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In episode 389 of The Physical Performance Show, Timothy Studley, physiotherapist at Pogo Physio, is joined by physiotherapist and PhD researcher Laura Anderson for a deep dive into shin splints, traditionally known as Medial Tibial Stress Syndrome (MTSS). Laura is the owner of The Injury Clinic in Geelong and is wrapping up a PhD on running retraining for runners with MTSS. Tim and Laura explore why MTSS may need a new name, what we do and don't know about the underlying pathology, and how to differentiate it from other causes of lower leg pain, particularly tibial bone stress injury. They also cover risk factors, load management, strengthening and plyometrics, and the limited role of gait retraining. It's a conversation that challenges conventional thinking for runners and clinicians alike. SHOW SPONSOR: 💯 Today's episode is brought to you by Pogo Physio's Telehealth consultations. If you're an endurance runner battling bone, tendon or joint-related concerns, our online telehealth consultations are an ideal platform to help get you back to your physical best. Book online at https://pogophysio.com.au. IN THIS EPISODE YOU'LL HEAR: Why MTSS is so poorly understood despite being commonly cited as one of the top three running injuries Why the JOSPT editorial argues MTSS needs a new name, and why "load-induced medial leg pain" (LIMP) was proposed: it's a pain presentation, not a syndrome, and it doesn't imply a bone stress injury The hypothesised tissue sources (soft tissue traction, deep crural fascia, cortical bone changes) and why none are conclusive, given similar findings in people without symptoms How the name "medial tibial stress syndrome" may drive bone-focused management and be nocebic for patients The main differentials: tibial bone stress injury, compartment syndromes, popliteal artery entrapment and nerve-related presentations Typical LIMP characteristics: gradual onset, may or may not warm up, usually eases within about 24 hours, and diffuse tenderness along the medial border (≥5 cm) compared with the more focal tenderness of bone stress injury Why LIMP and bone stress injury can co-exist, and why the athlete's story, training load history and symptom behaviour over time matter for diagnosis Why LIMP is typically persistent and recurrent, and why a previous history is a risk factor Risk factors: dynamic factors (foot function in walking and running, contralateral pelvic drop, plantar flexor endurance, lower limb muscle stiffness) are more convincing than static posture, plus female sex, higher BMI and previous history The state of the treatment evidence (shockwave, strengthening, graded running programs) and why effects often fade over time Why Laura treats LIMP as a load-based problem, and the challenge of balancing capacity-building with continuing to run How to decide what level of pain is acceptable by combining pain, function and symptom behaviour, including why Laura is comfortable with around 5/10 if function is maintained and symptoms settle Why capacity work (plantar flexor strength, plyometrics) may improve symptoms in the short term but isn't clearly linked to a faster return to running, with more to come from Laura's RCT Why complete rest isn't generally helpful unless pain prevents everything else The biggest load levers: intensity, frequency (rest days between runs) and volume, and why "easy" runs need to be genuinely conversational pace Why gait retraining isn't the most important lever, and how technique changes can shift load to other tissues Gym work: find the biggest deficit first, and combine strengthening with progressive plyometrics where testing isn't available Where the term LIMP may go, and why accurate language helps patients, coaches and parents understand the injury Laura's three tips each for runners and clinicians Laura's physical challenge for the week QUOTES / TAKEAWAYS: "Language as clinicians is incredibly powerful and we have to be careful." "It's a hell of a lot easier to explain if you just call it what it is." "You just have to get comfortable with, at present, not knowing what it is and realising that that's okay." "There's no blanket giving of gait retraining." "I don't think a period of rest either improves their outcome in the short term or the long term." "Walk more." TIME STAMPS: 00:00 – Episode introduction and overview 01:39 – Guest introduction: Laura's clinical work and PhD 04:54 – Why MTSS needs a new name 06:23 – The proposed name: load-induced medial leg pain (LIMP) 07:51 – Hypothesised tissue sources: soft tissue vs cortical bone 13:31 – Differential diagnoses 16:20 – Typical LIMP presentation vs bone stress injury 22:36 – Diagnostic clues and the athlete's story 24:54 – Risk factors 27:37 – The state of the treatment evidence 30:29 – Treating LIMP as a load-based problem 33:19 – How much pain is acceptable? 36:14 – Does building capacity speed up recovery? 37:43 – The role of rest 38:38 – Load levers: intensity, frequency and volume 41:26 – Gait retraining 44:16 – Gym work: finding the deficit, strength and plyometrics 48:05 – Where will LIMP go from here? 49:29 – Why terminology matters 51:22 – Three tips for runners and three for clinicians 54:40 – Laura's physical challenge 56:10 – Laura's PhD timeline and contact details 58:04 – Episode close Join The Physical Performance Show LEARNINGS membership through weekly podcasts here: https://www.patreon.com/TPPShow Our goal is to get you back to your Physical Best. Find out more about Telehealth Consultations and book online. YOUR HOSTS: 🏃‍♂️‍➡️ Timothy Studley - Pogo Physiotherapist: Instagram @timothy_physio 🔬 Laura Anderson - Physiotherapist and Researcher, The Injury Clinic, Geelong ([email protected]) The Physical Performance Show can be found at: Facebook: facebook.com/thephysicalperformanceshowpodcast X: @tppshow1 Instagram: @physicalperformanceshow Please direct any questions, comments, and feedback to the above social media handles.

In episode 388 of The Physical Performance Show, we're syndicating a conversation from the Physio Network platform's Physio Discussed podcast. Our own Brad Beer, Sports and Exercise Physiotherapist and Principal Physiotherapist at Pogo Physio, joins Dr. Brady Green, physiotherapist and researcher, and host Sarah Yule for a deep dive into calf muscle strain injuries. Brad and Brady explore where research and clinical practice meet: how to profile physical capacity after a calf strain, what strength and reactive qualities need restoring before running, how to make return-to-run decisions, and how much attention footwear and imaging deserve. Brad brings the view from the clinical coalface, and Brady brings the latest research from high-performance sport. A special thanks to the Physio Network platform for their generosity and collegiality in sharing this episode. SHOW SPONSOR: 💯 Today's episode is brought to you by Pogo Physio's telehealth consultations. If you're an endurance runner battling bone, tendon or joint-related concerns, our online telehealth consultations are an ideal platform to help get you back to your physical best. Book online at https://pogophysio.com.au. IN THIS EPISODE YOU'LL HEAR: What we understand better about calf strains than we did 5 to 10 years ago, including pathology, return-to-play timeframes, recurrence susceptibility and physical capacity profiling How the soleus vs gastrocnemius distinction has changed return-to-run prescription, including avoiding plodding on return to a soleus-based running program Why modifiable factors like strength, force production and stretch-shortening cycle proficiency matter alongside non-modifiable risk factors like age and prior calf strain history Brad's top three clinical mistakes: not clearly establishing the mechanism and training load context, progressing too quickly, and not impressing on athletes the need for ongoing preventative loading Why recurrence risk stays elevated long after return to play, and why preventative loading and load management may need to continue for the rest of the season Longitudinal AFL data showing athletes can build soleus strength from pre-season to early competition and maintain it through the season, and why a decline in strength is a flag to act on Why profiling the individual matters: a strong athlete may have strained their calf because of a stiffness deficiency or load management issue rather than weakness Brad's three-legged stool framework: repeated force (endurance), peak force, and reactive strength/plyometric qualities How to differentiate a gastrocnemius from a soleus strain using mechanism of onset, and why gradual, non-specific onset injuries are less likely to involve significant connective tissue disruption The clinical assessment toolkit: observation, progressive loading tests, RPE, palpation, pain on contraction and stretch, and differential diagnosis (bone stress, deep flexors, plantaris) Quality markers during calf testing, including eccentric control, long toe flexor clawing, rep counts and visible shakiness Home-based repeated force exercises such as single-leg calf raises, stair walking and pulsing, plus cueing tips like using a metronome and watching line of force through the foot Progressing from vertical to horizontal force production, including sled and Prowler pushes, step and box drills Return-to-run criteria: symptom resolution, performance readiness, 20+ slow calf raises, and 20 to 30 single-leg pogo hops with symmetrical quality Why holding your nerve for a few extra sessions at the end of rehab rarely costs you time, but rushing can Objective metrics with force plates: sub-maximal and maximal isometric testing, testing in dorsiflexion, rate of force development, reactive strength index, and pulsing to fatigue Footwear: Brad and Brady's "don't overcomplicate it, but be aware" approach, covering shoe drop, stiffness, rocker soles and stack height What imaging can and can't tell us, and Brady's top-down decision-making framework from index vs recurrent injury through to aponeurosis involvement The one thing each guest wants clinicians to do differently tomorrow QUOTES / TAKEAWAYS: "Do things well, not just at the level." "We don't need to overcomplicate it, but we do need to be aware." "The calf isn't always the culprit." "It's often the hardest thing is to make the complex simple." "You're not necessarily going to lose out if you hold your nerve for a few days or several sessions." "What is the property that we're reconditioning? What is the stimulus that we're trying to apply?" TIME STAMPS: 00:00 – Episode introduction and thanks to the Physio Network 00:46 – Episode overview and guest introductions 02:44 – What we understand better about calf strains now 04:08 – How clinical practice has evolved 05:01 – Soleus vs gastrocnemius return-to-run differences 07:53 – Top three mistakes when rehabbing calf strains 11:11 – How much strength is protective? Longitudinal AFL data 16:23 – The three-legged stool framework 17:48 – Differentiating soleus and gastrocnemius strains 20:40 – Clinical assessment: loading tests, palpation and quality markers 25:22 – Developing calf capacity in rehab 27:17 – Calf raise positioning and cueing 30:33 – Return-to-run criteria 35:19 – Force plate metrics and testing progressions 39:39 – How much attention should footwear get? 43:28 – Imaging and Brady's decision-making framework 48:11 – One takeaway for clinicians to apply tomorrow 50:05 – Episode close Join The Physical Performance Show LEARNINGS membership through weekly podcasts here: https://www.patreon.com/TPPShow Our goal is to get you back to your Physical Best. Find out more about Telehealth Consultations and book online. YOUR HOSTS: 🎙️ Sarah Yule - Host, Physio Network @physionetwork + @sarah.yule.carr 🏃‍♂️‍➡️ Brad Beer - Sports and Exercise Physiotherapist and Principal Physiotherapist, Pogo Physio: @brad_beer 🔬 Dr. Brady Green - Physiotherapist and Researcher The Physical Performance Show can be found at: Facebook: facebook.com/thephysicalperformanceshowpodcast X: @tppshow1 Instagram: @physicalperformanceshow Please direct any questions, comments, and feedback to the above social media handles.

