Nikki Buurma DPT podcast episode

Your Running Questions Answered By A Doctor Of Physical Therapy

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About this episode:

In this week’s episode, Corrine Malcolm interviews Nikki Buurma, DPT on some of the questions that have gone through every runner’s mind. Nikki debunks some myths surrounding runner’s knees, shin splints, and stretching. 

Episode Highlights:

  • Why you should have a physical therapist on deck to help with injuries early
  • What does a DPT say about foam rolling versus stretching
  • Muscle injury or a connective tissue injury and if you should use ice or heat

Guest Bio – Nikki Buurma:

Nikki Buurma Doctor of Physical Therapy specializes in treating runners at Lynden Family Physical Therapy in Washington. Nikki graduated from Ohio University with her DPT and has been practicing for 14 years, keeping runners healthy and reaching their goals. She is an ultrarunner, yogi, outdoor lover, and as she puts it, a “fan of all things running-related”.

Read More About Nikki Buurma:

Website: https://lyndenfamilyphysicaltherapy.com/staff/nicole-vanderwiele-dpt/

Instagram: https://www.instagram.com/nikkirunnerpt

Twitter:https://twitter.com/nikkibuurma

 

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Episode Transcription:

Please note that this is an automated transcription and may contain errors. Please refer to the episode audio for clarification.

Speaker 1 (00:06):

[inaudible]

Corrine Malcolm (00:07):

Joined by good friend and phenomenal doctor of physical therapy. Nikki Burma, when Nikki isn’t taking care of patients or treating athletes, literally at the trail head, you’ll find her challenging herself on mountain runs. And through ultra marathons here on the trainer podcast, we’re going to be doing something a little different today. Last week, I reached out to you to listeners and said, Hey, what do you want to know? What do you, what, what would you ask a physical therapist and you delivered with lots of really good questions, lots of basics, lots of things that we’re hopefully going to cover today that are going to help direct and steer our conversation. Nikki Ana, thank you so much for making time at the end of your super long Workday to join us.

Corrine Malcolm (00:51):

Thanks. Thanks for having me. Yeah. So, um, like I said, I put out this call on Instagram and I said, Hey, what do you want to know? And I think initially I was asking about questions specifically for physiologists and I, I ended up having to answer lots of questions. I’m like, well, what, what is a physiologist? And then what is a physical therapist? And then what is a psychologist? And so I ended up actually pulling questions into three categories, one for a physiologist that we’ll have on the show at a later date, one for a psychologist that will have a show on a show at the later date and then physical therapy. And that’s why you are here today. Um, I’m wondering if there’s anything in your intro that I left out to me, you’re a beacon of my former community Bellingham. You kind of keep us all together, um, and hold like literally hold us together the Trailhead. And I’m wondering if there’s anything from your intro that I, that I left out. Um, maybe from when, like your time going through grad school, for example.

Nikki Buurma (01:48):

Yeah. I got my doctorate at Ohio university and I’ve been practicing for 14 years now. And I’m part owner of a clinic here. Um, I like to think of PT as like in most states we have direct access to PT and so every runner should have a PT as a go-to resource. So when things start cropping up, you know where to go and get some answers. The sooner we can see you for an injury, the sooner we can start helping and the less of time off you’re going to need. So if something’s been bugging you for a few days and we get you in, you might miss a week. If something’s been bugging you for a few months and we get you in and can assess it, you’re going to miss a couple months because it’s just so important to stop those things at the beginning, because the corrections are small, where if you stop things late, the corrections are big.

Nikki Buurma (02:40):

And so having your own, um, resource or someone to go to is such a great thing. And I’m going to try to give general answers to the questions today, but everybody’s unique and every person really the answer is going to be, it depends. It depends on you. There’s no right training program for everybody and there’s no right PT for, uh, it, your PT should be measuring you and measuring what your body can do. And so the recommendations are always based on measurements, not just based on general, like, I mean, that’s play Google. Is there, if you want a general answer. So I’m going to try to give specific some kind of point you in the right direction. But really if you’re having a Trump problem, you need to see a PT in real life.

Corrine Malcolm (03:25):

Yeah. I couldn’t agree more. And for those of you who know me personally, it depends is maybe one of my favorite answers. Um, but it does, it truly does depend. And I think what you brought up was a really important point here that we can kind of jump off of is that, um, like I coach athletes remotely, right? Like all of you that might be listening, some of you are my athletes, their CTS, um, your coach remotely. And I always, whenever I meet with a new athlete, I say, okay, who’s your team? Who else is on your team? I’m on your team, but who else is on your team? Is that a psychologist? Is that a, is that a physical therapist? Is that a massage, you know, a massage therapist, a chiropractor, um, whomever, it might be a nutritionist dietician. It’s important to have that team on the ground because just like you said, you know, things are kind of general.

Corrine Malcolm (04:12):

Um, things are gonna be specific for the individual. And I can’t, you know, you’ve gotten so many texts from me over the years of like me saying like, okay, I’ve got an athlete. This is what’s going on. Am I going the right direction? Which I think phenomenal thing to have in your back pocket, but it does not replace seeing a PT in your local area. That’s super important. I guess one question I have is I think generally to start us off, is it important? How important would it be to see a PT maybe before anything goes awry? Like, is there value in seeing a PT ahead of a big training year or moving up in a goal just to kind of beat, to be proactive? Is that a thing

Nikki Buurma (04:54):

I would say, no, I would say if it’s not broke, don’t fix it. So I’m going in and having an assessment, like I could tell you areas that are like, oh, you have decreased flexibility at this part or your glute strength. And this side is worse than that side. And maybe give you some like things that you could start working on, but in general, if you’re running successfully and healthy and you don’t notice any big errors or kind of discrepancies side to side, then I wouldn’t go and seek PT just to get a baseline. Um, it’s more when kind of those early niggles prop pop, pop up that you’d want to see somebody

Corrine Malcolm (05:37):

That is very sound advice. I hope everyone takes that with, uh, you know, takes that to heart, right? Like don’t, if it’s not broke, don’t fix it. But as the niggles crop up, which they oftentimes do, um, I think both of us can agree that we frequently have niggles. It’s important that you get that checked out. So diving in two questions, um, the first one is started to fall. Start us off is actually from one of my athletes here in the bay area. Um, and he wrote what’s with the whole running is bad for your knees thing. We, a lot of us hear this. This is a big, broad question. It might be kind of hard to answer, but his question really is, is this myth, is there truth to this? Should he be worried? And like, maybe is there, is there any long-term consequences of running the research I’ve read, doesn’t really suggest that, but I’m curious from your angle, what you’ve, what you’ve seen or read.

