more and more across a lot of different areas of ultra marathon running not just injury which is going to be the predominant topic topic that we're going to discuss today but this is this concept that ultra marathons are not simply long marathons and we see that we see that theme pop up from a training perspective we see ultra marathon runners train a whole lot differently than marathon runners we see them look a lot different than other marathon runners just from a just from a visual standpoint their nutrition is different certainly from uh from marathon runners their psychology is different from marathon runners and zibi you've have done a lot of research in this area uh based on based on motivation we can definitely see a compare and contrast between the ultra marathon world and the marathon world but specific to this paper one of the one of the things that kind of came through is the injuries themselves are different between the marathon

community and the ultra marathon community and and i wanted i wanted to know can you help us kind of understand what that fundamental difference is and maybe why we see those differences in injuries between those two groups which you think would be similar because it's all just running right yeah that's true it's all just running but like we have to distinguish those all all those differences which we can see it's not only about the distance but also the pace the terrain the climate most of uh ultra runners uh run in the mountains so that's all the reasons which can lead us to that thing that it's not only longer marathon and i think one of the take-home points from that is is the way to potentially mitigate some of those injuries might not look the same as the way to potentially mitigate them in a in a running perspective so this is kind of where i'm gonna ask us to take our research hats off and put our practical like coaching and training hats on and maybe zibi you can jump in for from this perspective as well because there has been a relatively well established way to help prevent injuries from uh from a traditional running perspective and that runs all

the way from load management right and the very prototypical 10 rule of volume increases is predominantly rooted in this injury prevention uh perspective there's a lot of physical therapy modalities and strength training modalities and things like that that are kind of aimed at specifically keeping marathon runners healthy and i'm wondering if either of you can comment on is how much we should be translating those into the ultra marathon world with that same outcome knowing that the injuries are slight they're at least different whether they're slightly or or or to a large degree different that's to the eye of the beholder but should we at least be looking at it differently and then maybe even how can we look at those mitigation strategies differently so maybe let me say something first of all we have to separate uh runners i mean like uh uh because the reasons of the injuries uh when we have are different when we have uh let's say beginner we call him i call them sometimes non-starters which you know they practice a lot they're preparing for some let's say marathon first time in a year in life and then uh they probably are not prepared to the first marathon it's i think it's normal they are not prepared because they they cannot expect what they happen to them even uh and the most of the injuries in the marathon runners in the beginners are because they are unprepared for the month so that is the reason and uh the second reason is if we look at the let's say elite amateur or the professional runners and then we

try to touch the different different area of the injuries because they are because the this is runners these athletes are prepared for running because they know what to expect they run i don't know several times this distance or the the the the area and sometimes the injuries appear by accident i mean you know the uh the surface something just happened uh you know the the misconduct and everything and then another one which are uh unexpected because the the workload was so high that our body cannot you know survive this this workload uh which happens especially with elite amateurs with professionals with uh which try to win the race and then they push the body above the limit not above the limit because they were unprepared to the limit but it will be you know higher and higher higher as you know the um i tried to calculate it to the miles because normally we use kilometers the uh world record in 24 hour run is uh approximately 188 miles yeah which is huge distance 24 hours run so um uh the pace in miles is 7 64 minutes per mile cool 24 hours so you can imagine how great workload is put on the athlete okay we can lower it to some decent uh result i don't know which result in 24 hours you expect like let's say everything in my opinion everything above 130 miles per 24 hours is a decent result what do you think yeah i you kind of broke up there i didn't kind of i didn't

catch the last part of that question okay i mean that if you if the the decent result in 24 hour run it's above 130 miles yeah yeah let's say that yeah and if i could yeah you know calculate it's nine minutes per hour you know yeah and i mean it's a mile so it's also a very very hard workload and then we can we can look at the guys who is running at the speed at this level prepared unprepared and so and so on so these reasons are first of all separated with unprepared people and elite athletes two different worlds so it's the first reason and what about this unprepared well it's uh you know it's a lottery you can you can do any any injury but it's not the reason about the ultra marathon because the people are unprepared and in elite athletes then we can calculate and point specific injuries which are risen by uh by some other preparation okay so with the with with the normal people right the non-elite athletes based on what you are seeing in the research is it really just a matter of preparation i mean this is what you're kind of coming down to is it just is it really just they're screwing their training up essentially is the way i would look at it as a coach yeah just shortly mostly there's unprepared as sometimes i have the the examples with my friends they are over trained even sure you know they are ultra marathon runners but are very often over trained and then when it's coming to the to the to the race and then it's absolutely not working and and and mostly it's finished with the with the serious injuries even and let's but let me ask you this because alicia you might want to jump jump in

