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On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Chris Johnson to discuss empowering runners through rehab. He is a Seattle-based physical therapist, performance coach, speaker, and multiple-time Kona Qualifier.

 

In this episode, we discuss:

  • Is resistance training needed for runners?
  • Are training errors to blame for running injuries?
  • How can clinicians guide the decision-making process around pain and return to running?
  • Chris’s best advice to be a running injury expert.
  • How can the profession of Physical Therapy be thought of as your best friend in healthcare.
  • The importance of being present and curious.

 

Resources:

 

More About Dr. Johnson: 

Chris JohnsonChris Johnson completed his undergraduate studies at the University of Delaware, where he earned a bachelor of science with distinction while completing a senior thesis in the physical therapy department under Dr. Lynn Snyder-Mackler. Chris was a member of the varsity men’s tennis team, scholar athlete, captain in 2000, and recipient of the Lee J Hyncik award for excellence in athletics and academics. He remained at the University of Delaware to earn a degree in physical therapy while completing an orthopedic/sports graduate fellowship under Dr. Michael J. Axe of First State Orthopedics. Following graduation, he relocated to New York City to work at the Nicholas Institute of Sports Medicine and Athletic Trauma of Lenox Hill Hospital as a physical therapist and researcher. He remained there for the ensuing eight years until 2010 when he opened his own physical therapy and performance facility, Chris Johnson PT, in the Flatiron District of Manhattan. In May 2013, Chris and his wife relocated from New York City to Seattle to pursue a more active, outdoor lifestyle. In addition to being a physical therapist, Chris is a certified triathlon coach (ITCA), three-time All American triathlete, two time Kona Qualifier, and is currently ranked 16th (AG) in the country for long course racing. Chris is also extensively published in the medical literature and has a monthly column on Ironman and an elaborate youtube channel.

 

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Read the full transcript here:

Speaker 1 (00:00):

Hey, Chris, welcome back to the podcast. I’m so happy to have you on in our month. All about running and running injury and running rehab. So thank you for carving out the time.

Speaker 2 (00:11):

It’s fun to be back it’s it’s always a pleasure to connect with you. And it just snaps me back to New York city and I still don’t know how we never crossed paths when when we were both there, but here we are, and I’m glad we connected and also happy women’s history month. You’re someone who’s sort of spearheading a lot of great stuff in this space. And I think a lot of people, especially women look up to you and that you’re a role model. So things that you’ve accomplished and continue to work on.

Speaker 1 (00:47):

That’s very kind. Thank you. And now today we’re going to do a basic Q and a with Chris Johnson. So Chris gets tons of flooded with questions and comments and things like that from emails to social media. And so I thought, well, let’s see if we can make life a little bit easier, reach a wide audience and get some of these questions and concepts under control for you and out to the public. So let’s start with a common question that you get is all is kind of around resistance, training and running. Do you need it? Do you not need it? I know that’s a really broad question. So I’ll throw it over to you around the the, the concept of resistance training and

Speaker 2 (01:40):

Yeah, and it’s a, it’s such a great question. I think that everyone’s default answer is, you know, basically resistance training is a Holy grail for runners. And I do think it, it has its place, but I think that there are a lot of gaps in the research. And is it something that I prioritize myself as well as in working with the athletes I coach? Absolutely. But I think that anytime you’re working with the runner, the primary goal is to get them into a rhythm with their training and to establish consistency of training. And then you can consider to start layering things in this is assuming someone’s training and they’re healthy. They have no remarkable past medical history. I, I think that, you know, the answer to that question differs especially if we start to get into master level runners who typically have a remarkable past medical history because most of these injuries and conditions go under rehab.

Speaker 2 (02:41):

You and I both know that as clinicians. So I think that a lot of the resistance training may just be cleaning up sloppy rehab that perhaps they didn’t get around to addressing things at the tail end of the rehab. So there’s a quote that I love, which is, you know, resistance training is really coordination, training under load. So, so yeah, I do think it has its place but it should be there to support our running, into build our capacity to run, but I’ve seen a lot of people get it wrong and they end up whether it’s, if they’re racing, they go into races where they’re a little bit sluggish or they’re carrying some residual fatigue. I’ve seen people get injured in the weight room if they’re not perhaps if they’re, you know, younger and more green. So yeah, I, I do think it has its place, but like everything you have to approach that, that runner athlete on an individualized basis and just understand where they’re coming from.

Speaker 1 (03:40):

And in your experience, working with runners, what are the biggest barriers to resistance training for runners? Because not everyone has, you know, access to the same equipment and time and everything else. So what, what have you found to be the biggest barriers to resistance training?

Speaker 2 (04:00):

I think a lot of runners are intimidated by it unless they come from perhaps a multi-sport background where they’ve spent time in a weight room. I think right now with the pandemic, obviously resources and equipment or gyms are not as accessible or gyms opened in New York city right now are on a limited basis.

Speaker 1 (04:22):

They’re open on a limited basis. I think you have to make an appointment a certain times and things like that.

Speaker 2 (04:29):

Yeah. And then I think that when people do get to the gym, they may not know what to do, and they may resort to something that they see on social media, some of the time, which might be fine. But I think that with running running has predictable performance demands. So it shouldn’t be a mystery in terms of what we’re trying to do. We’re trying to challenge the calves, quads, lateral hip. And we’re also we’re not layering this in a ton. We’re layering it in maybe twice a week on average. So but yeah, I think a lot of runners lack direction, and that’s something that, you know, I try to put out a ton of content online. So people start to see how I’m approaching it. And I’m trying to essentially synthesize the literature and translate it to to just the everyday runner.