In episode 387 of The Physical Performance Show, host Tim Studley picks up part two of his conversation with fellow Pogo Physio physiotherapist Lewis Craig, continuing last week's deep dive into surf life saving and Ironman racing. This episode shifts focus from injury patterns to managing niggles, optimising performance, and the habits that separate top-tier surf ironman athletes from the rest. Tim and Lewis discuss the collaborative decision-making involved in managing a recurring niggle, the key training and screening recommendations every surf life saving athlete should have in place, the lessons Lewis has learned working with elite athletes in the sport, and his top tips for improving performance — from sand-specific training to fuelling properly for a demanding training load. SHOW SPONSORS: 💯 Today's episode is brought to you by Pillar Performance and Pogo Physio's telehealth consultations. If you are an endurance runner battling with bone, tendon, joint related concerns, our online Telehealth consultations are an ideal platform to help get you back to your physical best - book online at https://pogophysio.com.au. 💯 PILLAR Performance is leading a new frontier in sports nutrition through micronutrition innovation. Their new Collagen Repair formula, developed in collaboration with Gelita Laboratories, is designed to support tendon and ligament health while promoting collagen synthesis to help athletes stay healthy and perform at their best. For 15% off your first order, visit https://pillarperformance.shop (or https://thefeed.com for North American listeners) and use the discount code PHYSICALPERFORMANCE (one word, capitals) at checkout.   IN THIS EPISODE YOU'LL HEAR: A recap: this episode picks up where Part 1 (episode 386) left off, continuing the discussion on surf life saving and Ironman racing Managing recurring niggles: why the decision to rest or continue training should be a collaborative one between physio, athlete and coach How timing within the season affects the risk-benefit of resting versus maintaining training load Why a first-time niggle warrants a more cautious, rest-forward approach compared to a chronic, familiar issue Practical ways to modify training around a niggle — for example, adjusting swim technique (removing paddles, adding kick, more dry-land warm-up) rather than stopping entirely The physiotherapist's role in performance: keeping athletes pain-free and injury-free so coaches can focus on skill and aerobic development Baseline recommendations for surf life saving athletes: two gym sessions per week, individual screening, consistent dry-land warm-ups, and tracking training load How swimmers can track training intensity despite the difficulty of measuring heart rate in the pool, including simple session RPE-based load tracking Why tracking training load matters most when returning from injury or time out of the sport The performance and injury-reduction upside of athlete and team awareness around REDs and energy availability The value of a collaborative support team: coach, physio, dietician, sports psychologist and massage therapist working together Lessons learned from working with elite surf life saving athletes, including individual variation in pain tolerance, treatment preferences and communication style Common themes among top athletes: professionalism, a genuine quest for knowledge about their bodies and training, and long-term training consistency Lewis's top three tips for improving performance: sand-specific training with a focus on calf and lower-limb capacity, prioritising shoulder health from a young age, and taking fuelling seriously The best piece of performance advice Lewis has been given: you can only benefit from the training you can recover from Closing thoughts on the sport deserving more attention, and interest in having surf life saving athletes themselves on the show in future QUOTES / TAKEAWAYS: "It should always probably be a collaborative decision between the physio treating the athlete, the athlete themselves, and the coach." "Can I take one or two, three days now to maybe potentially avoid a bigger block or weeks of interrupted niggling soreness?" "You can only benefit from the training you can recover from." "Eat more than you think you need." "There's a professionalism, there's a quest for knowledge, and then there's a consistency thing." "It's trying not to confuse doing more with being best."   TIME STAMPS: 00:17 – Episode introduction and breakthrough experience 00:23 – Episode 387 introduction: Part 2 with Lewis Craig on surf life saving 02:22 – Managing a recurring niggle: how to approach the decision to rest or train through 03:20 – Timing within the season and its effect on rest decisions 04:20 – Why a first-time niggle warrants a more cautious approach 04:50 – Modifying training instead of stopping: examples from swimming 05:47 – The physio's role in performance: keeping athletes pain-free so coaches can coach 06:46 – Baseline recommendations: two gym sessions per week 07:41 – Screening to identify individual injury risk factors 08:06 – The value of consistent dry-land warm-ups 09:06 – Tracking training load and intensity in swimming 10:35 – Session RPE and simple load-tracking methods 11:06 – Why tracking load matters most when returning from injury 11:36 – Awareness of REDs and low energy availability 12:05 – Recap: gym, screening, warm-ups, training load, energy awareness, support team 12:32 – Lessons learned from working with elite surf life saving athletes 13:30 – Individual variation in athlete preferences and pain tolerance 13:59 – Common themes among top athletes: professionalism and consistency 15:24 – Lewis's top three tips for improving performance 16:22 – Recap: sand-specific training, shoulder health, fuelling 16:52 – The importance of eating enough to support training load 17:17 – The best performance advice: recovering from training, not just doing more 18:15 – Closing thoughts and interest in future athlete guests 18:45 – Episode close and thanks to Lewis Craig 19:17 – Recap of the two-part surf life saving discussion 19:36 – Pogo Physio Telehealth Consultations and closing details     Join the The Physical Performance Show LEARNINGS membership through weekly podcasts here: https://www.patreon.com/TPPShow Our goal is to get you back to your Physical Best. Find out more about Telehealth Consultations and book online.   YOUR HOSTS: 🏃‍♂️‍➡️ Timothy Studley - Physiotherapist: Instagram @timothy_physio 💪 Lewis Craig - Physiotherapist and Clinical Lead, Pogo Physio: Instagram @_lewiscraig_ The Physical Performance Show can be found at: Facebook: facebook.com/thephysicalperformanceshowpodcast X: @tppshow1 Instagram: @physicalperformanceshow Please direct any questions, comments, and feedback to the above social media handles.

In episode 386 of The Physical Performance Show, host Tim Studley sits down with fellow Pogo Physio physiotherapist Lewis Craig to explore the world of surf life saving and Ironman racing — a sport many listeners may be unfamiliar with, but one that shares a huge amount in common with traditional triathlon and endurance sport. Tim and Lewis unpack what a typical training week looks like for a semi-professional surf ironman/ironwoman athlete, the most common injuries seen across swimming, ski paddling, board paddling and soft sand running, the disproportionate impact running-based injuries can have on an athlete's ability to race, and why energy availability, sleep and recovery are just as critical in this sport as they are in any other high-volume endurance discipline. SHOW SPONSORS: 💯 Today's episode is brought to you by Pillar Performance and Pogo Physio's telehealth consultations. If you are an endurance runner battling with bone, tendon, joint related concerns, our online Telehealth consultations are an ideal platform to help get you back to your physical best - book online at https://pogophysio.com.au. 💯 PILLAR Performance is leading a new frontier in sports nutrition through micronutrition innovation. Their new Collagen Repair formula, developed in collaboration with Gelita Laboratories, is designed to support tendon and ligament health while promoting collagen synthesis to help athletes stay healthy and perform at their best. For 15% off your first order, visit https://pillarperformance.shop (or https://thefeed.com for North American listeners) and use the discount code PHYSICALPERFORMANCE (one word, capitals) at checkout. In this episode, you'll hear: An introduction to surf life saving and Ironman racing: swimming, ski paddling, board paddling and soft sand running combined into one demanding sport The semi-professional nature of the sport, and how prize money from series like the Shaw and Partners Ironman Series and World Ocean Series has helped athletes A snapshot of a typical training day and week: double training sessions, four swim sessions, two to three ski paddling and board sessions, two gym sessions, two standalone runs, and Irons sessions combining all disciplines Typical weekly training hours for competitive athletes — estimated in the range of 15 to 20+ hours per week Similarities to other endurance sports: shared challenges around shoulder health, running-related injuries, and managing training load, intensity and recovery Whether discipline-dominant athletes (runners, swimmers, paddlers) experience different injury patterns, and the possible link between strong runners and higher bone stress injury risk via REDs What first drew Lewis to working with surf life saving and Ironman athletes, including his early experience working alongside elite athletes at Pogo Physio Common injuries in the sport: shoulder tendinopathies (supraspinatus, subscapularis), low back pain, Achilles tendinopathy, calf strains, ankle sprains, toe injuries, knee pain, bone stress injuries, and trauma-related injuries from craft or contact Why shoulder health is a season-long priority, while injuries that prevent running (calf strains, ankle sprains, bone stress injuries) carry the biggest time cost due to their impact on race ability Estimated prevalence of athletes competing while managing a shoulder or low back niggle, and how this may fluctuate across the competitive calendar An overview of the surf life saving racing calendar: trials, the Coolangatta Gold, and a condensed back-to-back race season with minimal true off-season Why the Coolangatta Gold's extra soft sand running volume increases physical demand and potential injury risk Common misconceptions about the physical demands of the sport, including underestimation of the aerobic and neuromuscular demands of soft sand running The energy cost and muscle activation differences of soft sand running compared to running on grass or road (roughly 1.4–1.6x energy cost, near-double EMG activity in key running muscles) Why maintaining some running — and ideally some soft sand running — year-round may help reduce injury risk when returning to high-intensity training Physical qualities to develop for soft sand running: calf capacity, forefoot strength, neuromuscular control, balance and proprioception, and specific gym-based calf training strategies Why strong road runners can't assume they have the capacity needed for soft sand running Common training and recovery mistakes: under-fuelling relative to high training demands, and the potential role of low energy availability and REDs in this population Warning signs of under-fuelling to watch for, including low iron, frequent illness, low libido in males, and menstrual cycle changes in females The key pillars of recovery for these athletes: sleep, nutrition, well-structured and individualised training programming, and secondary recovery tools like massage, compression and cryotherapy Quotes / takeaways: "These athletes are really, really impressive... it really is akin to the traditional triathlete." "It's a real juggling act, but also then makes it really meaningful to try and help these athletes." "If we can't sand run, then often that's no racing." "Go for a run on the sand and see how hard it is." "I have a hypothesis that if these athletes all did more running, we'd see a heap of bone stress injuries." "It gets tricky to do it well and do it right consistently." Time Stamps: 00:00 – Episode introduction: surf life saving and Ironman racing with Lewis Craig 00:31 – What is surf life saving and Ironman racing? 01:30 – Semi-professional status and recent growth in prize money 02:27 – A typical training day and week for a competitive athlete 04:23 – Typical weekly training hours 05:23 – Comparisons to other endurance sports like triathlon 06:23 – Do discipline-dominant athletes get different injury types? 08:05 – What sparked Lewis's interest in the sport 11:28 – Most common injuries: shoulder, low back, running-related 13:26 – Which injuries carry the biggest performance and time cost 14:21 – Prevalence of athletes competing through shoulder or back niggles 16:34 – The surf life saving racing calendar and trials 18:24 – Biggest misconceptions about the physical demands of the sport 18:54 – The energy cost and muscle demands of soft sand running 20:24 – Bone stress injury risk around high-intensity competition periods 20:52 – Underestimating the aerobic demands of soft sand running 23:17 – Why maintaining year-round running and sand running may help 24:16 – Physical capacities to develop for soft sand running: calf, foot strength, balance 26:14 – Why road running fitness doesn't guarantee sand running capacity 26:43 – Common training mistakes: under-fuelling and REDs risk 29:35 – Warning signs of low energy availability to watch for 30:05 – Recovery pillars: sleep, nutrition, training structure 31:34 – Individualised recovery tools: massage, compression, cryotherapy 32:32 – Recap of key recovery pillars and closing thoughts THE TEAM: Join the The Physical Performance Show LEARNINGS membership through weekly podcasts here: https://www.patreon.com/TPPShow Our goal is to get you back to your Physical Best. Find out more about Telehealth Consultations and book online. Your Hosts: 🏃‍♂️‍➡️ Timothy Studley - Physiotherapist at Pogo Physio: Instagram @timothy_physio 💪 Lewis Craig - Physiotherapist and Clinical Lead, Pogo Physio: Instagram @_lewiscraig_ The Physical Performance Show can be found at: Facebook: facebook.com/thephysicalperformanceshowpodcast X: @tppshow1 Instagram: @physicalperformanceshow Please direct any questions, comments, and feedback to the above social media handles.