with this piece since you dived so much into the literature that that conclusion can we kind of base that off of a process of elimination or is it is it more are we coming more to that conclusion based on what is out there and what i mean by that is is you can look at okay this isn't causing injury that's not causing injury we can't supplement you know all that well to help prevent injury you know and eventually it just comes down to well the only thing that's left is is training right that's the only variable left that's like correlated with it or is is there something that's actually definitively pointing to people are just not training very well i hate to say that as a coach like we're not doing our jobs or whatever i guess what i'm trying to get to is is it a process of elimination or is there definitive research that's pointing to to to that answer that it's the training component that's driving most of these injuries well i think that is all about training in fact all other factors can also influence that but the the biggest influence is just about the training and also i wanted to add that um and the thing which is also important that are those injuries which are already ongoing and they are not completely healed before the race so just sometimes it's about the common sense and the decision

to make if it's really worth it to try to compete with that in that condition right you know what i mean well the the prevalency rate on that every time i go and i reread the literature on this i'm always shocked when i when when i see that to know that anywhere between like 10 and 60 percent of the people lining up for an ultra marathon have an injury when they're going when they're going into it i just once again i going back to my very original statement i just kind of shake my head and go we we are just doing this all wrong there's there's there it should not it should not be this way and i wanted to i wanted to know from you from you does is that shocking to either one of you like knowing the marathoning world knowing the endurance world knowing the marathon knowing the ultra marathon world that so many people are lining up on the start line already battling some type of injury yeah yeah it's still surprising a lot but for sure there is some motivation to do that we cannot deny and like i think that still ultra marathoners just uh they want to prevent it but still the the time they put into training and the efforts it's too much just to say that they don't want to compete uh for some period of time and just to give them rest

well i think a lot of it ties in zibi with some of your previous work that we weren't planning on talking about but we might as well jump into it and this is just the motivation amongst this group of athletes which is different than than uh than marathon runners but also i would say higher than marathon runners and then i'll also say that the amount of time or the amount of the frequency at which ultra marathoners compete at is higher than your prototypical marathoner then there's a lot of good statistics that i'll link in the show notes uh from run repeat site that'll point to that but i'm wondering if you could kind of jump in in in based on your previous experience with with motivation amongst ultra marathoners is that playing into this whole injury cycle that we're seeing in the ultra marathon community yeah absolutely i i think also the the good the good comparison uh is that you know a lot of people trying to decline to mount everest most of them are unprepared for this and i think sometimes it's very you know keen fancy to start in ultra marathon marathon what is it marathon now it's nothing well everybody run marathon let's try on a bad water or whatever yeah that's that's you know something yeah so i think that people you know trying to get on the you know high emotions with this and uh and and and i'm prepared trying to you know to evidence somebody to people and uh uh and in our paper there was there was a data that uh about the uh age and injury in ultra marathon and it was evidence showed that the older ultra marathon runners had less injuries than younger ones

and of course it's related to some some factors first of all they created a higher tolerance to pain and their body is prepared you know more most times they were prepared to extreme conditions than younger ones there is also data i don't know how to treat them but they they calculated that 10 years age difference uh is related to decrease by half injury so if you know if you if you pull apart the the ultra marathoners you know by 10 years uh brackets you know every 10 years training ultra marathon properly with the coach and they would according to all the rules decrease the uh the possibility of injury so that is the also the uh the reason and about this motivation now that is uh you probably know it's uh it's an interesting story because these motivations are completely different we are using i was using the let's say all the device or all the all the questioner which is motivation on marathon scale all those master songs like i don't know 40 years ago this i did it like 76 question which is you know boring to to put the marks and everything but i had a group very big one more than 1500 people uh did it and uh there was like two important words first was one just showing what is the this motivation and there is this these motivations are divided into four areas let's say psychological it's like life meaning self-esteem uh second one is achievement let's say such as sports

