Running Injuries with Dr. Kaci Lickteig and Dr. Hal Rosenberg | KoopCast Episode 8

Runners, trail runners, ultra runners, what is going on? I'll tell you what's going on. If you take yourself and two of your friends, I guarantee you at least one of you is injured or managing an injury. And what's the difference between those two? We always use this weird vocabulary. Yeah, I got a ding. I got a niggle. I'm sort of injured. I'm hurt. And who knows what any of that vocabulary actually means? It's always really confused me that we use these kind of silly pieces of terminology. But I digress. My point is, is that managing injuries, it's a part of the game. It's a hazard of the job. It's part of running. You know, it's going to have, you know, that's not a, it's not a if it's just when it's going to happen. We mentioned a study during the podcast that in excess of 70% of runners will lose at least, at least one day of training, at least one day of training in a given calendar year. That's a lot. I actually think it's everybody.

I think you look at every runner out there, they're going to lose at least one day or at least have one day of training compromised because of an injury. That's staggering. And to, and to even add to that, when you go out on the internet and you go out in the space, you ask your friends for advice, it comes from everywhere. Should you ice? Should you not ice? Should you use cryotherapy? Is heat good? Is heat bad? Should you change your diet? Should you rest more? Should you strength train? Should you not strength train? Should you get one of those silly rubber bands and wrap it around your knees and do these, you know, monster walks? Should you straighten your glutes? Should you stretch? Maybe not stretching is actually the answer. It's actually, it's actually kind of astounding. And I think the fact that we have all of this advice, many of which is actually contradictory to each other.

We have all this advice out there and still everybody gets hurt. I think that says that we really don't know what we're doing. Like even the, some of the best in the industry, it's just a lot of educated guesses. And that's the way with a lot of things in training and in life. But the point is, is as a runner, as a trail runner, as an ultra runner, you are going to have to manage some injury process at some time. And so in order to get a better fix on this, in order to figure out what to do, how to keep things on the right side of the injury line in the first place, I brought two great people on the podcast with me. The first of which is Dr. Casey Liktig. How many of you guys knew that the pixie ninja Casey Liktig is a doctor? Yeah. She's a doctor of physical therapy. She practices physical therapy at a hospital in Omaha. She's also, as all of you know, a really great runner and a great person. So I brought her on the show to help out with this answer. And I also brought somebody who practices keeping athletes on the right side of the injury line and helps them manage that whole injury process. Dr. Hal Rosenberg of Mount Tam Sports and Spine. Yeah. We've got two doctors on the podcast today. I'm the only non-doctor on this podcast.

That makes me the last person on the intelligence ladder, whatever an intelligence ladder is. Anyway, I've sent a number of my athletes to Dr. Rosenberg at his practice in Mill Valley, California. And we've always had great results with it, uh, with that, with him, him treating my athletes. It's always been a really good thing. It's kept people on the right side of the line. He's very, very well respected in, not only in the endurance space, but in a lot of other spaces. In addition to that, he's an aspiring hundred mile runner. We talk about his journey to the Javelin a hundred. It's going to be his first hundred miler. How'd he do? You guys will have to find out. I hope you guys listen with intent ears to this, because I tell you what, everybody has to deal with these injuries. And I'll also tell you what, we really don't know good ways of preventing and fixing them. We just try to get into the best situation possible. That's all we can kind of ask for. I do think we got a lot of, you know, knowledge bombs dropped on this one. I hope you guys enjoy it. And without further ado, Dr. Hal Rosenberg and Dr. Casey Lick-Tig.

You know, we were, we were talking in our coaching group the other day that, um, there was a study that came out, this is maybe like four or five years ago. And it, you know, it was one of those meta studies that looked at just the injury, just the injury rates within runners and the kind of combination of research that they were looking at stated that up, up to 70% of runners will be injured within a calendar year. And initially I looked at that and I'm like, that's staggering. Like, you know, cause I've been coaching runners for a long time. And if I had 70% of my runners be injured within a year, like I would be, I would go, man, I'm doing, I'm doing a really, I'm doing a really bad job. So we brought this up in our, in our coaching group the other day, but the consensus kind of around the group was, was that's it. Like it should be everybody. It should be like, in a lot of it, I think depends in the study kind of teases out as well. A lot of it depends on like how you're actually categorizing injury. That was my question is how they're defining that.

And, and so I want to see, or I guess what, one of the things I want to know from you, Hal, is, is like when you see somebody in your practice and you're doing an initial evaluation on them, are you able to like grade like the severity of what they're going through and how does that process actually look? The process looks, it comes down to a few different factors, uh, the severity of injury, the level of impairment. So is it, is it painful, but they're still able to continue to do activity or run or their sport, or is it something that they're shut down and they can't do, do anything with it? So, and, and how it affects other, other aspects of life too. So you get into the, you have to look at the whole picture.