Speaker 2 (05:18):

And I think that there’s also this element of rhythm and timing with running and that doesn’t always get addressed through resistance training. I think perhaps a little bit more since some of Ebony Rio’s research, but again, that’s really in the rehab sector space talking about tendons, but I think that a lot of the TNT work or the tendon neuroplastic training work just has such salience to resistance training programs as well. So anytime, you know, people work with me, they’re, they’re going to get accustomed to using a metronome. It’s just one more factor variable that I think that we can control for when we’re prescribing. I

Speaker 1 (05:58):

Love the metronome. I love it. Love

Speaker 2 (06:01):

It easy. After a while though, I

Speaker 1 (06:03):

Give to everyone, even with my, even with my younger athletes, they get it, you know, and actually with those younger athletes, I’m talking teens, it’s using the metronome, although they’re like, Oh my God, I have to listen to this again. But it is actually good to give them a little bit of discipline around the, around the movement, around the exercise. But I love, I love the metronome. I have my patients like download the metronome, get used to it when you’re exercising. I know it can be a little monotonous, but I think like you, like you said that with the research of Ebony Rio and others, I think it gives people, I don’t know, like a, a little bit more discipline around their training.

Speaker 2 (06:49):

Yeah. I use it a lot when, if I’m giving someone calf raises something like a rear foot elevated split squat. If we’re basically doing like a three zero three where it’s like down on three seconds, up on three seconds without pausing yeah. It helps to maintain this rhythm. And a lot of the times I’ll stop the exercise when they break that rhythm. Because it’s telling me that, you know, maybe we’re starting to reach the upper end of their abilities for that given exercise.

Speaker 1 (07:18):

Right. And we all know that three seconds to one person is very different to another.

Speaker 2 (07:22):

Yeah. Well, and this is what, you know, when Scott Morrison talks about anchoring and I just did that Instagram post on, you know, stop being awake or start to anchor. I’m starting to realize I’m becoming a dissenter. But you know, that’s where the metronome comes in. And I’ve played with this so much. I mean, my, my neighbors probably think I’m crazy because I’m like out front with a metronome going, and I’m doing all these weird exercises. Well, weird to them.

Speaker 1 (07:49):

What sort of things do you implement to get over the barriers? Well, you just answered that. Anything else that you may implement to get over barriers to resistance training for runners? Like, like you said, in that runner who is very intimidated, maybe never used resistance training before.

Speaker 2 (08:06):

Yeah. I mean, I, a lot of the times when patients show up to my house, I mean, I’m working out of my garage. We have a space on our property, you know, when they arrive a lot of times I’m deliberately training. So they see what I’m doing and they see that this is a normal part of my routine. And then they get a lens into my racing background, yada yada. And so I want them to realize that this is something that is normal. And I think in a lot of running circles, and I think this is starting to change that it’s not prioritized to the extent that it is. And maybe I’m just getting older because, you know, as a master athlete, it’s amazing having dealt with some patellar tendon issues, like my body craves resistance training, where if I don’t do it, I start to sort of get reminded. My knee feels so much better after I load it and load it relatively heavy. Now you have to be cognizant for reasons I mentioned before, in terms of like, you’re not going to want to do a bunch of heavy squats. If you have a race coming up you can keep your body under load, but you need to be a little bit more calculated with your exercise selection as well as your dosage.

Speaker 1 (09:12):

Yeah. And, and that’s where I think working with a coach or therapist or someone who understands understands one resistance training and two race training and how you can kind of blend those together is really important. And now sticking with training, let’s talk about training errors. Can we just blame everything on training errors? Is that, is that an okay thing to do now? Or am I, is that not good? And I say, I say that with a wink for those people who are listening.

Speaker 2 (09:40):

Yeah. I mean, I think it’s a convenient thing to do, but I think that I’m going to get myself in trouble here. I think it’s a little bit lazy too. In, in, I think that having lived in New York city that you realize the life load factor, right. You know, there’s different stressors in New York, between loud noises, you know, smelly things, you know, financial stressors in crowded spaces, you know, maybe your sleep has fallen by the wayside. So you may have a training program that’s very sensible. And, and then all of a sudden you have something come up. I think to one of my, I’m an athlete who I’m working with right now, and this guy’s just been just so tough and durable. And recently things have started to take a turn in a bad way. You know, he, he lost his mom.

Speaker 2 (10:38):

He’s been having to contend with that. He’s had some other job-related issues and and then he he’s come down with the patellar tendinopathy and his training didn’t change that much. And we actually dialed it back a little bit and it just shows it sometimes all of these other factors, you know, play such an important role in the overall being or totality of that athlete. So, you know, I, I, I think that we’d be much better off calling them ecosystem EHRs where perhaps there’s a disconnect, but I think that we have to be careful, always blaming it on training. And I, I get the point, I think that, you know, from a, from a research standpoint, maybe the reviewers are requiring the authors to, to present it in that manner. But I just think there’s a lot more moving parts. And I find myself having worked with a ton of athletes over the course of my career, being an athlete that you have to really be in touch with your ecosystem.