Nikki Buurma (06:26):

Um, that’s a hundred percent of myths. I think it’s your family members or friends who feel guilty, that they’re not running, who are trying to make you feel bad because there’s really no evidence to support that at all. All the research shows that are that running in general helps build leg strength and helps to protect your knees. And so they actually did a big study where they were trying to prove that running hurts your knees. And they had people train progressively for a marathon and they all had less knee pain. And so it proved the opposite that need that running does not impact your knees is not giving you arthritis. Arthritis in general is I like to think of it like a door hinge. If your door is hung straight, you can open it and close that door thousands of times. And it’s not putting wear on the door.

Nikki Buurma (07:11):

If the door is hung crooked and that hinge is crooked, then it doesn’t take that many openings and closings to make it not work. So if you have horrible mechanics and your knees are falling all over and you’re running through pain, or you just jump into a marathon with zero training, that’s probably bad for your knees because it’s not moving the way it’s supposed to. It doesn’t have adequate strength to support it. But in general, if you have built, taken your time to build up into a running program and you’ve taken your time to train properly for the event you want to do, there should not be any harm on your knees. Our bodies are all about load. And if the load you applied is the load that you prepared for, then it’s not going to be harmful to that joint.

Corrine Malcolm (07:53):

Interesting. And I’m wondering, does this hold true to larger runners? If you are someone who’s maybe coming into running, um, overweight, let’s say, cause a lot of people, a lot of people get into running because of that, right? They want to lose, they want to lose some pounds or maybe they’re, they’re getting into competitive ultra running and they want to lose some pounds. And they’re coming in as a bigger runner. Does that hold true there? Or is that still down to biomechanics?

Nikki Buurma (08:17):

Yeah, the number one, like the risk factors for arthritis, particularly in your knees would be genetics. So if mom and dad had arthritis, then you’re more likely to get it. Um, body mass. And so being overweight or being obese does put more strain on your joints, um, and previous injuries. So you’ve had an ACL tear, a meniscus tear, some sort of scope surgery. Those things, all predispose you to having arthritis in your knee. And then you might want to consider whether running is the best sport for you, or if it non-weightbearing sports such as biking, a swimming, it’s better. Those same people though, even at any size, you built the load progressively at the right amount. There’s no reason why you shouldn’t be doing that, doing that sport. It’s perfectly safe for you. As long as you’ve taken the time to build up to it. If you have more mass on you and you start a training plan, like any of the rest of us do that you aren’t prepared for and didn’t build up and allow your body to adapt to it, then it’s going to cause more strain. There’s more force if there’s more weight, but it’s still the same thing of if is your body adapted to what you’re asking it to do. And if you’ve taken the time to adapt, then it’s going to be fine.

Corrine Malcolm (09:31):

Interesting. And I would think too, that there’s probably some validity to the idea too, that like ultimately if you, if it is making you healthier, if it is, you know, you’re probably losing weight through this that maybe those, the initial negatives are outweighed by the ultimate positives, given that you’re on an appropriately structured plan for you as an individual, correct. Awesome.

Nikki Buurma (09:55):

Overall health benefits outweigh any negative consequence. And if your doctor has really proven that you have significant arthritis already, they might make, they might recommend you do a non-weightbearing sport like swimming, but really if your true passion is running, then you should be able to find a way to keep earning health fully. You just might have to adjust the volume or intensity, um, in ways that work with your body.

Corrine Malcolm (10:23):

And so another question that I think is very similar to this, um, is, uh, another runner actually, another, another person I know from the ski and biking community Petra wrote in, and she said, what’s the best way to avoid shin splints for a beginner runner avoid, prevent work with right. I feel like it’s very common. Um, so given right, we’ve talked about properly structured plans. Like it is that the only thing that’s going to prevention splints, or are there other things that are a new runner can do to avoid this coming in?

Nikki Buurma (10:59):

Yeah. Shin splints for one, there’s multiple different things that we call shin splints and they’re actually different injuries. And so medial tibial stress syndrome would be pain along the inside of your shin bone. That’s typically because of tight calves or because your foot is pronating a lot when you’re running. Um, true shin splints is actually the outside part of your shin or your anterior tip muscle is pulling on the bone there. And that’s a lot more to do with surface or having for both of them. Proper footwear is a big thing. And so the, the number one way to prevention splints is to adjust your training load properly and to build up at the right progression, which none of us want to go slow. Everyone’s like, oh, I want to run a mile and I want to run two. And then I want to run 10, no one wants to run a mile and then run 1.2 and then 1.4, that’s not fun.

Nikki Buurma (11:52):

So everyone wants to go faster than they’re ready for. And the, the real best answer is to say, adjust your training load to the load your body can tolerate. Now, the kind of ways you can maybe help that go a little better would be things like making sure you’ve got the right shoes for you. And so you might need a shoe that helps with pronation. You might need a shoe that actually has more cushion. It depends on what’s going on with your foot. And she maybe tried one brand and it didn’t work and you to do different branding, your shin splints, magically, go away. It’s worth experimenting and finding the right shoe for you. Um, sometimes things like calf sleeves will help. There’s not really evidence for that, but just anecdotally, a lot of people say that it helps, uh, and things like foam rolling a lot, keep your calves loose. Um, and working specifically on the muscles of the shin to help build them up. All those little things might make a difference. Depends on you. Depends on what’s going on with you. That’s causing that shin splints, but fundamentally it’s an, it’s a load issue.