it's a personal goal of achievement and competition a social and physical so there's like four areas you know and uh interesting was that uh um i divided the guys like uh marathon runners and ultra marathon runners they to became an ultra marathon in my experiment it has to be like finished three ultra marathon runs and uh okay well uh it was like uh maybe uh simple division division but i had to choose some and uh it was like the short distance runners uh you know rated uh psychological coping self-esteem uh competition and uh health and weight concept as larger motivations than ultra runner colleagues yeah uh what is interesting the the ultra runners were driven more by qualitative uh aspects of the of the running i mean the life meaning and affiliation so you know the for mostly for this i know a lot of them and for them the uh you know the traveling racing with friends uh being in this society is absolutely more important than uh good results and winning the competition it doesn't mean that they didn't strive to win but uh you know it's not so not so important so according to also according to the age it changes also so uh it was my second second paper what i did and uh uh it showed that absolutely before now it sounds absolutely funny you know that for ultra marathoners health orientation at all their ages is very important which sounds you know maybe also as a reason why the older ultra marathon runners has less injuries

because they take care of us this all kind of comes back and the one thing i could keep thinking about is that an overabundance of enthusiasm is the root cause of all of this right probably yes yes and you go back even this even even this age proposition which you know i mean i think if you presented that to somebody who is unfamiliar with the research and maybe that's they're like a freshman level exercise physiology student you said hey is it more likely that the younger athletes are getting injured or the older athletes are getting injured in ultra marathon they'd probably say the older athletes because they're older they're more frail they have more miles on their legs and all this other stuff and it's actually the opposite right the older more experienced athletes actually have fewer injuries and i think it's predominantly driven by the younger runners can handle they have an overabundance of enthusiasm and they can handle acute workloads much more readily and they don't know any better they can handle acute workloads much more readily than the older athletes but because of that four weeks down the line then they get hurt after all those you know acute workloads start to start to add up um is there anything else remarkable that is worth mentioning on this phenomenon of more experienced athletes get injured less and once again you might have to kind of take your research ahead often extrapolate a little bit but i think that this area is actually quite fascinating and

there's going to be opinions left right and center whether it's an experience thing or whether just the sheer volume of miles that they have makes them more tolerant or you know the younger athletes are are just stupid and not training correctly you know they or they have an overabundance of enthusiasm as i mentioned earlier but i was wondering what you guys think about that like is there anything that you observe or they can we can kind of like tease out of the research that is just interesting about this experience part where where more experienced athletes older athletes actually get injured less than less experienced athletes so maybe if you want if you want to stay safe because you're just thinking i'm not sure but i think in my opinion it's also about that years of training leads them to the reconstruction of their body right and that can help them to achieve more and to get injured less frequently and it comes on not only to muscles but also to the rest of the body right yeah and i i think maybe you can also talk about some of the time course of those adaptations and this ties back to the interventions piece that i was talking about earlier where a lot of athletes they'll want to take they'll want to undertake a physical therapy program or a strength training program or something to like shore up or strengthen their tendons and ligaments and things like that and if what we're seeing

in the research is that the more experienced athletes are getting injured less does that speak in parallel with some of the time courses of those particular adaptations specifically to the tendons and ligaments that we're actually that we're actually talking about or is it just something where it's we can't we can't really draw conclusions from i'm not sure i think that the body and if these are up in treatments i think that the younger ones are more uh efficient because they know them they use them you know it's uh it's a most more popular in my in my experience the older ultra marathon runners the only one is uh i don't know uh hot water after hot bath after the after run something like this even even some of them when we i was i was arranging i was there organizing like four times polish championships 24 hour run and 48 run and we uh we just uh prepared the uh massages for them the massagers you know and uh and let's say 10 of them use them less of them say okay we're finished let's go home it's done and then going to car traveling like 600 600 kilometers to home using no therapy and you know that's the first hours of the race are the most important time so it's um i think the older ones doesn't care about the about the physiotherapy i think it's my opinion i'm not my opinion am i just you know experience which i saw with the with the athletes i we had that once time we had a research like 48 hour run and then we keep them for three days in a hotel just