But you're taking, fundamentally you're kind of taking pain and function. Pain, function, and then you're looking at, at other factors of there's within the evaluation process. You're looking at movement patterns, you're looking at strength, you're looking at, um, orthopedic evaluation, orthopedic testing. Uh, so there's a whole screening process that goes through to be able to evaluate. So it's more formal than what most runners would say. Well, I'm dinged up, right? Is the vocabulary that we use, or, you know, I've got a niggle or I'm full on injured, right? There's like some, you've got like a, a sophisticated version of that within your practice. So wait, so how well does it match up when a runner comes in and says, well, I'm dinged up? How well does that match up usually, uh, from what you actually see when you get that evaluation on them?

Well, it kind of depends on what they mean when they're dinged up and they have a sense of it. Like if people have had injuries that are, have been bothering them over a period of time and finally they come to see me cause they're, they're tired of just dealing with it, um, and kind of riding this roller coaster or they just, they know that they can't continue on their own. They've tried a couple of things. Um, and it's maybe a fresher injury or that type of thing, or they can't run. They try to run, but they can only get like 10 feet and they end up stopping. Is that pretty typical? Um, in your experience where you're get, you're essentially getting runners that are like, they've stepped over the line, right? They stepped over the line. So they need help versus runners that are trying to stay on the right side of that injury line.

And so they're coming into you or another like physical therapist to, to essentially prevent them from getting into an injured state. Like what's the balance of that typically look like? I get, I get people on both sides of that, um, both sides of that line. It tends to be more people on the side that are, that are more injured than less injured for that. Uh, but there are other people who are feeling pretty good and they want to maintain that. Um, or they'll start to feel something coming on and it's not preventing them from, um, backing off their activity, but they, they want to stay ahead of it so they don't get to that point. But most of the people that are coming in is more so that they're precluded from, from running or doing whatever their activity is. So it's a fix me. It is. Type of, type of situation. Casey and I've been through this before where, you know, you go through that whole range, you know, a couple, couple, two, three, four times in a season where you get a little bit dinged up. I'll use the non-experts vocabulary, right? You get a little bit dinged up or you get a niggle. And then there's always this like decision making process of, do I kind of write it out? Do I just reduce my training volume? Do I go in and I see somebody and, you know, Casey, you and I, we've had that back and forth on exactly like what the typical tree, like what the typical triage is. And one thing that I've always really appreciated about you is that you put all that stuff in a really honest way, like in your training log. And I think that's like one of the first real steps. And you usually, you do a good job of taking the first step and saying, I'm going to go in and see blah, blah, blah. I'm going to go get this type of treatment. And I just wonder,

is that like a practice habit with you or is that something that you've just developed over time? I think it's a little both just being in the practice of physical therapy and knowing like being injured is something that's real. And then being an athlete also in knowing when your body starts to feel off and knowing the fine line between, is this just something I can work through? Or is this something that really should be seen by something or someone else to get a second opinion? And so I always liked having that in my mind of, I better see somebody else to, you know, justify why I'm feeling like this. Yeah. Typically the triage that we've, that we've taken just you and I between coach and athlete is, is like the first thing we look at is, is just like reducing the training load, right? I'll use load as like both, both the combination of volume and, and, and intensity.

Um, but one of the things that I've been noticing just more and more just in our coaching practice is we start to look at aspects that are outside of training load and biomechanics, which is kind of like where you guys' world is, right? Especially in the biomechanics side of things. But we also start to look at like other life stressors and even nutrition. And it's really interesting because the research actually teases this out as well. Just if, if your sleep is off or you, or you, or your, or your nutrition is off, you can become much more susceptible to, to injury. And I'm kind of wondering from both of you, both of your perspectives, how you can kind of start out. Is that something that like comes up when you have athletes come into your practice? Like they're always coming and say, ah, my knee hurts, but, but are they coming in and saying, ah, my knee hurts and I'm not getting a lot of sleep? Or is that something that you have to like conscientious or consciously like work with them on?