In episode 385 of The Physical Performance Show, host Brad Beer sits down with fellow physiotherapist Lewis Craig for a lateral ankle sprain masterclass. Drawing on material the pair recently presented at a Gold Coast orthopedic evening, Brad and Lewis cover the burden and prevalence of lateral ankle sprains, the three-part clinical assessment process, key differential diagnoses, rehabilitation phases, and preventative strategies including bracing and taping. The episode explores why lateral ankle sprains — despite their reputation as a minor injury — carry a significant risk of chronic ankle instability, and why a thorough, structured assessment is essential to a smooth recovery. Brad and Lewis unpack the different ligament and tendon structures that can be involved, the red flags practitioners need to rule out, the impairment categories drawn from Jay Hertel's model of chronic ankle instability, and how rehabilitation should progress from protection through to return to sport and long-term prevention. Show Sponsor: Pogo Physio also offers online Telehealth Consultations for endurance athletes managing bone, tendon, or joint issues — book online at https://www.pogophysio.com.au. And... PILLAR Performance is leading a new frontier in the sports nutrition industry through micronutrition innovation. Their Performance Health range is designed to support the crucial hours outside of training and racing, helping athletes return to the start line in peak condition. One of their newest releases is Collagen Repair, developed in collaboration with Gelita Laboratories and featuring the clinically trialled collagen peptide TENDOFORT. For 15% off your first purchase, head to pillarperformance.shop or, for North American listeners, thefeed.com and use the code PHYSICALPERFORMANCE at checkout. Pillar Performance continues to lead the way in sports nutrition through micro-nutrition innovation, now expanding into the Performance Health range. One of their newest releases, Collagen Repair, was developed with Gelita Laboratories (Germany) using a clinically trialled collagen peptide (Tendofort) to support tendon and ligament health in conditions like hamstring tendinopathy, Achilles tendonitis, shin splints, and patellofemoral pain. Head to Pogo Physio also offers online Telehealth Consultations for endurance athletes managing bone, tendon, or joint issues — book online at https://www.pillarperformance.shop (or https://www.thefeed.com for North American listeners) and use code PHYSICALPERFORMANCE for 15% off your first purchase.   Partners / links mentioned: Ortho Tools (Cumberland Ankle Instability Tool / CAIT): mentioned in-episode as the online questionnaire resource Contact: Lewis Craig — [email protected] In this episode, you'll hear: Episode context: Lewis Craig's return to the show after being last on around episode 109, and his progress toward finishing his Sports Masters through the University of Queensland The burden of lateral ankle sprains: why they're the most common musculoskeletal injury in sport across field and court sports, contact and non-contact alike Recurrence risk: why roughly 40% of people who sprain their ankle go on to develop chronic instability, and why the one-year mark is a key risk-reduction milestone Early predictors of chronic ankle instability: the Doherty 2016 study on single-leg landing and drop-jump testing at two weeks post-injury The three priorities of assessment: ruling out red flags and fractures, forming an accurate diagnosis, and identifying impairments Screening for fractures: mechanism of injury, the Ottawa ankle rules, weight-bearing ability, and key bony landmarks to palpate Differential diagnosis: ATFL and CFL sprains (70–80% of ankle sprains), peroneal tendon injuries, bifurcate ligament sprains, deltoid ligament tears, syndesmosis injuries, and talar dome injuries Why getting a clear mechanism of injury from the athlete is critical to an accurate diagnosis Identifying impairments: the ROAST consensus and Jay Hertel's updated model of chronic ankle instability — pathomechanical, sensory-perceptual and motor-behavioural impairments Clinical and objective testing: balance progressions, calf raise endurance and strength benchmarks, and power tests including triple hop, crossover hop and timed lateral hop The role of patient-reported outcome tools: the Cumberland Ankle Instability Tool (CAIT) and FAAM, and why they're useful for tracking progress and motivation Rehabilitation framework: protection and appropriate early loading, followed by strength, stability and mobility phases Managing specific injury types: use of moon boots, orthotics, low-dye taping and ASO ankle braces depending on the structures involved Addressing dorsiflexion loss: why regaining ankle range of motion is often one of the hardest parts of rehab, and the Torillin infographic on identifying the source of restriction Late-stage rehab and return-to-sport: hopping, change of direction, and integrating exercises into an athlete's normal training week for ongoing prevention Bracing and taping as secondary/tertiary prevention strategies to reduce recurrence Long-term consequences of poorly managed ankle sprains, including links to post-traumatic osteoarthritis and eventual ankle surgery The biggest mistake athletes make: assuming rehab is "done" once they can run, despite still having deficits in power, change of direction and stability Lewis's top tip: get every ankle sprain properly assessed, no matter how minor Quotes / takeaways: "It's just a simple lateral ankle sprain... and then someone who goes missing for months at a time." "Four out of ten people who have an ankle sprain go on to develop a chronic instability." "The better quality of the assessment, the more likely there's an accurate diagnosis." "It's really hard to sprain your ankle when it's really well strapped or with an appropriate brace." "Once someone gets running... you can run in a straight line really well and have really considerable deficits still." "Get it assessed. Understand what you've done and understand what impairments you might have." Time Stamps: 00:17 – Episode introduction and breakthrough experience 00:23 – Episode 385 introduction: lateral ankle sprain masterclass with Lewis Craig 00:50 – Sponsor: PILLAR Performance and Performance Health 01:15 – Collagen Repair: formulation, TENDOFORT and collagen health 01:44 – 15% PILLAR Performance discount with code PHYSICALPERFORMANCE 02:19 – Welcoming Lewis Craig back to the show 02:48 – Lewis's tenure at Pogo Physio and progress on his Sports Masters at UQ 03:45 – Introducing today's topic: lateral ankle sprains 04:37 – How common and burdensome are lateral ankle sprains? 05:36 – The "she'll be right" attitude and why it's changing 07:02 – Lewis's personal history with recurrent ankle sprains 08:02 – Impact on Lewis's own running and trail running 08:28 – The one-year mark and recurrence risk statistics 09:26 – Predictors of chronic ankle instability: single-leg landing and drop jump 09:53 – The Doherty 2016 study explained 10:51 – The three priorities of assessment 11:21 – Ruling out red flags and fractures 12:45 – Why assessment quality drives rehab outcomes 13:14 – Screening for fractures: mechanism, Ottawa ankle rules, bony landmarks 14:39 – Deciding on imaging: x-ray or MRI 15:06 – Differential diagnosis: the many subcategories of ankle sprain 15:35 – ATFL and CFL: the most common ligament sprains 16:35 – Peroneal tendon injuries 17:04 – Bifurcate ligament sprains 18:04 – Deltoid ligament tears with lateral ankle sprains 18:33 – Syndesmosis injuries and mechanism differences 19:31 – Clinical tests for syndesmosis 20:01 – Talar dome injuries and other easily missed diagnoses 20:30 – Why getting a clear mechanism from the athlete matters 21:29 – Identifying impairments: what it means and why it's important 22:51 – Jay Hertel's model of chronic ankle instability 23:48 – Balancing patient education without causing fear 24:17 – Motor outcomes: strength, power and kinetic chain 24:43 – Assessment time and thoroughness at Pogo Physio 25:08 – Objective testing: dynamometers, balance and calf tests 25:38 – Balance test progressions as return-to-sport criteria 26:37 – Strength testing: inversion, eversion and calf raise endurance 27:07 – Power testing: triple hop, crossover hop and lateral hop tests 27:33 – Using objective markers to guide return-to-sport decisions 28:01 – Patient questionnaires: Cumberland Ankle Instability Tool (CAIT) and FAAM 28:57 – Coping vs non-coping athletes and objective scoring 29:25 – Moving into rehabilitation: individualised management 29:54 – Protection and appropriate early loading 30:20 – Moon boots and protecting specific structures 31:16 – ASO ankle braces for lower-grade sprains 31:45 – The strength, stability, mobility rehab framework 32:14 – Early loading phase: range of motion, balance and strength 32:43 – Addressing dorsiflexion loss 33:13 – The Torillin infographic on restriction sources 33:40 – Progressing balance and strength exercises 34:10 – Preventative efforts and integrating rehab into training 34:40 – Late-stage rehab and return-to-play criteria 35:39 – Bracing and taping to prevent recurrence 36:08 – Long-term consequences: osteoarthritis and ankle surgery risk 37:34 – Lewis's own experience with taping and bracing 38:02 – The biggest mistake athletes make in managing ankle sprains 39:29 – Lewis's top tip: get every ankle sprain assessed 40:27 – Where to reach Lewis Craig for questions 40:52 – Episode close and sponsor reminder 41:20 – Pogo Physio Telehealth Consultations and closing details THE TEAM: Join the The Physical Performance Show LEARNINGS membership through weekly podcasts here: https://www.