to make uh you know blood samples and trust me most of them didn't leave the room even for nothing just waiting in the room to come to them we said hey there is a swimming pool there is some you know some area if you want no it's okay i'm fine okay i don't need anything i have a you know free time here so it's good perfect it brings me food everything that's nice yeah uh so it's uh i think you know sometimes i think that after a marathon uh you know people are out of the any rules you know it's absolutely for me and uh let's say we have to you know extract from this the professional ones you know which one usually you know strive for the world records for winning the competition like kuros or you know you know you know it's a totally other part of the world for me i i did the research on them and trust me we have some cases one case was like a guy on the during the 24-hour run it was like 14 hours already and he just had some problem with uh with breathing with the heart you know the the emergency took him from the race to the hospital checking all these you know ck levels i mean the cardiac on all which i show and and they did it three times you know they checking the machine if it works you know because his level of the ck was like six to 100 times normal so probably they said you cannot leave you know it's impossible you know according to normal people you are dead okay it was a belarusian it was a belarusian guy you know and uh he said well okay if i'm dead i can go back to the race you know he just got out from the hospital trust me and six hours

more just was running walking to the end of the of the race so you know these people sometimes get out of any scientific rules and anything which is also related to their motivation and tolerance to pain which they created during the years well and that's why i always caution people when they look at whatever successful lead athlete and they say well so and so does this in order to perform well or to become uninjured which is the theme of this this conversation so that's what i'm going to do you know it's i mean a lot of ways they just hit the genetic lottery at least you touched on this in the paper right i mean genetics might have a role to to play in all this that that you probably that that's a hard comp i have a genetics degree right that's a really complicated area to to to tease out but for certain we see athletes that despite themselves continue to remain uninjured and there's no explanation for it right they violate every single rule that you could see in training and everybody's yeah we're having a failure of audio here everybody's throwing up their hands on this on this zoom call um but i think supplies if i may interrupt you you know these guys it wouldn't last for this for the whole year for life right there is some point where the body has just say oh no stop i wouldn't need to do it anymore i have my paper about my case study about the ultra marathon you know extreme guy who was running from poland to vatican to spain now 42 marathons 42 days you know all the crazy stuff and we suppose that he's i don't know from steel for what yeah but being 51 he has a chest pain uh landing

in the cardio cardiology division in the hospital and so on and after two weeks of this you know the doctor said you know most of your uh heart you know enzymes cardiac functions are very bad but please don't stop running if you stop running you know you will die for sure so it was absolutely it was you know uh luckily he got to the to the professor cardiologist who was you know very you know educated in sports cardiology also because normal doctor normal professor put him to the bed lying for one year just getting you know recovery and you know he just said after two days he wanted to come to you know practice but uh okay after two weeks he came running still but of course you know lower intensity is just taking care more and probably he would not be injured to the end of his career because now he's very careful about it yeah i i completely agree with that anecdote there that there is a limit to it and typically sometimes it takes decades for that to actually show up but there are limits to it we got to be careful what we what we mirror it and or pair it in our own practices and what athletes mirror or pair it in their own practices that are based off of some other athlete that may or might may or may not work for them um i kind of want to steer this a little bit back to more of the injury prevention part of it so we we've kind of come to this conclusion this has been a conclusion on a number of from a number of different guests on my podcast that training load

management and experience are the predominant things that affect injury rates meaning more experienced athletes and athletes that are managing their injury load uh correctly are going to be the the the big the big heavy hitters here is there anything really specific that we can direct athletes to to get a handle on this because a lot of people listening to this they're not coaches they're everyday athletes they're looking at their training they're they're preparing for you know the western states 100 or hard rock or you know some ultra marathon either here in the u.s or abroad and they kind of want to know how to bring those best practices to life from a practical point of view right they know how much they're running right now and they want some direction some sort of like directional arrow on their training are there any broad recommendations that either get teased out through the literature or an extension of the literature alicia that that that you did that we can guide these athletes with to try to stay on the on the kind of the right side of this injury line yeah in fact one thing which came to my mind is just to practice also different activities to diversify our training right i know that many ultra marathons they are not only running uh that's not the way to do to be the best like you should add to your training also different uh other different activities like cycling some of them are swimming