That's something people, people may think that they're having an understanding that they're not getting enough sleep, but it's not that they're coming in and saying that. Um, but asking them how their sleep, sleep quality is their duration of sleep and that type of thing that can tie into it. Um, and just like with food and nutrition, when we, we talk about it from a rebuilding and recovery perspective, but if you back that up even further, if you're not getting that, that buildup in the recovery, then it can lead to injury from there too. Yeah. It's, it's interesting because, you know, I've, I've, I've been coaching for long enough to, to remember that it's maybe, you know, 10 or 15 years ago, the standard run of show whenever you're encountering any injured athlete is you put them on treadmill and look at their mechanics. And that seemed to be almost like the default to where all like the practitioners and even coaches and biomechanists and things like that, they would go, they would kind of go to that first and foremost. And now like, I almost asked the question, I'm like, okay, what else is going on in their life? Like, are they stressed out about, you know, work job? Are they getting enough sleep? Have they been trying to like, you know, lose an inordinate amount of weight or anything like that? I tend to, I almost tend to look at those first and foremost, as opposed to the mechanics or even what replaced the mechanics several years ago, which was the training load, right? We got really obsessed about training load and training load ramp rate, where it looks like how much load are you ramping up over, you know, shorter periods of time. And like I said, I've kind of seen that like permeate through the coaching world, but I don't

know from a, like from a physical therapist, practitioner's perspective, whether or not that's, whether or not that's true as well. I definitely find that you have to look at the bigger picture. It's not just the injury itself, but like what their life is, how it's happening at that moment. If there are the stressors, if there's the lack of sleep, if there's something else that is going to be impacting that injury, because you always default to focusing on the injury site. So if your life is kind of in turmoil, you go into physically thinking of, oh, my knee hurts really bad. It's just getting worse. And it kind of copes for what's going on outside of your life. Yeah, for sure. I, I, I, there's always that correlation between when there's a lot of life stress going on. It's definitely a precursor to just other things spiraling out of control.

And one of those things can definitely be injury. And to touch back where you're talking about training load and really the ultimate picture is life load, right? And then training load is one of the subsets of life load. Yeah, for sure. For sure. And like I said, from a, from a practitioner standpoint, we've definitely been more and more conscientious about taking those things into consideration and not just going straight to the mechanics. It's speaking of mechanics. That was another thing I wanted to talk, talk to you guys about. Um, I want to get your opinion on fixing things that are wrong, right? Cause it's very easy to put somebody on a treadmill and you can find 10 things that are going on the quote. And I'll use this in air quotes, right? Going on wrong with that particular athlete. They either have some sort of imbalance or they swing their arm in a weird way or their, you know, right foot lands differently than their left. And some of those times, those, those mechanics, you just need to let ride out because they've been running and locomoting like that for their entire life. But other times you need to look at and say, okay, this is what's actually, this is part of the problem. And we need to go about addressing this in this fashion. And so how I'll kind of start with you. Like, how do you, how do you go through that process when you're actually looking at somebody in mode, we'll just say in motion, right? Cause I know you work with athletes that are also not runners.

So you can like look at them and like in the field of play, how do you go about looking at them and addressing those things and deciding essentially what to fix and what not to? Well, which is a question that comes up all the time. And you see athletes that, you know, a lot of great athletes are great that way and they don't have ideal combat. Uh, they're, they don't have the ideal mechanics, but they're that way because they compensate well. And they can, if you change it, that they may not be the same athlete that they were. So what I'm going to do instead of, instead of looking at specific, um, mechanical factors, I'm going to look more at like movement and, and start, I'm not, I'm not going to change arm swing or change running technique specifically, but if I see an imbalance, I'm going to work with exercises or mobilization to address those imbalances that would have an impact on, on the, on the technique or the form.

And so give me an example of like something where you said the arm swing, right? That's not, that's not something that you're going to typically mess with, but give me something that you would see like in your field of practice and go, okay, let's work on this imbalance there. And it can be recent. You can, you can anonymize the example. Right. And I mean, a lot of it comes down to, um, looking at the whole picture of the mechanics of the athlete. But if there's, if there's some, some knee collapse or, uh, or hip drop that's happening, I'm not going to work with, with changing that or a crossover gate, but then I'm going to work with exercises that are going to address those muscles that, that are involved with that and work on building, building up for more, building up the, the individual as an athlete versus specifically a runner.

What do you wish runners would do so that they didn't have to come see you? Um, not to put you out of business or anything like that. Well, part of what I do is educate. So, you know, and, and getting, getting athletes to become more, more durable and more sustainable with what they do. So, um, there's the daily maintenance, um, daily mobility, some strength and stabilization, things that are just going to work with, as I was talking about before, working on having them become more of a better athlete and just more durable, um, as a person. So, um, Is there a, like a blanket type of routine that you could, like, if you were just say, listen, if everybody just did these five magic things, I could bottle it and make a zillion dollars and not have to practice anymore.

It would, it would be, there's a couple of concepts. I don't know if you could dial it down to, to that, but things with working with like ankle dorsiflexion mobility, hip mobility, um, upper thoracic mobility, those are some key things that we tend to, that tend to break down and have people across the board to have more problems that way. So working with mechanics in through there, um, doing a little bit of warmup, um, before they, before they go out and run a little bit of muscle activation and then doing a little bit of mobility or cool down afterwards, people have a tendency to just bust out the door and then they come back and then just right in the rest of their life without kind of having these, these little windows or these buffers between the rest of their life and activity where we can have a little bit of movement prep to get the T the tissues ready. And then a little bit of cool down to let them settle back in. So it's just simple stuff, warm up and cool down.