Corrine Malcolm (13:06):

Okay. So beyond, so once again, a load issue and maybe not coming into it quite quite right, but obviously proper footwear for your specific foot needs and kind of lower extremity mechanics is going to be very important. And I’m curious too. So you mentioned like a mobility aspect of this too, is, are people who maybe do not have the best mobility say like through their ankle? Is that going to be potentially like, is, is that what’s going on there with the variety of things that we cluster in Tish and splints altogether,

Nikki Buurma (13:38):

Right? Having a loss of dorsal flection range of motion or kind of a stiff ankle then, um, that may change the way your foot is progressing over or your, the way your leg is progressing over your foot, that might make a difference in shin splints. And you could probably see some, some increased peak loading forces. I think that they showed that in a recent study of bone stress injuries that people who had less store selection had higher incidents of bone stress injuries because your foot like your muscles or your shock absorbers. And so if your calf can’t absorb shock, because it can’t go through a full range of motion because of stiffness, then you’re going to have more increased risk of injuries in general, for running, you need to have adequate mobility to perform the movement, and you need to have adequate strength to control that mobility. So if you have too much mobility and you’re super flexible, then your muscles have to work harder in order to control your motion. But if you don’t have enough strength to, if you have too little mobility, then your muscles have to work really hard to try and enforce that where they’re hitting that in range. And there’s not enough motion there available to them. And so the force doesn’t dissipate in the same way.

Corrine Malcolm (14:55):

So you talked about mobilizing that zone. So via things like foam rolling, um, to, to increase mobility, but say your, say your week going in, are there specific things that people can do to target that from a strength perspective to, to, to balance out on that? And if the mobility part portion isn’t, isn’t their big issue.

Nikki Buurma (15:15):

Yeah. Mobility wise. Um, if the calf is tight, then something like foam rolling might make a difference, but if the ankle is locked, then it’s more of a joint mobilization to help get the ankle moving better. Um, and there’s ways to self MOBE, or you can have someone else mobilize it for you. Um, and that can be really helpful if that’s the issue. If it’s a strength issue, again, it depends on what kind of shin splints are we talking about. If it’s the anterior tib on the outside, then that’s a specific set of exercises. If it’s the calf muscles or the posterior tib, then that’s a different set of muscles. The most important muscle for running is the soleus. And I think a lot of people strengthen the gastrocs, but don’t strengthen the soleus. And so it was more strength, more solely as strengthening may be helpful at preventing shin splints. But it’s also going to be a load issue there too, where if the running is overloading your muscle, and then you’re trying to build strength by adding strengthening exercises on top of your overloaded muscle, it might actually create more of a problem and might want to do strengthening exercises some days and run other days until you’ve built that up better, like a day you did the bike, you could do some specific strengthening and then a day, the next day you ran, it’s already fatigued. You might not want to add more on top of that.

Corrine Malcolm (16:36):

Yeah. Maybe that’s when you hit the mobility thoroughly on that, on that day. So you’ve got that combination right. Of, of stress and then rest. And you’re going to say, oh, and I think that’s a big, a big theme here too, right? Beyond a proper progression for people. It’s also a proper, proper load followed by adequate rest and recovery. Yes. It’s complicated. And also simple like the human body. Yes,

Nikki Buurma (17:02):

Yes. We say in physical therapy, we see kind of two types of people, people who move too much and don’t know when to rest and people who move too little and don’t know how to apply stress. So if you’re somewhere in the middle and you’ve got a perfect balance, you’re never in my office.

Corrine Malcolm (17:17):

So most of us though listening probably are in the move too much and don’t know how to rest categories. Yeah. Yeah. That’s, that’s probably probably why we ended up in your office. Unfortunately. So speaking of mobility, a lot of the questions actually were geared towards mobility, which makes sense. I feel like a lot of friends, we are, we are mostly, we are tight, stiff individuals. There are some of us that are freaks and are hyper mobile, but I feel like most of us could use more mobilities. That’s a lot of what the questioning is geared towards. And we just mentioned foam rolling. So I think we’re in a jump that way. And then we’ll maybe move up the limbs towards the hips here in a second. Um, so one, I got a number of questions, not just, not just from one person from several people. And at one point literally just wrote, should I stretch or should I foam roll question, mark question, mark. Question mark. And then best, best times to foam roll. I feel like foam rolling. Is this kind of really hot idea? I’ve, I’ve personally read some of the research on this because I think it’s interesting. So how do we properly foam roll? Is there a way to properly foam roll? When do we foam roll versus stretch? Are they combined help? Help us take care of ourselves?

Nikki Buurma (18:31):

Uh, the answer on stretching is probably not, but maybe it depends on you. Um, if you have adequate mobility to do the act of running. So if you have enough range of motion to go through the mechanics of running, then you don’t really need to stretch. If you’re a sprinter or a hurdler, you need bigger range than if you’re a runner. If you have to jump over a hundred downs trees during your ultra, you might need more hip mobility than someone who’s just running down a flat road. So it depends on how much you need for the motion, but in general, runners do not want to be Gumby. You do not want to have a ton of mobility. Your muscles are Springs, and if your Springs are all stretched out, then they’re not going to have as much spring. And so there’s, you know, we think, oh, I need to be able to touch my toes.