uh some of they are practicing yoga and that's the thing because ultra marathon it's um it needs our whole body to to work sometimes even if um they are climbing the mountain they are using poles to do it and um in fact during the ultra marathon the runners are using their all the whole body i think and uh from my experience it looks like this that we we need something more than running so this kind of comes back to some of the differences between marathon runners and ultra marathon runners and the way their injuries show up so prototypical marathon injuries is a is an overuse injury right emphasis on the word overuse it's a repetitive stress injury you're doing the exact same motion within a very very very finite degree the exact same motion thousands and tens of thousands of times throughout the course of of any sort of training cycle when you get into an ultra marathon perspective and i'm and for this example i'm using kind of the prototypical ultra marathoner that's a that's a trail ultra marathoner not a 24-hour track runner or something like that that that repetitive stress is always slightly altered right because the surface is different the grade is different their stride length is different their stride rate is slightly different

all the different biomechanical angles that kind of compound into these overuse injuries all kind of get varied out and you see this play out in the types of injuries right between marathon runners and ultra marathon runners whether it's a ligament injury or or tendon injury so alicia your comment on the cross training modalities being being kind of part of part of that whole injury management equation is actually quite suited because the the modality isn't as specific right that's the way i would take that as the coach right a typical marathon run training program that mode is very very specific because all the biomechanics are are essentially identical right from the beginning to the training to the end of the training and ultra marathon since you're going uphill downhill off camber on camera on trail off trail all those biomechanics are so different that these cross training modalities might be able to a mitigate training but also be have a little bit greater degree of specificity towards the training process as well because it's not so locked into one biomechanical pattern yeah exactly like also adding some practicing of running downhills and just to get used to things which they are going to use during the race yeah training specificity this came out in your paper as well right training specific training specifically for the race we're all kind of laughing right now like why is that so funny it seems like such an obvious thing to do but yet so many people don't do it zibi you jump in right here because you just

made a really good really good smirk i mean is this is this something that we need to take in we need to put higher on the priority list in terms of overall training and and potentially mitigating injury this training specificity component yeah surprising is that this is so obvious as you said that people don't do this right so that's that's the reason why i don't know why i didn't do this but uh i also think that a really important thing that the people should um should make some testing uh during the practicing before the uh racing after racing you know i know it's not so obvious and not so popular but uh i think more i'm not saying about the injuries to our uh movement system on the muscles bones and cardio is okay that is i leave it behind but uh most of the overtraining about the cardiac you know problems uh comes from uh uh limited knowledge for people because i don't know you are as a coach probably how many people is taking a laboratory test of you to max yeah very few yeah very few yeah okay so so uh and during this test you you can find your border which shouldn't you you shouldn't you not exceed exceed i mean like the you know anaerobic anaerobic level which is you have to know that i would not exceed like i don't know 165 heart rate per minute or whatever because if i if i move above this limit for sure i finished in a bad shape probably with some with some problems and uh very little people is doing this and another one

is i which i suggest people which us which will hear us and uh make once i know it's not so easy but like making uh six or five times going to the blood testing with all the most important you know uh uh more for the more follicle parameters to test for instance the creatine kinest ck it's very popular one it shows the muscle damage in the in the humans and uh there is often normally in the train athlete after let's say 48 hours it comes to the normal pre-raised state level i mean like it's normally it's 300 units so you know at least sometimes it's 70 times this level which is absolutely you know it shows the muscles are absolutely damaged and in train at least after maximum 72 hours it comes to the pre-raised level so you know it's like huge huge race and then it comes to the to the uh to the normal level and very often in untrained people it took even more than seven days so if you go for at least slow jog a slow training after two days then you are still in the area where your muscles are damaged and you're damaging them once more so you know once per year once per let's say five or ten years people should do like how many times how long it takes my body to recover with this one simple you know this is creating kinase it will be great you know avoiding the injuries because i know many times i feel good my muscles feel good but you know the ck it doesn't pain so it's just you know in our blood it changes