I mean, it's the small things done consistently. What is what makes the biggest difference, right? Yeah. So just doing, doing just small things consistently, it doesn't need to be, I think a lot of people don't do it because they overthink it and they think it needs to be this big elaborate thing. But if people just did small, consistent daily, regular things, it's better. I think it's better to do smaller things consistently than larger things. Well, and people want the magic fix, right? I'm sure, you know, I'm sure both of you guys, you know, it like in, in working with people and working with athletes, they just want to be fixed. And so they want like the one thing that's going to take them from an injured state or a state where their, you know, performance is compromised to where they're functioning, functioning optimally. And that in life that, you know, the hack or the one, you know, the one golden thing very rarely exists. We're all still searching for it though.

It seems like, but it just very rare. It just very rarely exists in life. Um, I want to talk to both of you guys a little bit about the, the kind of the psychological side of injury as well. Um, and run runners are notorious for having B for, for blending all of these kinds of injury States, right? They can kind of like almost chronically be injured, but all honestly can perform pretty well. And you can look at the start line of any major road marathon or many, any, uh, major, uh, ultra marathon. And the majority of those runners speaking to the statistics that I was pointing out earlier, the majority of those runners that are towing the line have some type of injury compromise that they're, that they're going to have to manage throughout the, uh, uh, kind of throughout the course of the race. And whenever that's the case, when you have an athlete that's, that has to deal with something constantly and consistently, it's like a weight.

You know, I mean, it's like an extra, you know, maybe, maybe an extra hour less of sleep or something like that, just like any other kind of stress. And Casey, I'm, I'm kind of wondering like how you manage like that part of it, like having to go through, you know, really heavy training phases and phases where you're feeling good and phases where you're not feeling very good and having it almost kind of be a part of, it's almost like a part of the gig, right? It's part of the job and how you manage like the psychological side of, of dealing with that. Yeah. For me, I, I mean, there's rarely ever a time that I go into a race a hundred percent feeling on my A game. So just knowing and believing and trusting in yourself and your body. And every time you tow the line and the gun goes off or you start your, you have to manage what you have going on. But a lot of times it is psychological where it's like, I'm running. I really don't feel this pain that I've been dealing with for months and magically race day. It disappears. So a lot of it is something you, you just have to trust in yourself and trust and believe in your training and continue to go on out there. And maybe you start to feel it. Well, then you, you know, you adapt, you find the ways to work at not having it or to lessen it and not to let it get to you.

Cause it can be easy to have that injury ruin your race. So you have to work it towards on the positives, always focus on the positive. Or just as much as an injury, an injury can like physically take you out of the game from a training perspective. It can also psychologically take you out of the game from a training, from a training perspective. And I'm wondering how, like, cause you see you, I'm kind of, I'm saying this kind of tongue in cheek. You probably see a certain group of your patients every week, 52 weeks out of the year. Like they're always heard and dinged up and niggled and things like that. And I'm wondering if you, if you see that psychological ebb and flow as well, when they're like consistently coming into your office.

It's a, it's across the board, but it does, it, it definitely affects people. It's, it's people, people just want to go out and have fun. And it's something that people associate with that. It's a passion that they have. And it's for some, it's just stress relief. And for some, it's meaning as, as far as like who we are and, and, and the appreciation and happiness that it brings us to go out and do an activity of what it is. So when people can't do that, or they have an A race that, that they have and, and they know that now it's, they're not going to have the, go out with the same expectation that they typically would. Um, they get frustrated with that. So I, I understand and appreciate where they're coming from with that. So that's why I'm always striving to do everything that I can to, to get people back as quickly as I can and to, to help prevent them from having things like that come up. Do you have to put it like a psychology hat on every once in a while? Uh, there's definitely, I'm not a psychologist, but there's an aspect of, um, being empathetic and, and helping to reframe things. Um, and I think that, that being a runner myself, um, an endurance athlete myself, it helps me to be able to connect, uh, with my patients and my athletes and understand their perspective and where they're coming from and, and have an appreciation as far as what getting back to sport means to them. You know, it's so funny that you mentioned that because one of the, one of the frustrations that the athletes that I work with have whenever