Nikki Buurma (19:18):

You don’t, but you might want to be able to touch your knees. So it’s finding the balance of having enough mobility to do the motion without strain, but you don’t have to have a ton of flexibility. In general. Research on stretching is pretty poor. I think it’s something our parents did. And so we still do it, but really there’s not a lot of evidence that it’s helping you. Uh, if you have an area like, uh, usually, you know, people have one or two spots in their body or they’re like, oh, my hamstring is just really tight all the time. And then if stretching makes you feel better, go ahead and stretch. But if you have never stretched and don’t really like stretching and don’t feel like it’s helping you, then you don’t need to stretch. So, uh, that’s kind of what I would say on that. One is just that it, if it helps you, there’s just not a lot of harm. There is some harm. If you stretch right before an event, you actually might increase your risk of pulling something, um, and a diesel cruises, your power. So if you are about to do the a hundred meters, you don’t really want to stretch before then because it’s going to

Corrine Malcolm (20:30):

That’s static, stretching, right? Static

Nikki Buurma (20:33):

Stretching, correct. Yep. So static stretching would be anything you’re holding longer than 30 seconds. If you’re not holding it longer than that, then you’re not really causing any deprivation in the tissue. And really you can’t make a longer by stretching it. You can only make the connective tissue around it longer. And so a muscle will LinkedIn with more of like a dynamic stretch or a east centric movement. That’s when you’re actually going to add sarcomeres and make that muscle longer. And so dynamic stretches or something like a power or a Vinyasa yoga where you’re moving more quickly through the movements is more likely going to improve your mobility than static. Stretching is going to plus

Corrine Malcolm (21:17):

One for yoga. That’s the only type of stretching that I can convince myself to do. And I am a person who is on the extreme end of maybe of, of impractical mobility. So I need a little bit of extra stretch, maybe compared to some of, some of our trail colleagues. So static, stretching, not so good movement, dynamic east centric stuff better. And then how does foam rolling fit into that?

Nikki Buurma (21:45):

Yeah. Foam rolling is something where there’s not a lot of research evidence. That’s great to say that foam rolling works. Most people find that it helps in some way if they’re consistent with it. And if you, I just listened to a research day this morning, and they were saying that they had people foam roll for one minute, five times, and then they’re like, and it didn’t help anything. Well, that’s an awfully low amount to be doing it. And a lot of, so I think some of the studies don’t really look at foam rolling the way most of us would do it. They’re trying to make it fit into a research study where it can be controlled. And then sometimes I feel like that misses the point. So there’s, I think there’s more benefit than what the research really shows in. A lot of the studies out there.

Nikki Buurma (22:37):

A lot of the studies also show that your perceived pain decreases and your perceived mobility improves, but they didn’t actually show a change in tissue length think, well, I don’t really care if it’s actually longer, if it feels longer and it feels better. That’s kind of the important part to me is what it feels like to me, not the actual length that it measures. So I think sometimes when they say it had no, it no measured effect that isn’t really getting to the point of what most of us want it to do. The other complaint that they say in a lot of studies that they cite is that it’s a short-term effect. Yeah. But we usually recommend you doing it daily. So if you’re foam rolling for a little bit daily, then it’s short-term effect is good enough, right? If I’m going to foam roll today and expect to be loose a month from now, then that’s, doesn’t seem likely, and I can see why they’re showing there’s no effect.

Nikki Buurma (23:45):

I think for most people it’s worth trying to see if that helps you. A foam roller is a great way to scan. So as you sweep up and down your whole leg, or kind of go over an area, if it feels great, or if it feels the same right to left, and there’s not a lot of tender spots, then you know that your muscles are probably in pretty good shape. And there’s not a lot of soreness there where if you know, I’ve turned ultra and you try to get on a foam roller and you’re crying. Cause it’s like, I can’t even put pressure on that because your muscles beat up and it’s painful to put pressure on it. So that’s, if you’re going through and scanning kind of your major muscle groups or your usual problem areas, you can pick up on things earlier. So you might not notice calf pain when you’re running, then you go to roll and you think, oh man, there’s a big knot behind my, you know, me or towards the top of my calf.

Nikki Buurma (24:40):

That might be an indication to you that you might want to back off in training or take a little extra time to kind of give that muscle. Some love that you can prevent something from becoming a bigger problem. I mean, foam rollers were admit, were invented because most of us can’t hire misuses every day. So it’s a way, right? It’s like if we were all rich, we would just have someone else massage our muscles and we wouldn’t need to foam roll, but most of us can’t. And so a foam roller is supposed to be there as a way for you to kind of check your muscles health, see how they’re doing and work on some problem areas. If there’s something that feels restricted, if you’re rolling back and forth and you feel nothing, then don’t roll on that muscle. It’s like, okay, my Claude’s fine. I don’t need to do that today. And then you might roll to the next one and go, oh yeah. But my calf really does need it.

Corrine Malcolm (25:34):

Yeah. I think most of the recovery research that I’ve read so on different recovery modalities and foam rolling generally falls into that category is that there isn’t a lot of conclusive evidence. And by conclusive, I mean, particularly with like when they’re trying to measure specific things like a blood value marker, that’s going to mark like inflammation being lower or something, but they oftentimes found that the athletes felt better. They felt more recovered. And this goes for foam rolling for compression sleeves for, um, the puffy pants, things that certain FinTech blood. Yeah. Um, you know, uh, stem like stem devices, right. That are gonna get like, like and do some contraction stuff. Um, I think massage was included in that and it was like sincerely conclusive research on any of it. But if, but if you feel better, you generally perform better. It’s like, you look good, feel good type of thing too. So I think it’s one of those things where it’s like, uh, there’s probably no harm. So that’s kind of maybe the aim there.

Nikki Buurma (26:41):

Yes. I think it’s hard for them to, to design a study, to really measure what we want to measure. It’s so hard to actually measure those things. And so because of that, we try to simplify it into like, did the range of motion increase or did their power increase? It’s like, well, that’s not really, you know, I didn’t really expect that to increase, but I wanted the person to feel better and to feel less restriction. And usually those things are improved.

Corrine Malcolm (27:14):

Yeah. And so my, I guess my next question is like, so we talked about it being maybe short of short-term value and maybe that’s day to day. Um, and that’s kind of one of those things that limitation and a lot of those studies too, is like, how are they applying this thing? But, um, if we’re looking at the, okay, it’s, it’s got short-term effect, perhaps we don’t really know, is there a best time then? Like, should we be foamer? Should we get in the habit of foam rolling pre and post run? Like, what should that look like if we’re going to get the most out of the, you know, bed, bed, you know, decrease in pain and increase in perceived mobility, where does that fall into our day as an, as a runner?