membranes and and the blood flow is very complicated that i know you have to go to the doctor just to make a prescription for some testing blood testing so on but it's i think it's good to find out our mechanisms in my in our body individually and then you know that after such a heavy race i need two weeks complete rest for instance yeah and uh i think that will be reason that we help to just avoid some some basic overtraining injuries which came also that we are not rested already yeah it's interesting that you mentioned that because i've had a number of uh blood testing uh specialists on my podcast as well and they they've really emphasized two big things the first one it's both of these speak to exactly what you're talking about zibi the the first one is is having a purpose with why you're testing right so if you want to test for nutritional deficiencies you want very specific tests for that and you want a certain frequency for those tests if you want to test for muscle damage or the recovery from muscle damage you want very specific tests for that but also you want to do it at specific times that are different than if you're testing for some sort of mineral or nutrient type of type of deficiency and i think all too often people think that oh well i'm just going to get one test and i'm going to glean this treasure trove of information from it and really just one of them is just it's kind of meaningless unless it's like it's less something is very very far off the spectrum in a disease state um but you know only one

more just just one more easy easy way just to test our our conditions are you know heart rate variation tests yeah uh all we have you know the watches which even uh polar polar system implemented to the watch you wake up in the morning you're just using it like two minutes two minutes or four minutes you know and then you know how your body recovering how your heart is recovered or not so i i think that five percent of athletes doing this you know all of them know this but i don't know do you know any athletes doing such a testing do you know i mean i would say very very few it's really interesting that you mentioned that because i kind of come back to this i have to have interventions that people are going to that are people are going to comply with and intellectually this is going to be a complete tangent by the way you guys are just going to have to put up with it intellectually when people are putting in 10 to 20 hours a week of training you would think that they would be able to make the time to once every two months once every four weeks go get a blood test to spend two minutes every morning checking their heart rate variability but the compliance on those things that are such a small proportion of their overall training time is quite to be honest with you their compliance is just terrible no matter how much i emphasize it or whatever they'll do the 20 hours a week training but if they spend you know two minutes a morning checking their heart rate variability it's like 50 hit rate it's hilarious um yeah that is the reason totally what would you come you know that the injuries

appear you know people people don't care you know they have a training plan they do the okay they will do this training plan let's hope properly and that's done yeah they think that they are prepared for marathon or even some type from ultra marathon well but it doesn't work like this yeah well and it kind of comes back to this is the golden goose right so you guys mentioned from the onset that preparation is kind of the key right people are coming into events under prepared they're going into training their training environment or the training load that they want to adjust to in an under an under prepared fashion and a lot of ways if you think about it trail and ultra running is it's ripe for that because you can't make your training sessions as granular as you can on the road right with if you're doing road running you turn around at any point right you can run 10k you can run 10.2k you can run 10.4k with with a lot of precision right or whatever time equivalent on the trails that granularity gets kind of lost because of the logistics of it you get stuck on a loop or you want to do this route and it's either 10 miles or 20 miles or you know 15k or 30k or something like that like the differences in how granular you can make each training run or just or just last right a lot of it depends on the area but when we come back to this whole mystery alicia that you were trying to un to unravel and if it really is training load parts of it athletes have to have practical ways in order to adjust and design

their training load right or i guess i should say that opposite design and then adjust their training load and i think the first theme that we touched on earlier to kind of put a to pin on that is to think of yourself as a more experienced athlete right and you're just generally doing less at that point and the second thing is is if you have some very basic monitoring pieces those will go a long way and this is something that you didn't touch on touch on the paper but i'm going to bring up just because we've been talking about it here some very basic heart rate variability monitoring and or blood test monitoring and things like that will go will go a long way it doesn't need to be over elaborate but from an injury prevention standpoint you can pick up a lot of things alicia was there any is there anything else as we're starting to wrap up on this that was remarkable to you that kept coming up in all of the pieces of literature that you were reviewing which were a lot i was trying to take a tally a second ago uh hold on a second it's over 70 citations that are in this one uh review paper was there was there anything that was remarkable to you that just kept it kept coming up time and time and time again that's a theme that's worth touching on like right now it's quite difficult for me to to distinguish such a thing because it was over a year ago when i finished the paper uh like all those preparations and uh citing