they're trying to go and find a physical therapist is not the quality of the care that they're necessarily receiving, but it's the, that understanding part of it. In fact, I have this really often, uh, sentiment whenever, uh, whenever an athlete finds a physical therapist that they'll, that, that they'll have good success with and they'll continue to go back with, they'll just come back and say, well, they just get it right. They just get me. And it's not, it's sometimes it's not even things that are like endemic within running. Right. But for whatever reason, the practitioner is able to like connect personally with the runner. And I think that there's a lot of, you know, there's a lot of good psychology research that where, you know, when, when you, when you believe that you're getting better, you're actually going to get better. And that goes from, you know, physical, you know, physical injuries, like, you know, like we see in running, but also things with like cancer and, you know, uh, you know, other types of ailments. Um, but I think that that's a big, big, I think that's a big, big part of it is just like understanding the patient. Right. And from my perspective as a coach, understanding the runner and being able to like, and being able to connect with them. Um, I want to get your perspective on, on, on some, on something else. And this is, this has happened a number of times during my coaching career. And I, I, I am very fortunate that I live in Colorado Springs and we have a lot of high quality, just people that work in sports, right. The whole kit and caboodle from the massage therapist to the nutritionist, registered dietitians,

physical therapist, orthopedics, you, you kind of name it. And the training, the Olympic training center tends to, tends to drive a lot of that. And I've had this, I've had this conversation over and over and over with people on the orthopedic side and people on the physical therapy side and, and people in, in, uh, on the sports chiropractic side as well. And none of them have been able to come up with a, uh, with a very good answer for this. So I, maybe I'll take, maybe I'll get you guys' take on it and we'll be just as stumped, but we've all had this experience where we either know somebody or, or, or us ourselves personally has gone into a race with something going wrong. I have some, you know, tendinopathy or my ankle hurts or my lower back hurts or whatever. And the race fixes it, which is good. Casey's laughing at this cause she's had this happen before.

That is totally counterintuitive to any training or maybe, maybe I might be speaking out of turn, but it's totally counterintuitive to, to most logic, I guess is what I'm trying to say, because the race puts more physical stress on the athlete than any one single day of training. So it's, it's just improbable, or it seems improbable that the race would miraculous, miraculously like fix this ailment that's going on, but yet it happens time and time and time again. And I've always wondered why, like, why is that the case? Like, how can that be possible? I feel like there's something more internal that's causing that ailment ahead of time. And it could be the stress of the race. It could be, you know, just feeling of that pressure. And then once the race starts, I mean, you're starting. And so you're going on that journey and your mind's stopping, like it stopped thinking about that ailment and it's allowed you to release whatever's going on.

So I don't know if it's like more so not necessarily physiological, but psychological. And our bodies are really made incredible so that we really can't understand them. And I think the process of it is amazing and just go with it. That's the first time I've ever heard that. Like just, there's some sort of, there's just some, there's just some sort of joy that you get out of doing the race and going back to the psychological aspect that quote unquote fixes the injury. I don't know. How do you have another perspective on that? Do you see that? Have you seen that before? I do. I do. I, I, I, are you like me and you just go, what the heck? I've, I've seen it enough that I don't question anymore. And it almost to the point where I have, I have athletes who come to see me and they're doing okay through their training and their race is coming up and they're concerned about how they're going to do on the race. And, and to the point where I almost just kind of coach them through, just like go out there and just, just see how it is. And I've seen it enough times that I don't expect it, but I'm not surprised when it happens.

Maybe instead of a, what's the acronym that we're using for musculoskeletal injuries right now, peace and love, maybe we should include race in that. So what would that be like? P E A C E R whatever that comes out to, we should actually include that as part of, as part of, as part of the, as part of the treatment office, just go race. That's what she should do. Next time somebody comes in all hurt and dinged up, how just, just go into our race. She'll be fine. It'll all be fixed. What is it? So it's good that both of you guys, that both of you guys have kind of had that perspective because it's certainly been a, been a stumper for me. Um, and, and speaking of stumpers, so injuries are, are, are always tricky, right? But some are, some always seem to be trickier than others where you just can't get like a thumb on exactly what's going on. What are the more difficult ones that, that Casey, you can kind of start out on this one. What are the more difficult ones that you guys see or that you guys have actually like experienced as athletes? My biggest one is the nerve related injuries.

It's just hard to pinpoint where's this root coming from? Is it from the back? Is it from a pinched nerve in the glutes or somewhere higher, you know, just, um, just figuring it out. And there's so many referred pain patterns that you have to figure out too. And, you know, one, one day the patient may say it's, you know, my pain is in the thigh. The next day it's in the back of the thigh. And so just kind of figuring out that process. Um, how about you? Uh, similarly, but from more from a loading perspective. So like if someone comes in with foot pain or knee pain, uh, or lower leg pain, I'm pretty sure that most of the time it's not that specific area. That is the problem. It's not their, their, their, their plantar fascia is using that as an example.