Nikki Buurma (27:51):

Yeah, I would say it depends. It depends on you, uh, the best time to foam roll as a time when you’re actually going to do it. And so if for you formerly, while you watch TV at night is a time when it’s going to happen. Great. Do it then if doing a little bit pre-run helps that leg swing a little bit easier and feel a little bit better, do it. Then a lot of people do it immediately post drawn. And so run. When you get back, you spend five, 10 minutes kind of cooling down foam rolling. They actually, I think that they’ve proven that socializing while your post run like 10 minutes of recovery time where you’re socializing is actually the thing that’s most beneficial. So if foam rolling at the Trailhead where you talked to your friends is how you do it, then that’s going to just bring all the more benefit. Well, the double whammy of the double whammy, the social

Corrine Malcolm (28:46):

Plus the foam rolling. I could, I could be into that. I think, I think that would get me to foam roll

Nikki Buurma (28:51):

A little bit more. Yeah. There’s so many different devices too, and that, I don’t think there’s any research that’s looked at is in RA better than a thera gun, better than a trigger point roller better than a regular foam roller, the stick. Like there’s so many different devices and I think different body parts, like different ones better and different people like different ones, better. Some people it’s really hard to lay on your stomach and support your weight on your wrists while you’re foam rolling. And they’re just not going to do it. And so if using, sitting on the couch and using a stick as something that fits into your day, or it’s just easier for you to do physically, then it, I think whatever device works for you is probably the best device. Or I have one for each body part because someone’s just fit better on certain body parts. Totally.

Corrine Malcolm (29:42):

I’m a stick person for my calves versus like a big foam roller for my hips, hips, glutes, quads, the bigger, the bigger muscle groups. So I guess the biggest thing I’m taking away from that though, is that I think it, I love that you said that it was a good way to scan the body. Yeah. Like to take that moment to be like what left, right. How does that feel? You know, quads, hamstrings, glutes, calves, how, how did those things feel and kind of working through the checklist? Um, I think is a great, a great utilization of that tool.

Nikki Buurma (30:12):

Yep. I think it’s a great way to just kind of check in on how you’re doing or like I’ve taken say you take four days off after a race and you’re like, oh, I think I could run again today and you get on the foam roll and you’re like, everything’s still really hurts. You probably aren’t quite ready yet. Right. It’s like, maybe I should go for a walk again today or like really do a light jog because if it’s that sore foam rolling, then I probably doesn’t want me to run on it again yet.

Corrine Malcolm (30:39):

Yeah. And that’s a very, a very good, a good tool sometimes even like I’ll lean into something and I’ll be like, oh wow. Like, I’m like, okay, that chair told me that I shouldn’t run today. So I guess yes. A common thing that I think a lot of us try to foam roll and I don’t know if it’s effective. Um, one, one someone’s question was what can I do to prevent it band syndrome? And I feel like a lot of us are sitting there trying to foam roll the, you know, ever loving daylight out of our it bands. So what can we do to prevent being in that position?

Nikki Buurma (31:12):

Yes. And the, the it man in particular is a super dense strip of connective tissue. And so like, there is no research that has shown that you can perform that it band in any way by compressing it with a foam roller, particularly what attaches near the knee. You really don’t want to roll right on that too, when you’re rolling the it band, what you really want to be doing is trying to get your quad and hamstring connections off of the it band. Right. Kind of separating things out. So they’re pulling on their own are not all jelled together with scar tissue or junk whatever’s in there. Um, so it’s the main reason why you’re it. But I’m like the main reason that I team at Hertz is a load issue. Right? So once again, if your it van is tied, you’re having issues with it. It’s because your rate of progressing running is too fast. Um, but rolling or massaging or loosening it up, all of that can help to just make it feel a little bit better. But it’s mostly,

Corrine Malcolm (32:22):

Maybe about the surrounding. It sounds like it’s almost more about the surrounding tissue and mobilizing everything else than actually mobilizing the it band.

Nikki Buurma (32:29):

Yes. That’s what I mean. If you want to, if fall rolling helps your it band feel better, or if you want a, if there it, man, I wouldn’t think of like, you’re not trying to iron out the it band. That’s not gonna work. It’s too broad. But if you can kind of get in on the edges of it and try and free it up from some of the tissue around it, or just get things moving better through your whole leg that might help some, but don’t think of it as like you’re trying to pull her eyes, this it back.

Corrine Malcolm (32:58):

Yeah. That sounds to me, that sounds absolutely miserable. And I have no desire to pulverize anything near my it band. So it sounds like once again, most, most obviously athletic injuries are generally besides acute injury where maybe you’ve fallen or made a really funky movement. It sounds like most athletic injuries that runners are going to face are generally load dependent. And this also falls in to that category. And so obviously mobilizing is beneficial, but what, what else can a runner do beyond making sure their load is appropriate and they’re properly mobilized to try to prevent, you know, having, having it band problems.

Nikki Buurma (33:40):

Yeah. Some little things that like nuances of it, band that people don’t often know is one year ITN would typically feel better at faster paces than slower paces. That’s not all the time, but if it’s a stabilizing structure that’s spent to kind of stabilize your knees and hips, then if you’re going really slow and plodding along, that’s a lot more work for it. And so actually doing a shorter run, that’s a little bit faster than your normal pace. I’m not talking like sprinting, but like if you normally run eight minute pace, maybe run 7 45 and cut your distance from eight down to four, because you’re going to run a little bit more efficiently with a little bit better form for a shorter duration. And that a lot of times will help take load off of that it band and help it to feel better, uh, watching out for timber on the road, making sure that you’re not always running on one side having the right shoes so that your foot’s not doing funny things and, and putting extra load on it that way can make a difference. Um, so

Corrine Malcolm (34:43):

It kind of sounds to me like there’s like, um, like a mechanics or kind of structural and I mean, man, the whole body’s connected. Right? So it’s like if you’ve got an issue down downstream or upstream from, from your it band from, you know, you’re, you’re talking to major joints here, right. The hip and the knee. Okay. That’s a lot, there’s a lot of stuff going on there. So to me it sounds like beyond load, maybe load is also triggering, you know, some sort of imbalance like insufficiency either mechanically or body position wise in general that could be putting added strain through there. Is that a logical leap for it? Band stuff?