things that were like um but um let me think for a minute i think like many authors referred to ck for sure it was like one of the most popular um biomarker creatine kinase is what what you're referring to so the audience it's not familiar with that uh with that abbreviation um i think it is yeah okay it's a biomarker of muscle damage and in fact it was seen to appear in such many um papers that we already know quite much about ck and ultra running and many associations between other markers and ck and yeah that's the thing so in that case i think that we can take much more from blood tasting than it was before yeah and that that is one that where it has such a huge variability associated with it right i go back to some of the research i was trying to pull it up uh in this book that's on my desk um uh some of the research that was done at the ultra trail de mont blanc well though well where they will find some athletes will finish the race with uh ck value of around 3 000 and other ones over a hundred thousand and when you see that type of biological variability amongst the

people amongst people that have gone through the exactly the exact same thing right it's all 160 kilometers it's always quite remarkable and it makes you think why is that like why is that different and it comes down to training right the ones with more training exhibit less muscular damage and the ones with less training exhibit more muscular damage it kind of comes back to the simple proposition that we've come back to time and time again uh zibi is there anything else you want to you want to touch on within this research or anything else uh in your uh at your university in your lab that you guys are doing um generally you know is also there was a two research in this in this review paper that showed that uh absolutely uh the better the better runners i mean leaders show the lower levels of creative kinetics even if they have a greater intensity i mean they they had to put the greater workload because they won the race or they were leaders of the race so that is also important if you are well prepared i mean if you are not overtrained but well prepared which is sometimes uh really really hard point because the ultra marathon runners think that if they run more they will be better at the race which is not true because our human body you know has some limits to training and then you get overtrained and then you know you're just scavowed on the race because you are so you're done let's say but what i wanted to say and just to be kind of advice because we have a paper uh in 2018 in journal of clinical medicine about the uh novel cardiac biomarkers about the i mean the cardiac about the heart and i suggest every every marathon runner of especially alpha marathon runner just to first of

all make uh an echocardiogram or whatever they have they can do in the area before starting to practice really hard because many people's has many disabilities with the with the heart response and probably they can kill it themselves you know so that is the reason and uh another one that the the the that the the the cardiac biomarkers have a specific uh work or way of working of you know i don't want to just get into details but uh uh most of such people who want to race and make like 160 miles run they should absolutely make uh uh uh let's say it's uh it's uh it's uh no extensive no extensive like an animal i mean if you automate and cardiac research research with during the exercise how the heart works uh during the exercise i mean test it in the every every cardiology division has such a has such devices and then you will know if your heart is generally ready for the race and uh and we have uh we have many many examples in poland that very talented very young and very older ones let's say guys stopped training because they overused their heart and didn't treat any they never tested their heart you know that is the strange rhythm in poland there is in my opinion stupid rule when you're uh trying when you want to start in any race yeah just you just sign any you know certificate okay i agree i am i'm healthy and everything fine with me i take care about myself okay you sign it yeah and then uh 30 percent of ultra marathon runners you know after 12 hours of 24 hours

run just you know uh stop running because they can't do it longer in professional sport in poland you have to be tested by the by the medical doctor before you start the race and then you can imagine it looks totally different you know i don't know how it works in states but uh but probably the same case yeah that uh you you you you say that i'm everything fine with me i i sign anything and that's all so that's my suggestion to people who want to treat the ultra-mart running series and just test your heart during intensity during the the exercise because you never know what can happen and uh now uh i i saw many people you know uh during this four years four years of organizing this this uh race i saw so many even you know overrated people trying to make a ultra run i said what do you want to do you know you can show what that you are you know weighing like 20 kilos more than limit and you want to 24 hour run of course yeah after six or seven hours you just you know resign because it was impossible for from the beginning we were sure that they will not finish yeah so so so i mean that the people shouldn't you know okay mountain versus the highest mountain you know and everybody wants to go with the climate yeah but uh well if you want to run an ultra marathon something serious just get tested before you know and i suppose if we if people would start like this they would not be not injured but finish with happiness and smile at the face and not like being you know dying here's what's going to happen though because getting that type of test is actually i mean it's not easy but it's not hard in the u.s to get