It's tight because something else isn't loading properly and stabilizing properly. So it's doing the reverse engineering to determine where is that misfiring happening. And so when, whenever, whenever you see an athlete that does have, you know, plantar fasciitis is a pretty common running injury. You're always looking at what's causing it, like something mechanically that's going on. That's, that's loading it improperly versus, okay, go and, you know, roll out on the lacrosse ball or go and do those stretches, all of which are the treatment part of it. Right. But you're treating the injury at that point. You're not treating the root cause. Right. Yeah. So there's things in that case that, that would need to be oftentimes need to be addressed directly, but that's not the only answer to it. In fact, that's, that's the distractor from it. Yeah. You're treating the symptoms, but you got to find the root cause. Exactly. Yeah, exactly.

Well, I think a lot of times what we're doing with these modalities, whether it's a foam roller or, you know, one of the massage balls or the trigger point therapy things and things like that, we get kind of too caught up into actually like, okay, it hurts here. So I'm going to do something to that area versus taking a step back and going, okay, well, why is that hurting? Is it a mechanical thing? Is it a loading thing? Or are my shoes too worn out? I mean, there's like some simple things that, that runners can all kind of go through in order to address the root causes and not specifically, you know, the manifestation of what those root of, of what those things are actually, of what those things are actually causing. Um, how much, uh, how much do you pay attention to equipment? How? A lot, a lot. Yeah. Um, it's, we, we talk about shoes. It doesn't always come up, but you know, at, at some point if someone is, is chronically or persistently injured, we'll talk about shoes, um, and the types of shoes that people are wearing and the age of shoes that people have.

Some people, um, have things around for a longer period of time, or it, it doesn't necessarily match up with, with, with their mechanics or what they're trying to do with it. Um, site, I work with a lot of cyclists and triathletes. So, um, bike position, uh, is huge with that. So that's something that I'm continuously encouraging and, and I have some good bike fitters in the community that I'm, that I work with that, that understand it. Um, and that will take the time to look at previous injuries and movement patterns and biomechanics and how they're fitting on the bike and what type of riding they're doing, um, and what type of an athlete they are. Yeah. Cycling is always a, it's, it's more important to be precise with your bike fit, uh, as opposed to like having the most precise pair of shoes, right? Cause you're like fixed into the bike and there's no way to like run around it, right?

Your cleats are where your cleats are at. Great point with that because the, the bike, it's always the same bike and you're, you're going to be in the same position where with running shoes, I would actually, I encourage people to do the opposite and have a variety of shoes and run a variety of terrains and a variety of routes and, and to, to have that variation. Cause otherwise your body just gets into this same patterning over and over. And that's where it oftentimes starts to break down. So that variety helps with the durability. So barefoot running, yeah or nay? I think it has its place. Um, but overall, um, uh, it has its place at times. Casey, when was the last time you ran barefoot? I don't even barely walk barefoot. I did my actual, um, doctorate on this, um, but yeah, I, I believe that since, you know, as we're humans, we have always been in shoes. So our, our feet have molded to how we wear shoes. So when you go barefoot, you're straining other things. So it is, it's good because you want to still work those muscles and still those tendons and ligaments tissues, but not for, if you're just going out for a, you know, 10 mile run barefoot. I mean, you're going to have some aches and pains from that.

It's a process. And if you, if you train like that, you can do it, but if you don't, then don't. Yeah. I think in the, uh, born to run in the Vibram five finger days, you guys were getting a lot more business. I got more injuries from, from those shoes than all of their shoes combined. Should we still call them shoes though? Do they still classify as shoes? Globes. Foot coverings is a better way to do it. I think so. I think so. But I think, yeah, we're, when I say barefoot running has its place, I think it's a fantastic cool down on the infield of the track after a workout. Um, I think if you want to do a shakeout on the beach, um, and for, you know, 10, 20, 30 minutes and, and, uh, just let your feet kind of adapt and work through the sand. I think that can be beneficial.

You know, I always have this memory, uh, cause the, the running store that Tony Kaprichka used to work at is right next to my house. And the, the owner of that running store was actually, he's actually one of the first people that I met when I moved to Colorado Springs. And so he and I have been, been friends for, for a long, long time. I used to go in there and there would be just pieces of shoes all over the floor of this running store from what Tony had like, from what like Tony had, had cut up. And it was at that time, right. I was born to run time, be from time. It was this like constellation of, of, of influence in the trail running community where a lot of people started to gravitate towards a lot of this minimalist style. And now you hardly even see that anymore. Like it's, it's actually, if you wanted to go and find like a shoe with like a five millimeter stack height or a seven millimeter stack height or something like that, it's actually harder to find now, which is crazy. They were everywhere five or seven years ago. And I guess that's just, that's just, that just goes to show what the market's buying more than anything else.