Speaker 2 (11:39):

And I don’t know who first came up with that word. I know Greg uses it quite a bit, but I think it’s something that, that is great to consider. And anytime I start working with an athlete, I have a conversation and it doesn’t end during that initial consultation or phone call, but I’m saying, tell me about your life. What was it like growing up? You know, what, what was your relationship with food? You know, what kind of sports did you play? You know, were you in public school? Did you go to private school? What was college like if you went to college, you know, what’s your current situation? Are you single? Are you married? Do you have kids? Are you a single parent? You know, I need to capture all this information and that’s just scratching the tip of the iceberg in that conversation’s never ending. So I feel like the more I know where people are in life, the easier it becomes to start putting down sensible workouts on paper and make sure when you put them down on paper, they go and pencil nodding.

Speaker 1 (12:34):

Yeah. I love that. Getting deeper into those questions and, you know, we had a conversation a couple of weeks ago with the surrounding a female athlete on clubhouse and Tracy Blake, who is just fabulous. I don’t know if you’re familiar with Tracy. She’s a physical therapist in Canada. She’s worked with a lot of professional athletes there, including their Olympic volleyball team. And she was talking about questions to ask. And I think oftentimes this is sort of floated over kind of skimmed over by a lot of PTs because we asked, tell me about, tell me what happened, what happened with your injury? Tell me what happened here, not the questions you just said. Tell me about your life. Are you married? Like Tracy said, you know, a question she always asks is, do you have children? Do you have pets? What, cause that gives you an idea. What are your responsibilities throughout the day? Yeah,

Speaker 2 (13:29):

I always say, you know, look, give me a lens into your situation and let the conversation unfold from there. And I think, you know, whether you’re a physical therapist or coach, I think all physical therapists or coaches, whether they realize it or not, you know, you’re, you’re trying to basically capture that ecosystem. And to, to just have, you know, talk to people about, you know, I just have a candid chat with folks and from there, then we can start pulling levers.

Speaker 1 (13:59):

Right? Cause then you’re getting a, really, a more holistic view of this person. And then you can say, okay, they have two small children they’re working from home. Their kids are being at school, school, they’re at home. They don’t have the time to spend two hours a day between training and running and everything else. And how can you make things work for them? Is that about right? Yeah.

Speaker 2 (14:25):

And I think that any, any time a patient or athlete consults us, they’re looking at us as an agent of change and the true agent of change is themselves. And it’s trying to help them plot out their own course. And maybe you, you know, you’re shining a light on the path here and there, or making sure that they don’t step into a pothole along the way. But that’s something that, you know, I find myself more and more. I have any expectations to, I don’t do things to people. I sit there and troubleshoot with them. And, and I think that that’s what we, as physical therapists are phenomenal with. And not only do we have the skillset, but a lot of times it most of us have positioned us to have the time to do that. And you can’t rush that process. So but yeah, we’re, we’re not in a system that incentivizes that, you know, you don’t get paid to talk to people, you get paid to do things to people. And that’s the fundamental problem with, for the reimbursement structure, for people who are in network. I mean, you and I are a little bit spoiled in the sense that when we’re providing care, it’s just ourselves and the patient, but that’s, I think that needs to be the standard or approximate the standard. Yeah.

Speaker 1 (15:41):

And isn’t it like amazing when that aha moment comes as you’re sort of talking through things like you said, troubleshooting, and the patient goes, Oh, wait a second. I can do blah, blah, blah, blah, blah. Or, Hey, maybe that I didn’t even think about that. Maybe that is contributing to XYZ.

Speaker 2 (15:57):

Yeah. And I, that’s a lot of motivational interviewing and sometimes, you know, I was talking with a couple of people yesterday. Sometimes people who’ve already arrived, you know, if we’re, if we’re discussing surgery, you know, I think our goal is to always try to help people avoid surgery, but sometimes people are just dead set and you say, look, you know, I get the sense that you’ve really just you’ve arrived at the fact that you’re going to have this surgery. Am I correct in saying that, and you know, if that’s what you’ve elected to move forward with, this is your decision. What questions do you have about the surgery? You know, and, and then you may start getting into a conversation and say, Hey, can I, can I share my experience? You know, this happened to me with my clavicle. I was in Hawaii, we’ll be traveling to Argentina to speak.

Speaker 2 (16:44):

My wife was pregnant. We had a little one, I was going to have to do a lot of physical tasks. And I’m like, I just need the surgery. I didn’t have it on my right shoulder when I, my clavicle fracture. And I was just dead set. I’m like, I’m in Hawaii, there’s a competent doc. This is not a super involved procedure, like a soft tissue procedure of the shoulder hip. And I had this and I could have been kicked myself for doing it in hindsight, but no one would have talked me out of that at the time. So sometimes people have to learn through their mistakes and sometimes that can be a tough pill to swallow, but that, that patient ultimately controls that decision. So sort of bobbing and weaving, but,

Speaker 1 (17:25):

And, you know, you just led perfectly into the next topic I wanted to cover. And another question that you get asked often and that’s, and that is surrounding pain and pain and decision-making, so we, you, I feel like you led perfectly right into that. So let’s talk about how we as clinicians and practitioners, where our role is when it comes to pain and decision-making for that client or that athlete.

Speaker 2 (17:53):

Yeah. It’s it’s one of the first things, if not the first thing that I discussed with people I did a book chapter for this it’s called clinical care of the runner. Dr. Harris. Who’s a physician at university of Washington was the editor. And he asked if I would read a chapter on training principles. And I essentially said, the first thing that we needed to discuss is someone’s relationship with pain and what their understanding of it is and how they approach decision-making in around pain. Because if you’re running, you’re going to be dealing with pain at some point, you know? And and I think people have an inaccurate understanding a lot of the times. So, and I think sometimes we, you know, I’ll use an analogy that Mike Stewart or you used which I think is brilliant. You know, sometimes when we’re out training and we’re driving through a school zone, right?