In episode 384 of The Physical Performance Show, Brad Beer and fellow physiotherapist Tim Studley tackle a wide-ranging Q&A on tibial bone stress injuries. Following the recent bone stress injury mini-series and two-part tibial bone stress injury masterclass, Brad and Tim answer listener questions covering chronic tibial stress responses, recurring shin pain, rehabilitation, plyometrics, strength training, anti-inflammatory medications, and how to reduce the risk of future bone stress injuries. The episode explores some of the practical clinical questions that arise when athletes are trying to understand persistent shin pain and return to running. Brad and Tim unpack the difference between tibial bone stress injuries and medial tibial stress syndrome (MTSS), explain how workload and tissue tolerance interact, discuss when to introduce single-leg strength and plyometrics, and highlight why a thorough assessment of both biomechanical and biological risk factors is essential for athletes with recurring bone stress injuries. Show Sponsor: PILLAR Performance is leading a new frontier in the sports nutrition industry through micronutrition innovation. Their Performance Health range is designed to support the crucial hours outside of training and racing, helping athletes return to the start line in peak condition. One of their newest releases is Collagen Repair, developed in collaboration with Gelita Laboratories and featuring the clinically trialled collagen peptide TENDOFORT. For 15% off your first purchase, head to pillarperformance.shop or, for North American listeners, thefeed.com and use the code PHYSICALPERFORMANCE at checkout. Show Sponsor: Pillar Performance continues to lead the way in sports nutrition through micro-nutrition innovation, now expanding into the Performance Health range. One of their newest releases, Collagen Repair, was developed with Gelita Laboratories (Germany) using a clinically trialled collagen peptide (Tendofort) to support tendon and ligament health in conditions like hamstring tendinopathy, Achilles tendonitis, shin splints, and patellofemoral pain. Head to pillarperformance.shop (or thefeed.com for North American listeners) and use code PHYSICALPERFORMANCE for 15% off your first purchase. Pogo Physio also offers online Telehealth Consultations for endurance athletes managing bone, tendon, or joint issues — book online at pogophysio.com.au.   Partners / links mentioned: Show sponsor: PILLAR Performance — 15% off your first purchase using code PHYSICALPERFORMANCE at checkout. PILLAR Performance: pillarperformance.shop North American listeners: thefeed.com Pogo Physio Telehealth Consultations: pogophysio.com.au     In this episode, you'll hear: Chronic tibial bone stress injuries: whether an experienced ultramarathon runner can adapt to a persistent Grade 2 stress response and continue running without progressing to a stress fracture Recovery strategies: what sauna, nutrition and strength training may—and may not—contribute to recovery from tibial bone stress injuries Nutrition and bone health: the importance of adequate calorie and micronutrient availability, and why recurrent bone stress injuries may warrant review with a sports dietitian Calcium supplementation: what is known about calcium availability and why there isn't a clear tibia-specific dose linked directly to bone stress injury recovery Recurring shin pain: why an athlete can continue experiencing medial shin pain despite controlled mileage and well-rounded strength training The three-part clinical framework: biomechanics, workload, and tissue capacity as key areas to investigate when shin pain keeps returning MTSS versus bone stress injury: why persistent posterior-medial shin pain may represent medial tibial stress syndrome rather than a bone stress injury Individual differences: why some runners seem more susceptible to shin pain and why comparing your injury history with other runners can be misleading Plyometrics and single-leg strength: when to introduce spring-based loading, hopping and jumping during tibial bone stress injury rehabilitation Rehabilitation progression: why single-leg strength work can begin relatively early while plyometrics are generally introduced later Training the opposite leg: why the unaffected limb should continue to be trained during rehabilitation Return to running with persistent shin pain: how MRI findings, symptom location and clinical presentation can help distinguish MTSS from tibial bone stress injury Strength training progression: moving from higher-repetition, lower-load work capacity training towards heavier strength and eventually rate-of-force and plyometric training Anti-inflammatory medications: what regular use of ibuprofen and diclofenac may mean for bone and skeletal health, and why they are unlikely to be the sole cause of a running-related bone stress injury Posterior tibial stress reactions: how running workload can exceed bone tolerance and how factors including bone geometry, bone quality, biomechanics and psychology may influence risk Preventing recurrence: why runners with a previous bone stress injury have a significantly elevated future risk and need to identify and manage their individual risk factors The role of the gym: why strength and conditioning can help restore muscle capacity, support bone health and prepare the tibia for the demands of running Hop testing: why a pain-free hop test is useful when assessing tibial bone stress injuries, while recognising that other diagnoses can also produce pain with hopping The 10 cm palpation rule: why longer areas of shin tenderness are more consistent with medial tibial stress syndrome than focal bone stress injury Clinical assessment: why practitioners need to consider gait, palpation, loading tests, biomechanics, workload, tissue capacity and differential diagnoses rather than relying on pain intensity alone. Quotes / takeaways: "Bone stress is not something that the body adapts to." "Most people are paying a tax, I always say, to play the game they want to play." "There's no recipes." "It's never just one thing." "You need running workload and that workload exceeds, in simple terms, bone's tolerance." "Once a runner's had a bone stress injury, they have much heightened risk, six to seven fold for the rest of their running life."   Time Stamps: 00:00 – Episode introduction and breakthrough experience 00:23 – Episode 384 introduction: Q&A on tibial bone stress injuries 00:53 – Sponsor: PILLAR Performance and Performance Health 01:20 – Collagen Repair: formulation, TENDOFORT and collagen health 01:49 – 15% PILLAR Performance discount with code PHYSICALPERFORMANCE 02:18 – Episode begins: listener Q&A following the bone stress injury series 03:24 – How the listener questions were gathered and why these themes matter 03:53 – Chris' question: chronic Grade 2 tibial bone stress injury in an experienced ultramarathon runner 04:23 – Can the body adapt to bone stress and allow an athlete to run through it? 05:49 – Why symptomatic bone stress requires an appropriate deload 06:16 – Sauna, nutrition and other recovery techniques 07:11 – Micronutrients, calories and optimal skeletal health 08:07 – Strength training and progressive restoration of tibial capacity 08:33 – Calcium intake and the importance of sports dietitian review for recurrent injuries 09:57 – Zane's question: recurring medial shin pain despite controlled mileage and strength training 10:52 – Why some runners continue to struggle despite avoiding obvious training spikes 11:51 – The three key areas: biomechanics, workload and tissue capacity 12:19 – MTSS versus tibial bone stress injury 12:46 – Biomechanical strategies and the example of professional triathlete Josh 13:39 – Strength and conditioning relative to the demands of professional triathlon 14:07 – Why recurring shin pain may require a more individualised assessment 15:03 – Why comparing yourself with runners who appear injury-free can be misleading 15:33 – "Paying a tax" to participate in the sport you love 16:02 – Isaac Fishlock's question: when to introduce plyometrics and single-leg strength 16:28 – Plyometrics as a late-stage rehabilitation tool 16:57 – Why bones need spring loading and high rates of loading 17:26 – Introducing single-leg strength early and training the unaffected leg 17:55 – Why the opposite leg may also be at increased risk after deloading 18:18 – Are there strength or pain benchmarks before introducing plyometrics? 18:45 – Why rehabilitation progression needs to be individualised 19:15 – Rhonda Gainsford's question: persistent medial shin pain with a negative MRI 19:45 – Why persistent symptoms can point towards MTSS rather than bone stress injury 20:13 – What an MRI showing no bone stress response can tell you 20:42 – Focal versus longer-length tenderness along the shin 21:10 – Can the runner return to running? 21:41 – The Coil Crew's question: heavy reps versus endurance work for calf raises 22:10 – Starting with higher-repetition, lower-load work capacity 22:41 – Progressing towards heavier strength work 23:09 – The three-pronged calf framework: endurance, maximum strength and spring 23:39 – Clinical benchmarks for calf endurance and reactive strength 24:09 – Ryan Williams' question: can regular ibuprofen or diclofenac cause a stress response? 24:37 – Anti-inflammatories, collagen synthesis and potential effects on skeletal health 25:03 – Why anti-inflammatories are unlikely to independently cause a running-related bone stress injury 26:01 – How a posterior tibial stress reaction develops 26:31 – Running workload versus bone tolerance 27:00 – Bone geometry, bone quality, adolescent sport and other risk factors 27:29 – Why bone stress injuries are multifactorial 27:57 – Reducin

Physical Performance Show – Episode 383 Show Notes In episode 383 of The Physical Performance Show, host Brad Beer sits down with Professor Franco Impellizzeri, one of the most influential and outspoken voices in athlete load management research, for a wide-ranging conversation on why "load management" is an old concept dressed up in new data, why the acute to chronic workload ratio (ACWR) never held up to scrutiny, and why context — not more metrics — is what separates good decision-making from noise. Show Sponsor: Pillar Performance continues to lead the way in sports nutrition through micro-nutrition innovation, now expanding into the Performance Health range. One of their newest releases, Collagen Repair, was developed with Gelita Laboratories (Germany) using a clinically trialled collagen peptide (Tendofort) to support tendon and ligament health in conditions like hamstring tendinopathy, Achilles tendonitis, shin splints, and patellofemoral pain. Head to pillarperformance.shop (or thefeed.com for North American listeners) and use code PHYSICALPERFORMANCE for 15% off your first purchase. Pogo Physio also offers online Telehealth Consultations for endurance athletes managing bone, tendon, or joint issues — book online at pogophysio.com.au.   