The phases it goes through. Didn't Vibram get sued? They had like some class action lawsuit. They did. I don't remember the details of it, but I remember that happening. It was, it had something to do with like one, it had something to do with one of the claims that they made in their marketing. I think that's right. Cause it was a FTC, uh, it was an FTC deal to my, to my recollection. Anyway, I'm, I'm glad that phase is over. Yeah. Although it might come back. These things come around in cycles, right? You never know. You never, never, never know. So Casey with your doctorate, why don't you just take us through like what, like what that research was on and what the results were? Cause I think this is really fascinating. And the fact that you're a runner, right? Yeah. It's really pertinent. Yeah. So what, um, it's really, what I found the research on is people that run in shod or non shod. So running in shoes or not in no shoes or Vibrams. So basically the premises was they took a pool, like several samples of people and they watched and they saw them for several, you know, I did a lot of different research papers, but like for one of them, they sampled. The size was pretty large. And what they did is, um, had them come in, do running. They all did the same type of running, same type of testing. Just some had shoes, some didn't have shoes and their findings for these people, because these people had already been training without shoes and people that have been training in shoes. So it wasn't like they were

starting off, you know, clean slate, but they found that if you were predisposed to running in shoes or had been in shoes your whole life as a toddler, that your, your foot has molded into those kinds of shoes. And when they put them into like Vibrams, they started finding all these imbalances because of, you know, your, your foot is not mechanically set up for this. And so they were getting more injuries if they were put in Vibrams. But if the people that were in Vibrams initially were put in shoes, then they were having issues because their feet had not been accustomed to having that much structure underneath them. And so that goes for two ways, but 95% of the population wear shoes. And so, I mean, if you're going to go from wearing shoes to training without shoes, you're going to have those injuries pop up. And so research just based off of that was saying, you know, you have to train the way you are. You basically have to walk in flip-flops all day long and you have to be, you know, your, your lifestyle has to fit your running lifestyle.

You know, what's really interesting about that? And there's a reason why I had you kind of go through that is a lot of the marketing, a lot of the do this because, and then you won't get injured, marketing from shoe companies has to do with exactly that, but they spin it the opposite way. They're like, if you wear these shoes, they'll, your feet will start to naturally change into their, you know, into their more, into their more, uh, yeah. Into their more natural form is what I'm trying to say. Right. And, and, and you can actually, you can see that, right. You can take x-rays of the foot before and afterwards they're wearing this shoe and then wearing that shoe, your body's smart, your body's going to kind of adapt to the equipment that it's using and things like that. But they're, what they're actually saying is the opposite of what the research teases out, right? What they're saying is, is you will be, you will have fewer injuries because you're in a more natural state. But what the research actually says is no, because you're changing what you normally do and have done for many, many, many years, you're more susceptible to get injuries. So I've always thought that was an interesting marketing take. Cause when I first started to see that, I, that's exactly what I thought. I'm like, no, that's not what the actual research says. Yeah, that's what happens, but it's not what the actual research teases out.

So anyway, marketing versus reality, right? And then Casey, did anything come up where, um, they looked at lifestyle where I think, cause I've always thought that a lot of it, a lot of things that people have problems with shoes or no shoes has to do with lifestyle where in current society, we spend more time sitting in chairs and driving and doing things where if we go back, you know, several hundred years, we're doing, people were just doing more with their bodies lifting and, and on a daily basis throughout the course of the day. And we don't have that. We have a lot more sedentary periods. Right. Um, that I think ties into a lot of those factors as well. Definitely. And the type of shoe styles that we're forced to be wearing now too, and like business attire and things like that has definitely been part of that problem.

But yeah, I, they didn't really specifically go into that for the research I did, but I'm sure there's studies out there with it. Awesome. All right. We're going to wrap it up here. Uh, last question for you guys. Actually, I'm going to have one more question after this, but does that have anything to do with injuries? Last question for you guys. It's a two part question. So I get a little bit more bang for my buck on the last question. I want you to give everybody one thing that makes you pull your hair out when you see them do it. And you know that they're going to kind of keep coming back to you time and time and time again. And then one thing that when you see it, you're like, yes, I wish everybody would do this. They would be a whole lot healthier runner. How you can go first.

I think the, the thing that, that, that kind of gets me to pull my hair out a little bit more is people thinking that, that there's, there's an easy fix or something external that they can, that they can do. I think people, people may not have the answers themselves or know what they need to do or not realize that they're as empowered as they are. And so they're looking for something external and thinking that there's a quick fix for it. And sometimes things are going to happen faster than others. Um, but a lot of times things take time. And then that comes into the flip side of it of, of just doing, you know, the daily things that, that they can do that, that, uh, I love teaching people about that they can help to maintain, um, healthier lifestyle, better movement mechanics, um, better opportunities within sport and that type of thing.