Speaker 2 (18:48):

School’s in session, the lights are blinking, slow down. All right. Sometimes you may be driving through that crosswalk. School’s in session lights are blinking and you have a crossing guard. Who’s standing in the middle of the stop sign. Maybe that’s a case of someone’s dealing with the bone stress injury. So you need to really hate that. Other times you may be driving through that school zone. It’s a weekend, no blinking lights proceed as is usual. And I think that’s a good way to think about training, but you know, you and I both know that if someone has a lower limb tendinopathy, you know, we want to monitor their pain and understand how it’s responding as a function of a particular training session, whether that’s a run, whether it’s a plyometric training session or a heavy, slow resistance, but we don’t want to shut that person down in it.

Speaker 2 (19:37):

As much as we in our profession may be, high-fiving each other thinking that we’re doing a good job of this. Most of the people that consult me, even people perhaps worked with me in the past for short periods of time. They still, when they experience pain, they assume damage and inflammation. And what do they do? A lot of times they, they they’ll resort to taking anti-inflammatories and here we go. I mean, this is a, this is where things go South. So I think it’s just important to say, Hey, what sense do you make of this? You know, what do you, what are your reservations? Are you okay working through some pain? And I think from there then the stage is set to proceed. But with a lot of, I’ve worked with a lot of master athletes and they’re, they’ve had a history of lower limb tendinopathy.

Speaker 2 (20:23):

I know that with my left knee, that, you know, I, I worked through almost a year of pain, but I never stopped training. And I was just sensible in how I was staggering, my workouts to afford appropriate recovery time. And and also just knowing how college and synthesis behaves. So yeah, I think that people have a, a skewed understanding and it’s also something very personal, but yeah, if you’re working with athletes, it’s a critical conversation to have. And I do think that this is where I know Ellie was on talking about bone stress injuries, that if you are remotely concerned about a bone stress injury, and it involves a high risk site, like zero out of 10 pain is the goal. Most other instances, I’m a little bit more cavalier, but if I know, if I see some of the signs that I would associate with the bone stress injury, especially if we haven’t had imaging, I’m going to be conservative as hell. Yeah.

Speaker 1 (21:19):

And I think it’s important to, to note that understanding the runner and that’s where understanding the ecosystem comes in and understanding, especially for bone stress injuries, where those high likelihood of those injuries occurring. So it also like you have to know your stuff as well is what I’m getting at when it comes to runners and, and having that conversation around pain can be uncomfortable for that runner or for that person. Cause you may have to dismantle a lot of long-held beliefs. So how do you go about that with your, your athletes?

Speaker 2 (21:57):

I just asked everyone who who connects with me. I say, can you give me w what, what’s your understanding of your situation? You know, and I think runners, a lot of times may not come clean if they’re dealing with pain, because if they go to see a healthcare professional, they’re going to be concerned that they’re going to get shut down work. Perhaps they interpret it as a sign of weakness. If they’re out on a group run, they don’t want, want to be the one complaining. So I just say, Hey, you know, what’s your understanding of your situation? And no one’s ever asked him that. And that’s when the conversation unfolds. So, and I think the way people respond is going to be different pending the person, the situation. But I think it’s remissive anyone who’s working with a runner or an athlete if they don’t ask that question. I feel like I started to answer your question, but I don’t know if I do.

Speaker 1 (22:48):

No, you did. That’s exactly what I wanted. That’s exactly what I wanted to hear. Cause I want the listeners to get as much of this like great little tidbits of information from you as they can. And you know, all of the questions, the questions to ask the patient that you’ve given so far, I think are great jumping off points for any therapist, regardless of whether you’re working for, with a runner or an athlete. But that question of give me the, let me know, what is your understanding of what’s going on? And that opens up a whole lot of doors for you. And then, you know, as the therapist, you have to be well versed in the science behind pain and, and how to talk to people. And, and of course it’s a whole other conversation, but you know, I think what you’re highlighting here is that you can’t wing it.

Speaker 2 (23:36):

No. And I think sometimes, you know, I had a question from a third year DPT student who watched a presentation. I gave at some and they’re like, Hey, I feel like I’m starting to ask the right question, but then I don’t know how to respond and follow up. And and I think that, you know, you can’t rush this process if you’re in, if you’re a young clinician that you’re going to get better at this through reps, through life experience and just through sort of being in the trenches with people. But you know, the other thing I tell folks is I say, look, you’re a smart person, you know? And I, you know, when I first acknowledge the fact, I think it’s good that you’re being proactive and addressing the situation, but left to your own devices. What do you feel like you, you need to do to get on the other side of this and they start to formulate a plan and I do, I don’t need to do anything.

Speaker 2 (24:27):

I just need to pose these questions and say like, I think that’s pretty sensible, you know? Are you okay if we nudge a little bit and you start to basically prepare them for the fact that this plan has got to be progressive, if we’re talking about getting them back to running, because they have to get back to a low-level plyometric activity. And I just love these conversations. And, you know, people ask me, they’re like, where you learn motivational interviewing. And I’m like, I lived in New York city for decade. I’m like, I just talk to people and I have no agenda. I’m just curious, you know, it drives my wife crazy. Cause if we’re ever out in public this happened yesterday. I went to, I had to get a new watch because my watch crapped out and this guy was checking out some watches and we just got to talk to me. And my wife was looking over at me, like, where are we go?