Professor Franco Impellizzeri's work can be explored here: https://profiles.uts.edu.au/Franco.Impellizzeri And... https://scholar.google.com/citations?user=z35F1WAAAAAJ&hl=en   Listen in as we delve into the following: What "load management" actually means, and why it's a relabelling of concepts coaches have wrestled with since the 1930s–40s The double-edged sword of the data revolution: from heart rate monitors to today's GPS, wearables, and AI-driven analytics Commercial and career incentives behind pushing metrics — both from tech companies and researchers Confirmation bias and why interpreting data without a theoretical framework is "like reading tarot" The case against the acute to chronic workload ratio (ACWR): its lack of scientific support despite IOC endorsement A landmark runners' study showing the opposite relationship between ACWR and injury risk — and what that reveals about the field Why meta-analyses and systematic reviews in load research can be manipulated to "find whatever you like" The difference between using a metric personally versus promoting it as scientifically validated Why the most skilled clinicians tend to hold their conclusions with the least certainty A real-world case study: a soccer training drill "failure" that was actually a video-monitoring blind spot, not a bad drill The expanding role of data scientists in sport, and why interpretation — not collection — is the real skill gap Whether AI and machine learning can (or should) replace the sports scientist's judgement Individualised and personalised training approaches — and why even these are still built on group-level generalisations Distinguishing signal from noise, and why one "failed" intervention doesn't mean an athlete won't respond next time Practical advice for coaches and practitioners: accept uncertainty, treat training like a "trial of therapy," and reassess If he could track only one metric: heart rate (or perceived effort) over power The push for more honest scientific debate — including a proposed on-air "intellectual sparring" series with dissenting researchers   Quotes: "Understanding the quantity of training for athletes has been a hot topic since training methodology started... managing load is not new." — Professor Franco Impellizzeri "When you don't have a theoretical framework and an a priori idea strong and supported, it's like reading tarot, to be honest." — Professor Franco Impellizzeri "There's zero evidence that this metric can either help or can actually reflect some sort of mechanism." — Professor Franco Impellizzeri, on the acute to chronic workload ratio "Don't take yourself too seriously." — Professor Franco Impellizzeri   Timeline: 00:00 – Introduction: host's specialist physio training and the load management "viva" question 01:04 – What is load management? An old concept, relabelled 02:31 – From heart rate monitors to GPS: the rise of training data 06:14 – Commercial interests and the risk of becoming "slaves of data" 08:05 – Why load management matters: the drug-dosing analogy 09:24 – Load management as a decades-old coaching concern 10:23 – Confirmation bias and interpreting data "like reading tarot" 13:17 – Championing methodological rigor in sports science 16:33 – Meta-research, honesty, and acknowledging uncertainty 18:22 – Why the most skilled clinicians express the least certainty 19:18 – Origins of the critique of the acute to chronic workload ratio (ACWR) 20:09 – Takeaways for contemporary practitioners on load management models 21:34 – Why the ACWR lacked scientific and conceptual support 23:02 – Training load, time-at-risk, and reframing injury risk 24:24 – The contradictory runners' study and what it implies 26:43 – Cherry-picking and overfitting in load-injury meta-analyses 28:34 – Taking a stronger public stance on social media 30:34 – Science as a self-correcting process 31:31 – The discipline required to properly read and critique research 33:58 – Why data alone can't tell you what to do 34:24 – Case study: the soccer drill that "failed" — until the video told the real story 36:49 – The role (and limits) of data scientists in sport 38:46 – Could AI replace the sports scientist's job? 40:42 – Advice for coaches and practitioners: accept uncertainty 42:09 – Individualised approaches are still a form of generalisation 44:31 – Separating signal from noise — and why not to give up early 46:56 – If only one metric: heart rate over power 48:21 – One piece of advice: "don't take yourself too seriously" 48:51 – This week's physical challenge: swimming without pain 50:16 – What's next: meta-research projects and replication studies 51:43 – A proposal for public scientific debate, and Ian Shrier's work on consensus 56:32 – Why genuine debate is hard to find in science communication today 57:59 – Episode close THE TEAM: Join The Physical Performance Show LEARNINGS membership through weekly podcasts here: https://www.patreon.com/TPPShow Our goal is to get you back to your Physical Best. Find out more about Telehealth Consultations and book online at pogophysio.com.au. Your Host: 🏃 Brad Beer - Instagram & X @Bradbeer and YouTube @PogophysioAu The Physical Performance Show can be found at: Facebook: facebook.com/thephysicalperformanceshowpodcast X: @tppshow1 Instagram: @physicalperformanceshow

Physical Performance Show – Episode 382 Show Notes In this episode of The Physical Performance Show, host Brad Beer sits down with Pogo Physio's Tim Studley for Part 2 of their two-part mini-series on shin pain and tibial bone stress injuries. Having covered diagnosis and differentiation between MTSS and tibial bone stress injuries in Part 1, this episode shifts focus to management — mechanics, return-to-run programming, strength and conditioning, footwear, and terrain considerations for runners recovering from (or trying to prevent) tibial bone stress injury. Show Sponsor: Pillar Performance continues to lead the way in sports nutrition through micro-nutrition innovation, now expanding into the Performance Health range. One of their newest releases, Collagen Repair, was developed with Gelita Laboratories (Germany) using a clinically trialled collagen peptide (Tendofort) to support tendon and ligament health in conditions like hamstring tendinopathy, Achilles tendonitis, shin splints, and patellofemoral pain. Head to pillarperformance.shop (or thefeed.com for North American listeners) and use code PHYSICALPERFORMANCE for 15% off your first purchase. Pogo Physio also offers online Telehealth Consultations for endurance athletes managing bone, tendon, or joint issues — book online at pogophysio.com.au.   Listen in as we delve into the following: Biomechanical vs. biological risk factors, and why running intensity matters more than mileage for bone Cadence, overstriding, and how a heel-strike pattern increases tibial loading Foot pressure distribution, lateralised loading, and how footwear/orthotics can help A case study: how cadence cueing, orthotics, heel raises, and calf strengthening resolved recurrent tibial bone stress injury Managing anterior tibial cortex injuries: why they're high-risk, slow to heal, and often need surgery Moving from time-based to symptom-led (optimal load) management for posterior-medial tibial bone stress injuries The five evidence-based criteria for returning to running after a tibial bone stress injury Why a 10% increase in pace can cut a bone's fatigue threshold by 50% Structuring intensity and volume in a return-to-run program to avoid a "double whammy" of risk Strength and conditioning phases: contralateral leg work, weight-bearing progressions, and pre-running plyometrics Clinical strength benchmarks for calf raises, leg press, hamstring curls, and hip abduction Footwear considerations: heel wedges, rocker-bottom shoes, and the debate around carbon plates Surface and terrain: why stiffer surfaces and flat terrain are preferred during return-to-run Treadmill running and its effect on distal loading What's next: an upcoming Q&A episode, and future instalments covering the femur, sacrum, tarsal bones, and calcaneus Quotes "Muscle loads bone." — Brad Beer "That runner doesn't need to be strong. They need to be uber strong." — Brad Beer, quoting tendon researcher Ebonie Rio "A 10% increase in pace reduces the fatigue threshold of a bone by 50%." — Brad Beer Timeline 00:00 – Introduction & sponsor: Pillar Performance 02:26 – Running mechanics and tibial bone stress injury risk 03:18 – Cadence, overstriding, and heel-strike patterns 05:43 – Foot pressure distribution and medial tibial bending 07:39 – Case study: footwear, orthotics, and cadence cueing 08:37 – Overview of bone stress injury management complexity 09:35 – Anterior tibial cortex injuries: high risk, slow healing, surgery 11:30 – Shift from time-based to symptom-led management 14:49 – Balancing speed of return with recurrence risk 15:48 – Five evidence-based return-to-run criteria (Sheeran & Reid, 2024) 18:11 – Why intensity is a greater risk factor than volume 20:35 – Strength and conditioning: matching capacity to running demands 22:29 – Three-phase strength progression: pre-, during-, and post-weight bearing 24:52 – Clinical strength benchmarks for return to running 26:16 – Return-to-run walking milestones and symptom monitoring 27:16 – Pain tolerance guidelines: the "any pain, stop" rule for bone 27:45 – Footwear considerations: heel wedges, rocker-bottom shoes, carbon plates 28:42 – Surface and terrain considerations 29:40 – Treadmill running and distal loading effects 30:39 – What's next: Q&A episode and future bone stress injury series 33:01 – Episode close & sponsor mentions THE TEAM: Join The Physical Performance Show LEARNINGS membership through weekly podcasts here: https://www.patreon.com/TPPShow Our goal is to get you back to your Physical Best. Find out more about Telehealth Consultations and book online at pogophysio.com.au. Your Hosts: 🏃 Brad Beer - Instagram & X @Bradbeer and YouTube @PogophysioAu 🏃‍♂️‍➡️ Timothy Studley - Instagram @timothy_physio The Physical Performance Show can be found at: Facebook: facebook.com/thephysicalperformanceshowpodcast X: @tppshow1 Instagram: @physicalperformanceshow

In episode 381 of The Physical Performance Show, host Brad Beer — sports and exercise physiotherapist — sits down with Pogo physiotherapist Tim Studley for the first instalment of a two-part mini-series on shin pain and tibial bone stress injuries, following on from their earlier three-part bone stress injury series. This episode is essential listening for runners, coaches, and clinicians alike, unpacking how to tell the difference between medial tibial stress syndrome (MTSS/shin splints) and a true tibial bone stress injury — two conditions that can feel identical but require completely different management. Brad and Tim walk through the physiology of bone loading, the palpation tests that separate a "safe to keep running" diagnosis from one requiring an MRI, and the loading tests used to stress-test the tibia safely in clinic. Show Sponsor: Pillar Performance continues to lead the way in sports nutrition through micro-nutrition innovation, now expanding into the Performance Health range. One of their newest releases, Collagen Repair, was developed with Gelita Laboratories (Germany) using a clinically trialled collagen peptide (Tendofort) to support tendon and ligament health in conditions like hamstring tendinopathy, Achilles tendonitis, shin splints, and patellofemoral pain. Head to pillarperformance.shop (or thefeed.com for North American listeners) and use code PHYSICALPERFORMANCE for 15% off your first purchase. Pogo Physio also offers online Telehealth Consultations for endurance athletes managing bone, tendon, or joint issues — book online at https://pogophysio.com.au. Listen in as we delve into the following: The prevalence of tibial bone stress injuries and why the shin is the most common bone stress site in runners Why bone stress injuries occur: workload errors, loading frequency vs. magnitude, and individualised risk factors The continuum from "happy bone" to stress reaction to frank stress fracture Why pain magnitude doesn't reliably predict injury severity The heterogeneity of bone innervation and why the periosteum is key to understanding pain Differentiating MTSS from tibial bone stress injury — and why the management is entirely different The 10cm palpation rule: a clinical prediction rule for when to suspect bone vs. soft tissue Why the anterior (front) shin is a higher-risk, non-union-prone injury site The loading-test ladder: double leg calf raise → single leg calf raise → single leg hop → side-to-side hop → forward hop The role of muscle-bone synergy: how calf strength and girth influence tibial bone stress risk Recovery timelines by injury grade, and why MRI matters for prognosis and athlete buy-in A real case study: a triathlete's navicular injury, deconditioning, and return to tibial bone stress injuries Quotes "You can go from hero to zero really quickly with bone."  "Higher levels of pain don't necessarily mean a worse injury."  "Muscle loads bone."  Timeline 00:00 – Introduction & sponsor: Pillar Performance 02:15 – Introduction to Tim and Brad's conversation 02:27 – Prevalence of tibial bone stress injuries 03:56 – Why bone stress injuries occur: workload and biomechanics 05:22 – Symptom patterns: bone stress injury vs. other shin pain 07:42 – Heterogeneity of bone innervation and pain variability 10:10 – Why pain severity doesn't predict injury severity 11:07 – MTSS vs. bone stress injury: two schools of thought 12:06 – Brad's clinical experience and personal injury history 13:59 – Cardinal signs and symptom progression in MTSS 15:23 – The three-legged stool: history, physical exam, imaging 16:19 – The 10cm palpation rule explained 19:43 – Applying the rule in practice 20:42 – Anterior shin pain: a higher-risk presentation 21:39 – Loading tests: from calf raises to forward hopping 24:07 – Individualising the loading-test progression 26:03 – Does the 10cm rule apply anteriorly? 26:55 – History as the biggest predictor of reinjury 27:53 – MRI, prognosis, and grading via the Fredericksons scale 29:15 – Reading hesitancy and movement quality in loading tests 31:10 – Why bone stress injuries aren't purely about vertical impact 33:03 – Calf girth and bone stress risk correlation 34:56 – Case study: a triathlete's navicular injury and recovery 35:58 – Episode close & sponsor mentions THE TEAM: Join The Physical Performance Show LEARNINGS membership through weekly podcasts here: https://www.patreon.com/TPPShow Our goal is to get you back to your Physical Best. Find out more about Telehealth Consultations and book online at pogophysio.com.au. Your Hosts: 🏃 Brad Beer - Instagram & X @Bradbeer and YouTube @PogophysioAu 🏃‍♂️‍➡️ Timothy Studley - Instagram @timothy_physio The Physical Performance Show can be found at: Facebook: facebook.com/thephysicalperformanceshowpodcast X: @tppshow1 Instagram: @physicalperformanceshow

In episode 380 of The Physical Performance Show, host Brad Beer and Pogo Physio physiotherapist Tim Studley conclude their three-part expert series on bone stress injuries by focusing on what happens after diagnosis. From imaging and prognosis to rehabilitation, return to running, and long-term prevention, this episode provides a practical roadmap for athletes, coaches, and clinicians managing these complex injuries. Brad explains why identifying the underlying causes of a bone stress injury is just as important as healing the bone itself. The discussion covers deloading, progressive reloading, strength and conditioning, bone-building exercise, and the simple but powerful strategies that can dramatically reduce the risk of recurrence. Show Sponsor: PILLAR Performance is leading a new frontier in sports nutrition through micronutrition innovation. Their new Collagen Repair formula, developed in collaboration with Gelita Laboratories, is designed to support tendon and ligament health while promoting collagen synthesis to help athletes stay healthy and perform at their best. For 15% off your first order, visit pillarperformance.shop (or thefeed.com for North American listeners) and use the discount code PHYSICALPERFORMANCE (one word, capitals) at checkout. In this episode, you'll hear Why MRI remains the gold standard for diagnosing bone stress injuries and guiding treatment When a clinical diagnosis may be sufficient—and why imaging usually provides better certainty and prognosis The three-step rehabilitation framework: identify risk factors, deload appropriately, then progressively reload Why treating the underlying cause is essential to preventing repeat bone stress injuries How rehabilitation differs depending on injury severity and high-risk versus low-risk bone sites Practical principles for returning to running, including restoring volume before introducing intensity Why the opposite limb also requires strength and bone loading during rehabilitation The role of strength training, plyometrics and osteogenic exercise in rebuilding bone capacity Why bone responds best to short, novel loading sessions rather than long continuous exercise The concept that "bone cells get bored easily" and how to optimise bone adaptation Why multidirectional movement remains important long after returning to sport The impact of childhood sport participation and bone geometry on lifelong injury risk Brad's personal journey with osteoporosis and what it taught him about endurance athlete health Three practical strategies every endurance athlete can implement to reduce bone stress injury risk Why recovery—not just training—is where adaptation actually occurs Quotes / takeaways "Treat the cause—not just the injury." "Restore volume before you restore intensity." "Bone cells get bored easily." "It's not the training you adapt to—it's the recovery from the training." "Eat more than you think you need." Partners / links mentioned Show Sponsor: PILLAR Performance — 15% off your first order using code PHYSICALPERFORMANCE at checkout. North America: thefeed.com Timeline 00:00 – Introduction, sponsor and final episode of the Bone Stress Injury mini-series 02:27 – Clinical testing for femoral neck bone stress injuries 03:26 – Clinical diagnosis versus MRI: when imaging is essential 05:14 – Why MRI improves prognosis and return-to-sport planning 07:03 – The three-step rehabilitation framework: risk factors, deload, reload 08:58 – Deloading strategies for high-risk bone stress injuries 09:50 – Progressive tissue loading and returning to running 10:46 – Why training volume should return before intensity 11:45 – Reloading the unaffected limb during rehabilitation 12:44 – Strength training, muscle function and long-term bone health 14:30 – Why bone cells "get bored" and how osteogenic exercise works 15:56 – Novel loading strategies, multidirectional movement and chaos hopping 17:23 – Childhood sport participation and building stronger bones 19:14 – Brad's personal experience with osteoporosis as an endurance athlete 21:40 – Three practical strategies to reduce bone stress injury risk 24:29 – Skeletal deload weeks and cross-training alternatives 25:27 – Recovery as the key driver of adaptation 26:26 – Final advice for athletes and clinicians 27:49 – Brad's top performance tip: "Eat more than you think you need" 28:18 – Listener challenge: fuel immediately before and after every training session this week 28:56 – Episode close and conclusion of the Bone Stress Injury mini-series THE TEAM: Join The Physical Performance Show LEARNINGS membership through weekly podcasts here: https://www.patreon.com/TPPShow Our goal is to get you back to your Physical Best. Find out more about Telehealth Consultations and book online. Your Host: 🏃 Brad Beer – Instagram & X @Bradbeer and YouTube @PogophysioAu The Physical Performance Show can be found at: Facebook: facebook.com/thephysicalperformanceshowpodcast X: @tppshow1 Instagram: @physicalperformanceshow

In episode 379 of The Physical Performance Show, host Brad Beer and Pogo Physio physiotherapist Tim Studley continue their three-part expert series on bone stress injuries by shifting the focus from training errors to the biological factors that determine whether an athlete's skeleton can tolerate training demands. This episode explores the critical role of energy availability, bone health, recovery, and risk stratification in both preventing and diagnosing bone stress injuries. Brad shares practical screening strategies developed over two decades of clinical practice, explaining why identifying the underlying cause—not just treating the injury—is essential for long-term athletic performance and injury prevention. Show Sponsor: PILLAR Performance is leading a new frontier in sports nutrition through micronutrition innovation. Their new Collagen Repair formula, developed in collaboration with Gelita Laboratories, is designed to support tendon and ligament health while promoting collagen synthesis to help athletes stay healthy and perform at their best. For 15% off your first order, visit pillarperformance.shop (or thefeed.com for North American listeners) and use the discount code PHYSICALPERFORMANCE (one word, capitals) at checkout. In this episode, you'll hear Why biological factors may contribute more to bone stress injuries than training load alone The long-term consequences of early sport specialisation and why multi-sport participation builds a stronger skeleton Medical conditions and medications that can compromise bone health and increase injury risk Why low energy availability (RED-S) is one of the biggest contributors to bone stress injuries Practical screening questions clinicians should ask to identify athletes who may be under-fuelling The relationship between training volume, mood, gastrointestinal symptoms, sleep, life stress and bone health Female-specific indicators including menstrual irregularities and amenorrhoea Male-specific indicators including reduced libido and changes in morning erectile function Why blood tests, iron status, vitamin D and hormone profiles provide valuable clues to athlete health The importance of working with sports dietitians to optimise energy availability and performance Common locations of bone stress injuries throughout the lower limb and pelvis How injury location can provide clues to whether biomechanics or under-fuelling is the primary driver Understanding high-risk versus low-risk bone stress injury sites and why blood supply matters Practical assessment strategies including observation, palpation and functional loading tests When hop testing is appropriate—and when it should be avoided Clinical pearls for distinguishing bone stress injuries from other common running injuries Quotes / takeaways "Training loads the skeleton—but biology determines whether the skeleton can cope." "Eat more than you think you need." "The biggest driver of bone stress injuries is often invisible." "Above the knee, think fuelling. Below the knee, think biomechanics." "Treat the cause—not just the bone." Partners / links mentioned Show Sponsor: PILLAR Performance — 15% off your first order using code PHYSICALPERFORMANCE at checkout. North America: thefeed.com Timeline 00:00 – Introduction, sponsor and recap of the Bone Stress Injury mini-series 02:27 – Why biological risk factors deserve greater attention than ever before 03:51 – Early sport specialisation and athletic history as risk factors 04:50 – Medical conditions, medications and bone health 05:45 – Sleep, stress and the biological contributors to bone stress injuries 07:08 – Understanding low energy availability (RED-S) 08:32 – Practical screening questions for under-fuelling 09:02 – Female athlete indicators: menstrual health and amenorrhoea 10:29 – Male athlete indicators: libido and morning erectile function 11:51 – Blood tests, iron studies, vitamin D and hormone profiles 13:18 – Why even small daily energy deficits accumulate over time 14:16 – Working with sports dietitians and estimating energy requirements 15:40 – Brad's number one recommendation: "Eat more than you think you need" 16:08 – Common sites of bone stress injuries throughout the body 18:00 – Using injury location to distinguish biomechanics from under-fuelling 18:48 – High-risk versus low-risk bone stress injury locations 21:12 – The most commonly missed bone stress injuries in runners 22:37 – Clinical examination: observation, palpation and localisation of symptoms 24:19 – Differentiating shin splints from bone stress injuries through palpation 25:14 – Functional loading tests and when hop testing is appropriate 26:31 – Hop testing, femoral neck injuries and clinical safety considerations 27:24 – Differential diagnosis and key assessment principles 28:25 – Episode wrap-up and preview of Part 3 THE TEAM: Join The Physical Performance Show LEARNINGS membership through weekly podcasts here: https://www.patreon.com/TPPShow Our goal is to get you back to your Physical Best. Find out more about Telehealth Consultations and book online. Your Host: 🏃 Brad Beer – Instagram & X @Bradbeer and YouTube @PogophysioAu The Physical Performance Show can be found at: Facebook: facebook.com/thephysicalperformanceshowpodcast X: @tppshow1 Instagram: @physicalperformanceshow