No quick fixes from how then. Okay. So what do you wish everybody would do? So the, the, the, what I was just talking about is just the, the do things day consistently daily. Um, and that could be, you know, doing some of the muscle activation things or doing some of the mobility things, um, whatever it is, be consistent with it, be consistent and, and, and don't overthink it. Don't think that it needs to be this, this fancy thing. Like, like I've mentioned earlier, sometimes doing something more consistently that has just slightly less efficacy is worth way more than doing the thing that has the most efficacy once a month or once every week or something like that. So there's a lot, there's a lot to, I would rather that that's the, the, the thing that I see is, is if I give people too much or if people get too much from their doctor or their therapist, it's the, they sometimes tend to get overwhelmed. So it would be great if people could spend, you know, 30 minutes or an hour a day doing it. I'd rather, but if they have so much and they just never think that they can get it in, they're not going to do it. But I'd rather have someone spend five or 10 minutes a day doing something consistently that they'll actually do and get done. That's in a, in a manageable amount of time that they can do.

Casey, I guess for me, the biggest pet peeve would be is when people have something going on that they ask everyone, they go on Facebook and ask everyone, have you had this injury? What do I do? And you get 5 billion responses. Oh, the crowdsourcing. Yes, crowdsourcing. Go to your, you need to find somebody you can trust, like a physical therapist, an orthopedic doctor or somebody, just go to them where they can really give you their actual details of what's going on. I love that. So find an expert. Yes, find your expert and stick with them. Oh God, that's so good. That's so good. And it's easy. It's easy to get a lot of uninformed opinions these days. You'll get everything from you have cancer to you have tendonitis. I mean, you will get every spectrum of an injury.

That's awesome. And everybody's experience that's, that's very broad and, and, and it's not that broad. Well, I mean, it's like anything, right? Once you have done something, you're automatically an expert in it, right? I mean, you could say that about nutrition. You can say that about coaching. You could say that about like triathlon is the best example of it, right? Everybody that's finished an Ironman triathlon, Ironman triathlon is qualified to give other people advice about an Ironman triathlon for whatever reason. It's that community specifically that is like a hyper example of that. And I love, I love triathletes. I have a lot of like really good friends that are triathletes, but there's, it's just something about that community where everybody's an expert. Um, anyway, okay. Thanks for all the awesome information on injuries. Now we're going to have a little bit of fun. Both of you two are running the Javelina hundred tomorrow. It's T minus how many hours, 10 hours or so from race day or from, from when the gun goes off, how, what's your prediction for Casey and Casey? What's your prediction for Hal? Casey get in. So for everybody listening, this is Hal's first hundred miler. It's going to happen tomorrow. He looks scared shitless.

We can't tell right now. He really, he really does look scared. So Casey, how do you think Hal's going to do? He's going to nail his A goal. 22 hours. Absolutely. And to just, you know, be yourself, run happy, manage yourself. Such positivity. You gotta be positive. Expect nothing less. Nothing less from Casey. How, what's Casey going to do? You know, Casey's a rock star. She's been, she's been around the sport for a while. She's proved herself. Um, but I know that she knows how to have fun. Um, but she knows how to, how to dig deep and, and how to suffer and, and get results, um, and do well in a race. And Casey, finally, your trusty pacer, Miguel's running tomorrow. He is. What's your prediction for Miguel? Miguel's sitting in the corner of the room, really quiet.

He's also freaking out about this. He's going to run well. He's, he's got this sub 24. He's got it. All right. You heard that. Sub 24 from Miguel. All right. Thank you guys. Really appreciate it. Yeah. Yeah. And good luck tomorrow. Thank you. All right. Runners. What'd you think? You've got some information to keep you on the right side of the injury line. Got some more ammunition to arm yourself with in this winter season. Training's coming up. It's going to come up around January. You're going to start to increase your volume, maybe do a little bit of intensity. That's when all the injuries start to happen. When you start training harder and harder and harder. So take all that advice to heart. Hopefully you got something out of it. And I really appreciate how sentiment of making sure that you do the small things consistently, and they're normally worth doing the big things inconsistently. Small changes over a long period of time is the right way to go about it, both from an injury prevention standpoint, and also from training, right? That's what we talk about. A lot of coaches do small things, do them consistently. The results will follow. Thank you, Hal Rosenberg. Dr. Hal Rosenberg. Thank you for being on the podcast. And thank you for taking care of a lot of athletes. You can find him if you just Google Mount Tam Sports and Spy, and you can find Casey Licktyg on Twitter at, as you can find Casey Licktyg on Twitter as, at runner underscore Casey, and on Instagram as

ultra runner Casey. She's got an awesome Instagram following. So positive. I love it when she comments on my Instagram posts. It's always something fun. Go give her a follow. Great person to follow. Thank you guys both for being on the KoopCast. And as always, we will see you on the trails. Thanks for listening to video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video video