Speaker 1 (25:12):

Your wife is looking at her watch, like, come on, Chris, get it together

Speaker 2 (25:18):

And things off the shelves.

Speaker 1 (25:21):

But it’s true. I think that, you know, asking good questions, motivational interviewing a lot. Yes. There’s a lot of books. You can pick any book on motivational interviewing and read it and it will definitely give you some insight, but it’s the more you do. It’s the more people you talk to and not just your patients, anybody, the more you talk to anybody, it will help you be a better motivational interviewer. And the more that you listen and like really listen and start to formulate it’s practice. I guess you start to formulate your follow-up questions in your head as you’re listening. And again, it’s just practice, practice, practice.

Speaker 2 (25:57):

Yeah. And it’s, it’s fine. I think that it takes on a slightly different flavor as a function of, you know, what generation the person’s coming from too, you know? So but yeah, it’s just fun to help troubleshoot with people and to really get them to trust in themselves. Because most of the, the folks that consult me, I mean, they’re endurance athletes, namely runners and triathletes these days, and they’re going to manage their situation conservatively. Sometimes I feel like they need to be talked off the ledge. If they’re going to opt for a more invasive procedure, if that’s not really appropriate or perhaps an injectable of some sort. So, but yeah, getting people to trust in their body and and not drag them in for therapy all the time, you know, and I, I have to prepare people for that to say, you know, how do you anticipate this is going to go?

Speaker 2 (26:49):

And they’re like, well, maybe I’ll see you two to three times a week for six to eight weeks. I’m like, who’s footing that bill. No, no, one’s good. Yeah. So I say, you know, but this, this requires a lot of work on us on the back end because when I write an email, I mean, email, I wrote to this person yesterday, it was basically like, you know, two pages and cause it, kids dealing with the bone stress injury, the parents don’t really understand the implications of it. He’s going to be running competitively in college. And, and I think that he was under the notion that he was going to be back to running in four weeks. And I’m like let’s talk about more like four months. And I lay this out and I’m like, you know, I know this is probably a little bit, you know, overwhelming, or you weren’t expecting to hear this. What are your thoughts on this? You know, to engage him, to just know where he is after I’ve presented this information and he got the memo. But that’s, that’s a tricky thing about bone stress injuries is people fall under the, you know, the idea that they’re just gonna take a couple of weeks off and plugged back in.

Speaker 1 (27:49):

Yeah. Yeah. And again, that’s where you, as a, as a therapist and a coach comes in and helps the decision-making you’re ultimately, you’re not that runner, you’re not that athlete. So you’re not the ultimate decision maker, but your job is to give as much information and, and your professional opinion as to their situation as you can.

Speaker 2 (28:14):

Yeah. And I, I think that it traces back to that question is like, what are your expectations or questions around this surgery? I mean, this is a very involved procedure. They’re putting you under anesthesia and they’re cutting your body open. Never we’ll frame it like that, you know, when I’m working with people. But you know, I, I rehabbed all of these people after these very involved, soft tissue procedures of the shoulder when I was in New York, coming from Dr. Nicholas in his staff. And yeah, I’m like, this is going to be six months to a year before you feel like your, your shoulder is like firing on all cylinders.

Speaker 1 (28:47):

Yeah. Yeah. I had, I had a complex soft tissue shoulder repair and it was a year anyway, we can go on and on when it comes to a patient mindset, fear, trepidation, everything else. I think that’s for another podcast. But I think you definitely got across the decision-making process on behalf of us as a therapist or coach and how we can influence that process for the patient.

Speaker 2 (29:12):

Yeah. And I think that if patients aren’t on board, I mean, if they are around muddy water where there’s a sinister situation and they start sort of dilly-dallying, I think that we need to really put our foot down his therapist too and say, look, you know, you’ve consulted me and here are my recommendations or here’s my professional advice. And if you’re not going to take it, let’s just, let’s just part here. And sometimes we don’t need to do that a lot, but I think sometimes we drag our feet as clinicians and we need to, we need to put our foot down if we have to protect that person from themselves, because we can’t get tangled up in that mess. I can’t think of the last time that’s happened, but it has happened over the course of my career.

Speaker 1 (29:57):

So those, I mean, those are sticky conversations to have, but for the safety, I mean, our job is to protect that, protect our, our athlete, our patients. So if that is our job, then you have to have those sticky conversations. Yeah. And that’s it. All right. So I think that was thank you for that conversation on decision-making and hopefully it sparks plant some seeds in our listeners here. And now we’ll go on to two more questions that you usually, that you get the easy ones. You will we’ll breeze through these too. These are easy. How do you become a runner running injury expert To how many times do you get that question? How can I do what you do?

Speaker 2 (30:41):

Yeah, I it’s, I, I love getting it it’s flattering. You know, and, and it’s something that it was sort of, I looked back and all, I, there, there were a couple of defining moments in my life. And one was when I was told that I’d never be able to run again. You will never run again. Right. I heard that a couple of times from very world-renowned orthopedists. And I think that’s what ultimately put me on a trajectory to do this. And I never ran competitively when I was younger. I probably should have been channeled into a little bit more of a, a running program, but I was always playing sport, different sports, you know, from skateboarding to soccer, to tennis, to baseball, to basketball, to lacrosse, to, you know, rollerblading snowboard, like you name it. I played it. And except football, just because my high school didn’t have a football team.