Nikki Buurma (35:23):

Yes. So if you’re falling into a lot of D valgus, that’s going to put increased load on the it band. If you’re like a lot of times when people first get it is long runs. So whether your a run is for whether long run is 24, when it’s a long run for you, and you’re starting to hit that fatigue point where your quads and hamstrings and things are fatiguing out, the it band, isn’t a muscle it’s connective tissue, so it can’t fatigue out. And so the load kind of transfers into that it band and it’s going to get overworked. And so the reason it’s irritated because you’re overworking it and cutting those long runs a little bit shorter can help, but having the better mechanics you have the less load there’s going to be on it as well. So if your foot is driving your knee into valgus, or if weakness in your hip is allowing your knee to kind of fall in both of those can create more strain on the it van. So some gait retraining, uh, working on your form sometimes can be helpful, changing your cadence to not have bigger steps, can vary curious your ground reaction force. And that can take strain off the it band. So a lot of it is the amount of load you’re putting on it. And then the mechanics of just how you’re moving. And that’s something where if you’re having trouble and it’s not responding, then having someone assess you individually and figure out where, what links in your chain are going wrong.

Corrine Malcolm (36:53):

Yeah. It sounds like what the, it bands that there’s so many different things that could be going wrong here that it’s like, really, you’re not going to Google your way to an answer is my, is my feeling about an it band you’re going to need to see someone and be like, is it your glutes? Is it your hamstrings? Is it the left side versus the right side? Is it as, is it, I mean, oftentimes with runners, it’s a strength thing, right? It’s a strength that can’t maintain that load for a 20 mile long run. It can maintain it for a 12 mile long run, but it can’t, it’s not strong enough yet. So I feel like this is a great, this is a great ad for any local PTs in any of the listening air, his that’s who you want to go see if you’re having, having issues like this, you’re not going to Google, Google your way through it. But if we move upstream from there, there’s another question that kind of, I think is, is similar as far as like strength and mechanics goes, and it was specifically about, um, if there’s anything that they could do exercise wise to improve pelvic position when running. And I’m wondering if that’s an instability thing or if it’s just like they’re, they’re bought they’re fatiguing. And so their, their form is kind of falling apart

Nikki Buurma (38:00):

There. Yeah, it could be. There’s lots of different reasons. So again, it would be an individual assessment of what’s going wrong with you. Um, but at not having good core strengths can make your pelvis anteriorly tilt, having too tight of quads and hip flexors will make your pelvis anteriorly tilt. And so a lot of us sit all day and that makes your quads and hip flexors short and tight. Or if you just pounded a bunch of downhills and your quads are super tight, you might notice that you have more of that tilt and you’re getting more compression in your low back or just feeling that more. Uh, and so then something like formal rolling or getting your quads and hip flexors looser might help or doing some mobility exercises, some dynamic stretches that are going to help to stretch those areas might be helpful, but, uh, your, your glutes and hamstrings can kind of help balance that out.

Nikki Buurma (38:56):

And so it’s typically an imbalance between the muscles on the front side and the back side of your pelvis that are helping to hold it. But even if you have good strength, so some people will test and they have good strength, they’re just not using it. So you have this bad habit that you’ve learned. A lot of gymnast have learned to stand an anterior pelvic tilt. Cause they did it for years as a kid. And now that’s just your natural resting posture. Your body wants to be as efficient as possible. And so if you can hang on your ligaments and just kind of let everything relax, it’s not going to actively use your muscles if it doesn’t have to. And so sometimes it’s about retraining and learning to activate and learning to use a better pattern than the one that your body has developed as a habit.

Corrine Malcolm (39:46):

Is that where, and I’m, I’m a person who’s, I’m my, my sides are imbalanced. So I’ve got one that’s tilted one way and one that’s tells it the other. And it kind of decides what day, which one’s going to be tilted where, but is something like you’re talking about activation of muscles. Like I’m strong enough to have everything work, but things aren’t working right. They’ve decided they can work around whatever is going on. So does that, is that something like where I can utilize activation exercises going into a run to set myself up? Well, like how do, how does a runner take that information? Um, I mean, obviously it’s individual what’s going on, what needs to be activated, but is that an appropriate place to apply that, to seek benefit from it?

Nikki Buurma (40:33):

Yes. It’s, it’s not really activation cause it’s not like your muscles not working. It’s more like motor retraining. You’re trying to teach it to use the muscle in the right way. So it’s kind of like you’ve developed a bad habit and you need to break the habit by giving it increased input towards the way you want it to move. So it’s not like, oh my glutes asleep. I need to wake it up. It’s just going, Hmm. My body’s using a pattern that doesn’t use my glute as well as it should. And so I’m going to emphasize the group a little extra so that hopefully when I go into my run, I can forget about my glute and it will keep on activating better because I gave it that pre input to use it. So I, I don’t, it’s not really that it’s not working or that it needs activated. It’s just a programming issue of trying to get things to, to activate, to work together, I guess, in a better pattern.

Corrine Malcolm (41:37):

Yeah. I found sometimes I even have to like stop in the middle of a run and if I like stop and do my little exercises that have been given to me, given my weird specific issues that sometimes like, cause I did them before, while procrastinating starting my run as, as one does. And then it’s like, it gets kind of sleepy again. It falls back into old patterns, right? It’s not that it’s not working. It’s just not, not maybe seeking the right stimulus cycle, but if I stop mid run or whenever I notice that all of a sudden, I feel like I can kind of get back into that pattern again. But I do have to like, like actively think about it. Like I can’t get lazy. It seems.