*]:pointer-events-auto R6Vx5W_threadScrollVars scroll-mb-[calc(var(--scroll-root-safe-area-inset-bottom,0px)+var(--thread-response-height))] scroll-mt-[calc(var(--header-height)+min(200px,max(70px,20svh)))]" dir="auto" data-turn-id= "request-WEB:6a57fa5e-c460-45da-be9f-861e67a1cd4e-2" data-turn-id-container= "request-WEB:6a57fa5e-c460-45da-be9f-861e67a1cd4e-2" data-testid= "conversation-turn-4" data-turn="assistant"> In episode 378 of The Physical Performance Show, host Brad Beer is joined by Pogo physiotherapist Tim Studley for the first instalment of a three-part expert series exploring bone stress injuries. Drawing on decades of clinical experience and the latest research, Brad unpacks the mechanisms behind one of the most common and misunderstood injuries affecting endurance athletes. This episode explains how bone stress injuries develop, why they occur, and why they're often missed until they become more serious. Brad and Tim discuss the relationship between training load, bone physiology, symptom progression, and risk factors, while providing practical insights for athletes, coaches, and clinicians seeking to identify problems before they become stress fractures. Show Sponsor: PILLAR Performance is leading a new frontier in sports nutrition through micronutrition innovation. Their new Collagen Repair formula, developed in collaboration with Gelita Laboratories, is designed to support tendon and ligament health while promoting collagen synthesis to help athletes stay healthy and perform at their best. For 15% off your first order, visit pillarperformance.shop (or thefeed.com for North American listeners) and use the discount code PHYSICALPERFORMANCE (one word, capitals) at checkout. In this episode, you'll hear Why bone stress injuries exist on a continuum—from healthy bone through stress reactions to true stress fractures The biology of bone remodelling: osteoclasts, osteoblasts, microcracks, and why recovery is essential Why running intensity has a far greater impact on bone stress injury risk than training volume alone How a 10% increase in running pace can dramatically reduce the bone's fatigue threshold Why many athletes mistakenly blame the "last run" rather than the workload accumulated four weeks earlier The importance of deload weeks and allowing the skeleton time to repair accumulated microdamage Understanding the Fredericson grading system and what distinguishes stress reactions from stress fractures Why shin splints (medial tibial stress syndrome) are not the same as a bone stress injury How pain location and symptom behaviour provide more valuable diagnostic information than pain intensity Why serious bone stress injuries can sometimes hurt less than relatively minor periosteal injuries The progression of symptoms from post-run discomfort to persistent and night pain How clinicians assess training history, workload, Strava data, intensity distribution, terrain, and footwear The major biomechanical and biological risk factors that contribute to bone stress injuries Previous bone stress injuries as one of the strongest predictors of future injury The emerging discussion around performance footwear ("super shoes") and potential changes in bone loading Why muscle strength and tissue capacity remain important contributors to skeletal resilience Quotes / takeaways "A bone stress injury is simply stress of a bone." "It's not usually the kilometres that catch people out—it's the intensity." "Don't judge the severity of a bone injury by how painful it is." "Symptoms often appear around four weeks after the training error—not the day after." "If it's really obvious, it's probably important." Show Sponsor PILLAR Performance creates evidence-based sports micronutrition products designed to support recovery, sleep, health, and performance for athletes and active people. For all your PILLAR products visit https://PillarPerformance.shop, or for our North American listeners, head to https://TheFeed.com.  🔥 For 15% off your first purchase enter PHYSICALPERFORMANCE at the checkout. Timeline 00:00 – Introduction, sponsor and overview of the new three-part Bone Stress Injury series 02:27 – Brad introduces expert editions and welcomes Tim Studley 03:54 – What is a bone stress injury? 04:23 – Bone loading explained: intensity versus training volume 06:50 – Bone physiology: microcracks, osteoclasts and osteoblasts 08:44 – Why recovery weeks are critical for skeletal health 09:14 – Bone remodelling timelines and why symptoms are delayed 11:40 – Bone stress injuries versus stress fractures 13:05 – The Fredericson grading system explained 14:26 – Shin splints (MTSS) versus bone stress injuries 15:21 – Why pain severity doesn't reflect injury severity 17:42 – The importance of symptom behaviour over pain intensity 19:08 – The progression of bone stress injury symptoms 20:30 – Taking a running history: training load, Strava and identifying workload errors 22:22 – Why today's symptoms often reflect training from four weeks earlier 23:20 – Biomechanical versus biological risk factors 24:17 – Previous bone stress injuries as a major predictor of recurrence 24:47 – Performance footwear ("super shoes") and emerging research 26:03 – Terrain, footwear changes and other biomechanical considerations 26:57 – Muscle capacity, tissue resilience and assessing the athlete   THE TEAM: Join the The Physical Performance Show LEARNINGS membership through weekly podcasts  here: https://www.patreon.com/TPPShow Our goal is to get you back to your Physical Best.  Find out more about Telehealth Consultations and book online. Your Host:  🏃 Brad Beer - Instagram & X @Bradbeer and YouTube on @PogophysioAu   The Physical Performance Show can be found at:  Facebook: facebook.com/thephysicalperformanceshowpodcast X: @tppshow1  Instagram: @physicalperforamceshow Please direct any questions, comments, and feedback to the above social media handles. *]:pointer-events-auto R6Vx5W_threadScrollVars scroll-mb-[calc(var(--scroll-root-safe-area-inset-bottom,0px)+var(--thread-response-height))] scroll-mt-(--sticky-padding-top)" dir="auto" data-turn-id="081498ac-bc39-4ab2-a81c-691cffa69424" data-turn-id-container="081498ac-bc39-4ab2-a81c-691cffa69424" data-testid="conversation-turn-5" data-turn="user">

In episode 377 of The Physical Performance Show, Sports Physiotherapist Nick Kane joins host Brad Beer to unpack the rehabilitation of hamstring strain injuries. Nick is the founder and director of SportsMap, one of Australia's leading professional development platforms for sports medicine clinicians. Drawing on more than a decade working in elite sport, including ten years with the Essendon Football Club in the AFL and five years as lead physiotherapist, Nick shares practical, evidence-informed insights into managing one of sport's most common and frustrating injuries. This episode explores the common mistakes athletes and practitioners make during rehabilitation, the critical role of high-speed running exposure, how to assess injury severity, key risk factors for recurrence, and the practical steps required for a successful return to sport. Nick also discusses eccentric strength training, fascicle length, T-junction injuries, and the characteristics that separate great clinicians from average ones. Whether you're an athlete, coach, physiotherapist, or sports medicine practitioner, this episode delivers practical takeaways you can immediately apply.   Show Sponsor PILLAR Performance creates evidence-based sports micronutrition products designed to support recovery, sleep, health, and performance for athletes and active people. For all your PILLAR products visit https://PillarPerformance.shop, or for North American listeners, head to https://TheFeed.com.  For 15% off your first purchase enter PHYSICALPERFORMANCE at the checkout.    How To Check: LinkedIn - Nick Kane SportsMap – https://sportsmap.com.au Listen in as we delve into the following: • The three most common mistakes in hamstring rehabilitation • Why maximum speed exposure is essential for successful recovery • The dangers of over-prescribing and under-prescribing sprint work • Understanding hamstring injury pathology and injury mechanisms • Key clinical assessment findings for hamstring strain injuries • Risk factors including eccentric strength, fascicle length, and running mechanics • The "push and pull of strain" concept • Practical strength benchmarks for rehabilitation progressions • The role of Nordic hamstring exercises and eccentric loading • Monitoring recovery using objective clinical markers • Criteria-based return-to-play decision making • Preventing recurrence following return to sport • Why regular exposure to high-speed running matters • Understanding T-junction hamstring injuries • What differentiates great clinicians from average practitioners • The value of curiosity, continual learning, and athlete-centred communication Quotes "Preparing to sprint is preparing to play." — Nick Kane "The highest strain you can apply to the hamstring is sprinting." — Nick Kane "Consistency is key." — Nick Kane "If you stop training eccentrically for two weeks, those fascicles shorten." — Nick Kane "The person who stays curious and continues learning is the one who keeps improving." — Nick Kane Timeline 00:00 – Introduction and sponsor messages 01:20 – Introduction to Nick Kane and SportsMap 04:08 – The three biggest mistakes in hamstring rehabilitation 05:35 – Over-prescribing and under-prescribing high-speed running 09:16 – Why sprint exposure is critical for recovery 10:34 – Understanding hamstring injury pathology 13:54 – Key risk factors for hamstring strain injuries 16:12 – The push and pull of strain concept 18:29 – Eccentric strength and fascicle length 20:22 – Practical strength assessment benchmarks 23:13 – Essential clinical assessment tools 27:20 – Using objective markers to guide return-to-play timelines 29:21 – Sponsor messages 31:14 – Return-to-play criteria and rehabilitation progressions 34:41 – Preventing hamstring injury recurrence 37:29 – Understanding T-junction hamstring injuries 41:41 – What separates great clinicians from average clinicians 44:25 – Nick Kane's one piece of performance advice 45:53 – The weekly physical challenge: 10 minutes of stillness 46:51 – Where to find Nick Kane and SportsMap 48:27 – Episode wrap-up and upcoming shows Your Host Join the The Physical Performance Show LEARNINGS membership through weekly podcasts  here: https://www.patreon.com/TPPShow Our goal is to get you back to your Physical Best.  Find out more about Telehealth Consultations and book online. Your Host:  🏃 Brad Beer - Instagram & X @Bradbeer and YouTube on @PogophysioAu   The Physical Performance Show can be found at:  Facebook: facebook.com/thephysicalperformanceshowpodcast X: @tppshow1  Instagram: @physicalperforamceshow Please direct any questions, comments, and feedback to the above social media handles.