Speaker 2 (31:39):

So I always relied on running to help me in sport. But I feel very fortunate in hindsight that I never started really formal distance running until I moved to New York city around like maybe 24, 25. But I, I think that when I started getting into triathlon is when I started working with a lot more runners. And I think when I started distance running, that was around the same time and it’s just a fun bunch to work with. And I think that initially I was overconfident and it got to be frustrating when I’m like, geez, this is a healthy person. Like I would send them out. I’m like, Hey, I think you’re doing good. And they would come hobbling home. Or they would call him and be like, Oh, I blew up on that run. And I’m like, why are these people blowing up on these runs?

Speaker 2 (32:25):

Like I thought they were doing a good job. And then it just really forced me to stare at myself in the face and say like, what do I need to be doing to really help these people? And, you know, I started reading a lot of the research. I started spending time around runners. I started speaking a lot with this fellow Bruce Wilke, who was sort of like a savant with running who unfortunately has since passed. But I started to really get a handle on running and not only on running, but just the mindset of runners, how they approach training how they’ve sort of just been dismissed by the medical community. Because you’re like, Oh, here’s a runner here comes another crazy runner. And then you start to realize that runner, when someone tells you they’re a runner, you don’t have other athletes.

Speaker 2 (33:09):

When you meet someone, you know, you could meet someone, you could meet a world-class athlete and they may not come claim that the fact that they play a competitive sport professionally, or they play a professional sport until you talk to them, runners like I’m here, I’m a runner, you know? And so they really stuff, they go through an identity crisis. So you have to look at this from so many different lenses. You have to understand the performance demands of the sport. You have to understand, you know, just running communities. You need to understand that these people’s identity revolves around their running. So they become fragile when they’re not running. So I just loved the challenge of, you know, addressing all these different factors and and it helps that I, that I’m still training and racing competitively because I sort of go through, I think a lot of the same struggles and challenges that they face so I can speak to them.

Speaker 2 (34:01):

But I think that if people want to go, go in on running as a young clinician, coach running is having a moment go all in, right. We saw an uptick and running with the, you know, with the pandemic. And I think that if you’re going to work with runners, you don’t want to say like, Oh, I do general outpatient orthopedic, orthopedic rehab. It’s like, no, my whole practice revolves around running. You know, people are like, they come to me because they know that, you know unfortunately I’ve had a pretty rich experience in terms of my, my didactic training. And, you know, when I was getting reps under my belt in New York city. So I feel like now I can look at things through a very global lens when a runner presents and we can troubleshoot most of the time, I’m seeing people for one, maybe two sessions. But I think that that running rehab is challenging in a lot of different ways, but if people have a, an interest go all in,

Speaker 1 (35:02):

I think that’s great advice. And I also really liked that. You just mentioned, Hey, I’m not seeing runners three times a week for six to eight weeks. You know, I’m not, this is not how I’m, I’m, I’m building my practice. And I think that’s important to let people know, because I think a lot of newer graduates or students might be thinking, Oh, this is going to be great. I’m going to be working with people several times a week for six weeks. And then they’re all better. Not so much the case when it comes to running injuries.

Speaker 2 (35:31):

Yeah. And their runners just seem to perpetually get these niggles and aches and pains. But, you know, I, I, I think it’s doing a disservice because if you bring someone in, if you say, Hey, look, I need to see a couple of times a week for the next six to eight weeks. You know, someone told me that I’m like, man, I must have something serious going on. So I just say, Hey, look I’m not concerned. Anything sinister is present. I want you to be sensible. You’re around muddy water, but carry on. All right. In calling me if you need me. And I think that they’re like, wow, I’ve had people reach out and are, you know, this person told me they were running five to six days a week and their quads were a little bit sore. I’m like, Oh, you’re good, man.

Speaker 2 (36:10):

You don’t need to see me. You know, I said, and I asked him some, some more involved questions, but I’m like, you don’t need to see me. That’s a really empowering message, you know, because the person’s like, Hey, I’m here ready to pay you. And you’re telling me that you don’t want to see me. I, one of a guy who’s become a good friend of mine. He was dealing with some hip pain. He was in a bicycle accident and he had some films in between x-rays MRR because of a woman who who’s pulling out of a parking lot, had collide with him for whatever reason. And you know, and I got a lens, you know, I saw his power profile on his bike. I saw the lifts that he was doing because we were training at the same facility. And he’s like, I, I need to come and see you for physical therapy.

Speaker 2 (36:52):

I’m like, no, you don’t. I’m like, I’m watching you lift, man. You don’t need to come and see for, you know, let’s, let’s just chat. If we cross paths here and he’s become a very good friend, he, he always jokes. He’s like, you’re the only PT you’ve told me not to come and see you. He’s like all these other people are like trying to get me in and get me on these programs and tell me, I need hip surgery and PRP and yada, yada. So, but you need to know that nothing sinister is going on the flip side of the coin.

Speaker 1 (37:19):

Right. And that’s where experience comes in and confidence as a clinician comes in as well. And that takes time. So you’re not going to be, so what I’m getting is if you want to be a running injury expert, go all in, read the research, do the things, take the classes and take time. It takes time and leave your ego at the door.

Speaker 2 (37:39):

Yeah. And I think the patterns will become, they’ll become pretty straight away in terms of where runners are getting into trouble. You know, where are these injuries are manifesting? And, you know, I, I think that most of it is being disconnected or out of touch with your ecosystem and not laying down programs that sort of reflect your ecosystem and realize that target is always moving. Right?