an exercise ekg you know the accessibility is there if you really want to go do it but most of the times what happens is is you end up going into your run-of-the-mill cardiologist that is well intended but they're not working with an athletic population and so they don't have the experience to interpret the results amongst an athlete and an athlete's heart is you know as you guys are well aware of is in many cases markedly different than a sedentary heart or somebody who is is unfit or even diseased heart um but mark my word this is what's going to happen we're going to come back on a year from now and then revisit this discussion all of the wearables your garments and your suunto's and your coros watches and things like that they're the hardware is going to get good enough to where you can get exercise ekg on the wrist top they're they're getting there now but it's going to be more prevalent probably within about the next 12 to 24 months when that data starts to come out people are going to freak out like people are just like they're gonna freak out am i gonna kill myself on my next run because they're there it doesn't exist right now and when it starts to exist on mass it's going to cause it's going to cause a lot of panic because there already is this uh there already is this undercurrent in the endurance community that yes you can exercise too too much either too hard too much too much volume or whatever and that's deleterious to to uh to cardiac function once once the armchair uh uh cardiologists

start to come out and start analyzing all of these ekg results on on mass because of the wearables it is it trust me it is going to cause so much panic we're gonna have to leave that banter for for another day though but i i'm i'm kind of with you that um especially for athletes that are experienced just going in and getting routine exercise ekg with a uh with a with a cardiologist is a really good baseline to cross just to make sure that you know your heart's and your heart's in good shape and yeah yeah just to just to check it i think that that's a really good course of practice for any anybody who wants to stay in the running game for an appreciable amount of time all right you guys we're gonna let you go thank you for coming on and thank you for your research alicia this is i know this is a really big task to to undertake you're probably fortunate to have it in the rearview mirror now knowing that you looked at this a year ago but i appreciate you bring it back up um do either one of you uh before we uh let you both go uh want to let the audience know where they can find more about you the lab or the research that you're doing yeah okay i think the easiest way to reach me is go to the research gate which you know where all my data all my papers are fully accessible in pdf files so i invite you seriously and uh and maybe at the end just a short short joke uh at some point i wanted to you know to improve my personal record of marathon well it was lousy because it was in athens i did

like four hours 15 minutes that was great for me and then i come to my friend this this you know this chest pain marathoner and i said you know uh you have to help me to write me some training plan or whatever just to be like 330 okay that's just looking at me looking at me say you know zibi uh the history of the marathon result even just touch yourself you know is there sense for this or not and i was thinking about it okay and from this point i running like 4 30 4 45 happy drinking water as water stations like standing and talking with nice girls and you know guys that is also the reason maybe sometimes we push our bodies our you know but it's you know to useless maximum which is nonsense sometimes you know so maybe let's stop and run and you know look around just see speak with somebody running and then we just prevent our injuries that you know running just getting the better results take the simple things is what you're trying to say all right i appreciate you guys coming on we're gonna let you go and we'll bring you back on at the in the year once we start to look at all these ekg results thank you guys thank you all right there you have it there you go folks much thanks to alicia and zibi for coming on the podcast today i'm going to bring them back uh at a at another point in time i will also put links in the show notes to some of zibi's research that he has done with this whole motivation aspect that we talked about and i do think that that goes hand in hand with a lot of

what we see from an injury perspective and as i mentioned during the podcast i think a lot of this can come down to this over abundance of enthusiasm that we see in the trail and ultra running community which is a really awesome part of the community but also can be detrimental to the athletes themselves and particularly when we're talking about injury rates within ultra marathon runners as always you guys i appreciate the heck out of each and every one of you if you like this podcast you can share it with your friends or you can give it a rating on itunes both of those help the podcast out a tremendous amount and as always we will see you out on the trails you