Nikki Buurma (42:16):

Yeah. And sometimes when people are coming back from injuries, you have to really cut your run down because you have to consciously think of a new way of moving or kind of relearning about out of a bad habit. And it’s hard to concentrate for a long time. So to expect myself to run with a new, new found pattern that I want to use for 20 miles is probably not going to happen, but to go out and do two or three and say, Hey, I’m going to kind of be more aware of what I’m doing and try and correct this problem. That’s part of also why you’re getting in early, right? Like if I had something that was bothering me and I compensate for two months, then part of my rehab is learning to stop compensating where if I went in the beginning and just said, Hey, this is hurting and I need to stop this. You didn’t have all these repetitions of grooving in a compensated way. So you don’t have to unlearn the compensation. You can just move forward with the rehab. Gotcha. I

Corrine Malcolm (43:19):

Feel like in Nordic skiing, for example, we actually have athletes do, uh, basically technique intervals. So they’re not going hard. They’re not going, you know, um, tempo or VO two max while doing technique. But they, I say, okay, like, you’re gonna go and you’re gonna go think about this. You know, you’re gonna think about this for 10 minutes. And then you’re going to relax and just ski for five minutes. And you’re gonna think about it again for 10 minutes. And it’s like a little cue. It’s like, okay, my arm is going to do this thing or my tempo, you know, if it was running would do this thing. So I feel like it’s, there’s a way maybe to stretch it out, but you utilize bits of focus so that you, and then try to stretch that focus out. And the more and more time you’ve spent focusing on that new technique, eventually you don’t have to focus on it anymore because just what your body knows how to do again.

Nikki Buurma (44:13):

Yeah. They’ve shown some good research with improving injuries with just gait retraining with really simple cues, like make your knees headlights and have them point straight ahead. Right.

Corrine Malcolm (44:26):

Or come up chest.

Nikki Buurma (44:30):

Yep. So coming up tall through your chest and trying to have your head be high or tall so that you’re not slouching into that posture or getting that anterior tilt. So it’s can be in, everyone’s going to have different cues and different things that are right for them. But finding a few little things to think about that help you to have a good posture, um, or kind of have improved or that the best possible you mechanics that you can have. Um, some of those can help and there’s no right or wrong way to run. It’s not like we try to make everybody run the exact same pattern. You just look at someone running and say, what issues are they having in is the way that they’re moving, contributing to that issue. And if it is, is it worth changing? Like what, what’s the cost to change that?

Nikki Buurma (45:19):

Like, is it going infect their efficiency by a ton if I have a move in this way versus that way. And then what’s the, the change in load on their tissue. So you might temporarily choose a different pattern because of the load. Like you might need to unload one issue. And so we kind of change your form for a little bit to allow you to still run, but then that’s again, like how long do you want to do that pattern? Because you might want to go back to the normal pattern that you used to use to. And so there’s a balance there of adjusting things to keep you running, but not allowing too big of compensations that you kind of learn or fall into bad habits.

Corrine Malcolm (45:58):

Yeah. There’s um, there was a guy who I got to hear speak a couple of years ago, who works at the CU sports medicine clinic. And he does, this is what he does. He does like gait analysis and that kind of work. And they’re in the lab, like in the lab slash clinic there, which was kind of cool cause they’re working alongside PTs and, and all that kind of stuff. So it’s just really kind of, I don’t know, it feels like a holistic approach to have all of that under one roof. Um, but what he was saying was that sometimes our runner runs in a certain way and you’re like, Ooh, we need to fix this. And it’s like, it’s their arm carriage or it’s their, you know, their leg, their need as a weird thing. But he’s like, oftentimes if we fixed one thing, it caused a different thing or they weren’t actually inefficient and they weren’t injured.

Corrine Malcolm (46:46):

And so it wasn’t worth fixing to make them look like they ran a certain way. And so it was really interesting to think like, oh, okay, like this thing that I would see on a runner, I’d be like, Ooh, that’s weird. We can make a small tweak and this will fix this. This will change how they run. But the downstream effects of those seemingly innocent changes, unless you have issues, if you’re chronically hurt. Yeah. Maybe you do need to change something in your gate. But if, once again, this kind of circles back to at the very beginning of this conversation, like if it’s not broke, don’t fix it.

Nikki Buurma (47:22):

Yes. Yeah. I think gait is the biggest one where that rule kind of applies where you don’t want to changing someone’s form. Uh, if they’ve not had an injury before, like so many people read that they should own their toes. And I have people coming all the time and they want to run on their toes and their forefoot. And I think why, why do you want to do this? And they’re like, but I read it in a book. And, and then they have a new Achilles injury because they’re overloading a tissue that didn’t use to be overloaded before because they changed for, uh, they think that they’re faster because fast people run on their toes. And I think, well, yeah, but you’re slower now because you’re hurting yourself. And so it really is not, it there’s not a correct form for everybody and you can’t just generally apply. Like I, my favorite runner runs like this. So I want to have that kind of form. It’s finding the way that is most efficient for you. And if you keep having repetitive injuries than the form you’re using now is probably not the most efficient for you. And you might want to think about changing some minor things in, in your gate.

Corrine Malcolm (48:33):

Yeah. I that’s, that’s really important. Same with like cadence. People are like, well, I have to run with this cadence. It’s like, well actually you don’t have to run at that cadence. Your body’s going to naturally shift once again to what’s most efficient. And unless you’ve got injuries that are coming up because your cadence is slow because you’re overstriding or something like there’s maybe not, you know, there’s not a real reason to, to latch onto these specific form pieces or these specific like numbers like cadence. So I guess I’ve got one last question or topic area to kind of round us out. And, um, I think it’s interesting. I think this is definitely very much in your wheel house and the question was, does strained or injured muscle tissue and writing like role differentiate here, right. Muscle tissue versus other tissues. Um, does it feel, does it heal faster rather with ice or heat? Like what’s the appropriate go to for injured muscle tissue? And then maybe we can talk about some other tissues, um, for repair and healing as well.