Brad shares what's happened over the last two years, why there has been infrequency in episode production adn what teh plan is from ehre. Listen into this brief update as he explains what shape the podcast will take and what content you can expect.  We want to say a special thank you to you, our loyal listeners. Without youthere wouldn't be this podcast, we deeply apprecaite you.

In episode 376 of The Physical Performance Show, professional triathlete Ellie Salthouse joins Hugh Darnell and Brad Beer for a deeply honest conversation about resilience, pressure, and longevity in elite endurance sport. Recorded following knee surgery and a strong return to racing, this episode unpacks what it truly takes to rebuild confidence, performance, and belief when the path back to the start line is anything but straightforward. Ellie reflects on her Wollongong T100 performance, the physical and mental demands of injury rehabilitation, and the systems that now support her consistency at the pointy end of the sport. From working with specialist coaches and reshaping her mental game, to mastering race-day execution, fueling, recovery, and decision-making under pressure, Ellie shares the frameworks that continue to sustain her elite career. Show Sponsor: The Rehab Mechanics offers Simple Tools and Real Results. Easy fixes for your feet with a massive impact. For 20% off all The Rehab Mechanics products. Go to www.therehabmechanics.com.au Enter discount code TPPS20 at checkout. In this episode, you'll hear Wollongong T100 debrief: executing the plan, racing at home, and handling the "always want the podium" competitor mindset Race-week routines: keeping things consistent, arriving a week early, and why Ellie doesn't taper heavily The injury story: severe knee pain pre-70.3 Worlds, major swelling post-race, scan results, and surgery timing (Feb) Rehab timeline & milestones: back on bike + pool at ~10 days, building trainer time, returning to road riding, quad activation challenges, strength work, and a ~6-month return to start line The mental toll of injury: identity, motivation, sponsor pressure vs internal pressure, and staying process-driven with "small controllables" Return-to-racing lessons: Vancouver as the first race back, managing expectations, and surprising run performance with minimal prep Mental performance breakthrough: building a "toolbox" with a sports psych, handling pressure, thoughts, and race-week spirals Tools that work: "a thought is just a thought," bus analogy, and the "monsters in the boat" approach to sitting with emotions Coaching structure shift: moving from one coach (8 years with Siri) to specialists (swim/cycle/run/strength) + managing training load Training with data: the steep learning curve of power/metrics and why it took ~12 months to truly click Partner + coach dynamic: boundaries between "boyfriend Zach" and "coach Zach," and why switching off matters Race-day execution: whiteboard cues, focusing on controllables, and adapting plans on the fly Fueling evolution: from "a few gels and Gatorade" to calculated carbs/sodium/fluid + planned recovery Recovery essentials: movement-based recovery, boots, protein targets, sauna/ice baths, sleep, magnesium, and tracking what actually works Filtering the '1%ers': ease of use, time cost, measurability, and avoiding noise What's next: 70.3 World Champs (Marbella) then camp in the Canary Islands and T100 World Champs (Qatar, Dec 13) Ellie's advice: stay disciplined, stay hungry, trust your instincts Listener challenge: 20 x 3 min tempo / 3 min endurance on the bike (yes… brutal) Quotes / takeaways "A feeling is just a feeling. A thought is just a thought." "If it's a chore or doesn't integrate into your life, it's probably not the right 1%er." "Who's willing to suffer the most — that's the name of the game." Partners / links mentioned Show sponsor: The Rehab Mechanics — 20% off with code TPPS20 at checkout (therehabmechanics.com.au) Follow Ellie: @elliesalthouse (Instagram) Timeline 00:00 – Introduction & sponsor: The Rehab Mechanics + TPPS20 discount 01:13 – Hugh introduces featured performer: Ellie "Salty" Salthouse + Wollongong T100 context 02:43 – Ellie joins: quick bio + why this conversation has been a long time coming 03:42 – Wollongong T100 debrief: home-race energy, execution, 4th place 05:04 – Race-week process: keeping routine consistent + days leading into race 06:21 – "Pressure in the athlete hotel": being around competitors all week 07:43 – Knee injury origin: severe pain pre-70.3 Worlds, race week adjustments 09:03 – Post-Worlds swelling + scan findings: missing cartilage + floating fragments 10:17 – Surgery timing (early Feb) + season disruption + finding positives 11:43 – "Blessing in disguise": freshness late season + only 5 races so far 12:37 – Rehab milestones: back on bike & in pool ~10 days post-op 13:59 – Quad shutdown challenge: stim/BFR + "it finally clicked" 14:28 – Return-to-racing timeline: ~6 months off the start line 14:57 – Mental toll of injury: motivation, identity, checklist of controllables 16:20 – Sponsor pressure vs internal pressure: clauses, but mostly self-driven 17:14 – First race back: Vancouver expectations + rebuilding run fitness 19:02 – Surprise outcome: 11th place + faster-than-expected run execution 19:31 – The "low expectations / low pressure" effect when returning 20:48 – Key win: testing the knee under race stress (sand, mounts/dismounts) 21:48 – Perspective from Jan Frodeno: same surgery took him a year 22:44 – Mental performance shift: why big races used to unravel 24:07 – Working with a sports psych: building a toolbox for pressure + thoughts 25:28 – Why mental coaching should be "the 4th discipline" 26:54 – Advice for athletes who didn't gel with a sports psych before 27:47 – Readiness + openness: why it clicked this time 29:54 – Practical tools: "thoughts on a bus" + "monsters in the boat" analogy 33:26 – Coaching evolution: leaving Siri after 8 years + hard "breakup" conversation 36:10 – Why specialists: swim/cycle/run/strength + being great at all three 39:42 – Adjustment year: results dipped before training began correlating again 40:08 – Learning to train with data: cadence/speed → full power metrics 42:32 – When it clicked: 12 months to understand, 18 months to see new numbers 43:30 – Negatives of multi-coach model: communication + squad consistency when travelling 44:47 – Partner + coach dynamic: boundaries, downtime, and early arguments 47:35 – Race-day execution: Zach's whiteboard cues, focus, and adapting plans 50:16 – Discipline vs instincts: sticking to plan without getting dragged into racing emotions 52:14 – The "ability to suffer": born with it + learned deeper over time 55:33 – Hard sessions nerves: nothing to lose vs race-day stakes 57:23 – Fueling shift: from "whatever felt right" to calculated carbs/sodium/fluid 59:47 – Recovery pillars: movement, boots, protein targets, sauna/ice baths 01:01:33 – Sleep & performance: 8+ hours, magnesium, investing in a great bed 01:03:21 – Filtering "1%ers": track it, keep it easy, avoid time-wasting noise 01:07:27 – What's next: 70.3 Worlds (Marbella) + Canary Islands camp + T100 Worlds (Qatar) 01:08:20 – Ellie's advice: stay disciplined, stay hungry, trust your instincts 01:08:49 – Listener challenge: 20 x 3 min tempo / 3 min endurance on the bike 01:10:14 – Episode close, credits, and sponsor reminder   THE TEAM: Join the The Physical Performance Show LEARNINGS membership through weekly podcasts  here: https://www.patreon.com/TPPShow Our goal is to get you back to your Physical Best.  Find out more about Telehealth Consultations and book online. Your Hosts:  🏃 Brad Beer - Instagram & X @Bradbeer and YouTube on @PogophysioAu   💪 Huw Darnell - Exercise Physiologist & Performance Coach : YouTube: ⁨@huwdarnell⁩ & Instagram @huwdarnell The Physical Performance Show can be found at:  Facebook: facebook.com/thephysicalperformanceshowpodcast X: @tppshow1  Instagram: @physicalperforamceshow Please direct any questions, comments, and feedback to the above social media handles.