Speaker 1 (38:03):

Yeah. Yeah. Excellent. Okay. Final question of our interview here. And again, it’s, it’s an easy one. So, so we talked about this ahead of time. This is an easy one. So, well, how do I even phrase this in looking at the profession of physical therapy, what can we do better to define what we do and kind of stake our claim on what we do as a profession?

Speaker 2 (38:37):

Yeah. I still am organizing my thoughts around this. I went into physical therapy because I thought it put me in the best possible position to help troubleshoot with people through a conservative approach. And I think that the challenge we have is physical therapy is a very tricky thing to define. And I think that where we’re ultimately, and this is a quote from Jen Shelton, who was you know, in born to run, she was a young gifted ultra runner at the time. I don’t know what she’s up to these days, but she’s she’s a trip in all great ways, but she said physical therapists are your best friends in healthcare. And I think that we’re well positioned to be the first line of defense because we’re trained across such a broad through such a broad range. So, you know, you may see us working in cardiopulmonary capacity.

Speaker 2 (39:40):

You may see us working in wound care. You may see us working in a neurologic geriatric with geriatric population. You may see us basically with working with pro sports teams you know, pelvic floor. I mean, it’s tricky when you have all these moving parts, but I, I don’t think that we’ve defined who we are as a profession, to the extent that we need to. And and I think that’s why a lot of other people end up defining us sometimes in good ways sometimes in bad ways. But I think that it’s sort of like, you know, I’m in Seattle, I’m going to use a microbrew example. You know, you have run of the mill rehab. And I think some people lump physical therapy ended up, but physical therapy to me is sort of like a microbrew, right. We need to tell people what to think about it.

Speaker 2 (40:34):

We can’t let them conjure up their own ideas. We need to really define who we are as a profession. And and I, I don’t think we’ve done that yet. I think that we’re, we’re getting there, but I don’t, I don’t think we’ve done a really good job defining physical therapy. Cause if you ask people, you know, people are like, yeah, I’ve tried physical therapy and we know the same, the response, it’s a heat ultrasound TheraBand. And it’s always funny when people connect with me, they’re like, this is so different from like what I expect to physical therapy to be. And I’m like, well, what did you expect it to be? And it was generally the response is what I just mentioned. And they’re like, you just helped me troubleshoot and in sort of the seamless way. And, and that’s what I think we do.

Speaker 2 (41:21):

We triage and troubleshoot. But we look at things through the people who I really respect in life. They’re able to look at challenging situations through multiple lenses. And I think that that’s how we’re trained as physical therapists. And I think that that’s why we’re in such an incredible position to troubleshoot with people. So I don’t know why you’ve got my gears grinding even more. And I, I, I think about this morning, noon and night is, you know, how do we better define our profession? So we don’t let people conjure up their own ideas of what it is, because I think a lot of times if they’ve had a bad experience, that it becomes very skewed in physical just saying physical therapy doesn’t capture it.

Speaker 1 (42:09):

Yeah. I agree with that. And so what can we do as a profession to change that? I agree it needs to be changed. And I agree we need to be the ones out in front talking about what we do and how we do it and why we do it. So when, when you think about that, what sort of ways can we be out in front and take control of the narrative?

Speaker 2 (42:33):

I mean, I think it needs to be orchestrated. And I think that that’s, that’s a major challenge right now. Because I think that is a profession we’re a little bit more fragmented than, than one might think. So I think that we have to have a lot of people come together from different sectors of the field and have have a long, hard staring in the mirror and talk with each other to try and arrive in a definition for what we do. And I think it’s a really challenging thing, but I think it’s something that is very important, but I think also individuals like yourself where you start to represent the profession. You know, I try to do the same thing. I think that holds a lot of weight too. So I, I think it, you sort of have to take a multi-pronged approach.

Speaker 1 (43:23):

Yeah, yeah. So you have to take that 30,000 foot approach by having a lot of people from different areas come together and give that wide umbrella. But then from a micro position, individuals can also be out there and trying to, to change, to make a change.

Speaker 2 (43:40):

Yeah. And and I, I’m confident that we’re going to do that. I don’t know. I feel like I’m in my early forties now and I’m starting to become more reflective in life. Right. And and really think about, you know, a lot of things, one of which is a profession and, you know, I just feel like a pig in poop having landed in this profession because I’m such a diehard PT, but I also, like, I feel like the perception of physical therapy needs to change too.

Speaker 1 (44:09):

And, you know, I will say that I do see it changing slowly. I mean, this is a big ship to turn and I’m talking from a societal standpoint. And I say that because I see more and more in mainstream media, whether it be on television, print, blogs, podcasts, et cetera, that journalists are now reaching out to physical therapists. Whereas they would have reached out to a trainer, a chiropractor, a yoga instructor, or something like that when it comes to their articles on everything from training to, I just did an interview yesterday about pillows, you know? So it seems like, well, what, why would they reach out to a PT about pillows? You know, but it’s nice that they are reaching out to PTs about things like that. And things about training and things about COVID rehab and, and long haul COVID patients, you know, physical therapists are now being part of that conversation. I’m seeing that more and more from main street, main stream journalists. So I feel like that’s a good sign.

Speaker 2 (45:12):

Yeah, for sure.