Nikki Buurma (49:30):

Yeah. On a research side, kind of evidence-based I would say there’s probably not a lot of research to support either one. So do whatever feels good for you because you’re probably not hurting something and it’s probably only helping your perception. Um, there’s generally a few just strange something then rushing a whole bunch of blood flow to it when it could like actively still be bruising seems like a bad idea. So in the initial kind of acute phase first day or two, you probably would want to ice, but beyond that, if heat makes it feel looser, then that can be helpful. If it feels hot and inflamed, then you should probably, I say, um, if you’re somebody who hates ice and it makes you feel really tense, then that’s probably not helping your muscle get looser. So figuring out kind of what works you. And it depends on what exact tissue it is when it happened, how it happened, what it looks like.

Nikki Buurma (50:34):

So there’s a lot of different variables. Um, but both of those are generally safe. And I would say that if it helps you feel better, then you can use that I would not ice right before you’re going to run. Um, generally you would warm tissue up before you’re going to use it. And then afterwards, if it feels really inflamed, you would want to ice it. And so before ice after is sometimes helpful. Um, if you feel like that just really needs more blood flow, you can alternate heat and ice. Cause that’s just going to help get blood flow to the area. But, um, movement is better than either of those. So like you’re going to heat a muscle up a lot faster going for a walk than you are, but putting a heating pad on it. I’m

Corrine Malcolm (51:19):

Into that. I will definitely go for a walk. Um, so question question comes to mind for me here. Um, so muscle tissue, right? A little bit different than say something like tendon or ligament. And if people have tendon or ligament strain, let’s say strain as opposed to like something more serious. Right? Um, what, to me, you just talked about heat and ice and how alternating it would create more blood flow. Those things are not super well. They’re not very vascular, right? Like they don’t have a lot of their own blood flow. So would that be the most logical approach for a tendon or ligament issue? I don’t, I don’t know if there’s a good answer there.

Nikki Buurma (51:58):

I don’t think either ice is going to do much to attend an aura. Ligament. If say you sprained like a ligament, I’m thinking like ankle, right? So you sprained your ankle ligament. You overstretched that ligament a little bit. If you have a lot of swelling because of that, that smelling is stretching the capsule, which is going to decrease your proprioception. It’s going to make you feel it’s going to make your ankle feel more stiff. And so I seem to reduce swelling so that the ligaments and surrounding muscles can function properly so that the joint can move through its motion properly. That’s going to help. Um, same thing with a knee. If your knee has been grinding and it’s irritated and it’s puffing up it’s console on the front, or a lot of times the swelling will go behind your knee, even though the pain is actually from your patella on the top of your knee.

Nikki Buurma (52:46):

Then I think so that the joint moves normally is going to help it to move better. And so some of those areas where you’re getting acute swelling, either after activity or just after, um, kind of daily life stuff, then you probably want to ice to manage swelling. If something feels really stiff, like you wake up in the morning and your Achilles is really stiff, then putting some heat on it so that you can actually like put your foot flat on the floor and not walk on your tippy toes around your house that, um, taking a hot shower. So that, that muscle loosens up a little bit, then that is probably gonna make more sense than putting ice on something that already feels incredibly stiff.

Corrine Malcolm (53:32):

Yeah. We’re laughing because I’m sure both of us have done that before, you know, getting out of bed and getting out of the bed in the morning and your heels don’t touch the ground. I think that might be an all too common experience amongst, amongst the listening audience here. So I guess I’m gonna, I’m gonna let you go for the evening so that you can go have dinner, um, and get out of your office after a long day. But to summarize here, obviously we’ve talked about a lot of different topics, but you know, it seems like load is important, right? Understanding where you are in your training progression, um, to not overload is going to be one of your best ways to avoid injury, um, mobility and things that make you feel good are, is probably the next most advantageous thing, right? Like if it makes you feel good, it makes you your muscles feel better. It’s probably okay. It’s definitely not hurting. And then seeking help early for a, um, is better than running through it for days, weeks, months, years, maybe in our cases, um, is probably the best, best course of action to get back out, running sooner. I’m wondering, am I missing anything? That’s key take home messaging.

Nikki Buurma (54:44):

Yeah, I think those are the highlights of really almost all injuries in running and just in general, life is a load issue. And so proper training progression and proper load having a coach or someone to hold you accountable when you want to do something, that’s probably not the right amount of load for you is a great idea. And the more tailored that kind of plan is to you and your needs or someone watching and kind of looking at your feedback from training and seeing if you’re overloading or if they notice a pattern of you’ve been fatigued and kind of backing off before something becomes a problem, um, can make such a difference. And the, uh, all these other little things are things we do to try to help us tolerate more load than what we really can. And so, um, uh, I listened to one of my favorite PTs and he just said that he was like, you guys are doing all these things to help you tolerate more load. I said, yeah, we’re ultra runners. Of course, that’s what we’re gonna do. Um, none of them are extremely effective, but it also, some of them might be a little bit and since running more is what most of us want to do, then it it’s worth your while to spend some time in some of those things, but know that the number one thing you can do is have the proper training load and that rusting and stressing your body and appropriate proportions is probably the best thing that you can possibly do to avoid being injured.

Corrine Malcolm (56:18):

I think that that is the perfect way to end this moderation for all of us. Even we’re ultra runners and moderation is not maybe our favorite thing. Um, if you liked this style episode, I’m hoping to do more like this. If you’ve got specific PT questions, um, slide into my DMS, Nikki as well. I’m Nicki Burma, PT on Instagram. She posts amazing videos. Um, I find them really helpful. I get to incorporate them into my life and I get to, I send them to athletes when they have specific issues. So check out Nikki again, there’s Nikki Burma, PT on Instagram, and we will link that in our show notes. Nikki, thank you so much for joining us this evening and we’ll see you all out on the trails.


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