Speaker 1 (45:14):

A good sign, for sure. And, and also showing that journalists are open to hearing from different groups. So I always say to physical therapists like contact your local newspaper, if you live. And, you know, I’m from a small town in Pennsylvania contact that local newspaper asked to write an article, ask to, you know, be a contributor, get onto your local news stations find, cause that’s, that’s the way the general public finds out, you know, on social media, there are some people like yourself and others that have great social media followings and are putting out great content designed for the consumer. But a lot of physical therapists on social media, probably myself included do social media posts for other therapists. So it’s a little different, right.

Speaker 2 (46:01):

Yeah. And I think that’s okay. And I think it’s

Speaker 1 (46:03):

Okay. Yeah. But I think we, it could be broader.

Speaker 2 (46:07):

Yeah. I just, I think that when I work with folks and I, I’m not alone here, but when people start getting a lens into my thoughts on a particular situation, if they’re like, Hey, I have some calf pain, they call me on the phone. They’re like, they may be an athlete. And they’re like, Hey, I have some calf pain, but a great example. This guy reached out to me the other day. And he was dealing with what he was told was an Achilles tendinopathy. And he was under the care of a physician and other rehab professional outside of the profession and I’ll leave it at that. And when he came to see me, his primary complaint was he was starting to lose coordination in his left, lower extremity on the run. And he started to feel more disjointed on the bike. This isn’t an Achilles tendinopathy.

Speaker 2 (46:54):

He may have symptoms that, you know, that are consistent, but that’s not what’s driving. So, you know, you start to think of, okay, well what could this be? You know, is there something going on maybe like from a differential diagnosis, you’re starting to run through like, Hey, is he’s telling you this, like okay, is this unilateral? Is that bilateral? You know, is there any loss of sensation, strength, power you know, is this, like if we just start asking a different set of questions, you know, could this be a runner’s dystonia? Could it be something like multiple sclerosis, it could be ALS. So you have to, when someone says, Hey, I have this complaint, we’re asking in terms of what’s running through our mind and the questions we ask, they’re very different. So I’m going to start challenging him from different coordination tasks.

Speaker 2 (47:44):

I’m going to take them through lower quarter screen. I’m going to get a lens into his running. You know, I’m going to understand how an Achilles tendinopathy would present if he’s not having issues doing calf raises. And he’s able to sit there and jump in place. I’m like, you’re killing is, is pretty, pretty good, man. You know? So for whatever reason, there’s this timing issue in his Achilles is probably seeing a different or an unaccustomed rate of loading that, that he’s not withstanding from a timing perspective. So, you know, he’s someone that probably ultimately needs to consult a neurologist, right? So why is no one told him that for a year? And they’re telling him that he needs to do a more aggressive form of scraping and he’s a candidate for a PRP, excuse my language, but that. Right. So this is where our role is just so critical because we sit, we spend an hour with people or at least, you know, a lot, and we, we can sit there and troubleshoot with people and really get them into the right hand. Why is no one ever he’s like your assessment makes so much sense to me. And so many examples. Yeah,

Speaker 1 (48:51):

Many, many examples. Well, Chris, this was great. What a good conversation. I think there’s a little bit of got a little bit of everything in here, and hopefully we answered a lot of w V a lot of the questions that you get on, on a daily, weekly, monthly basis. So thank you so much now, where can people find you?

Speaker 2 (49:11):

I can’t tell you no,

Speaker 1 (49:13):

I’m going off social media now.

Speaker 2 (49:17):

Instagram is good. I’m just at Chris Johnson, the PT, and I’m in the process of revamping my website and that should hopefully be done at some point in the next couple of weeks. And and that’s gonna really just, I think, make it easy to understand what some of my offerings are and how to sync up with me. And yeah, for folks, if, if you want to sign up for a crazy newsletter please join my newsletter. It’s a little bit of reverence. So I’m preparing it now in, in good ways. So,

Speaker 1 (49:49):

And how can they sign up for your newsletter? That’ll be on the website and Chris Johnson, pt.com or Zara and PT.

Speaker 2 (49:56):

Chris Johnson, pc.com. Yeah. Going back to my roots,

Speaker 1 (50:01):

Go keeping it simple. Right? Well, this was wonderful. Last question, knowing where you are now in your life and career, what advice would you give to your younger self now that you’re, you’re pondering, you’re pondering life in your early forties.

Speaker 2 (50:18):

Oh, stop taking yourself so seriously be present with people, equally people, power, power, your phone off, and and be present with people. And for folks who are who are coming to see you understand that a lot of what brings about changes in what helps people are these non-specific effects, you know, during a clinical interactions. So don’t feel like you need to have this gnarly didactic knowledge. That’s going to come in time by continuing to read the research, spending time around other mentors or clinicians. You respect taking courses from them. But if you can just be present and engage with someone, take a genuine curiosity in their situation, that’s going to do wonders and and yeah, take the pressure off yourself.

Speaker 1 (51:07):

Excellent advice. Excellent. And I thank you so much again, Chris, for taking the time out. And we will see you in a couple of days next in a week or so for a round table discussion, which I also think will be phenomenal. So thank you so much.

Speaker 2 (51:22):

Yeah. Thanks again for having me on Karen and keep up the great work. It’s fun to, to just sort of follow your, your journey and calling me if I can do anything to support you.

Speaker 1 (51:31):

Thank you so much. And everyone, thanks so much for listening. Have a great week and stay healthy, wealthy and smart

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©2019 Karen Litzy Physical Therapy PLLC.

©2019 Karen Litzy Physical Therapy PLLC.