Thriving as an Easily Injured Triathlete

TDP 368 - Thriving as an Easily Injured Triathlete

Carrie: Hey everybody, welcome to the show. Today is the collab episode between the TriDot Podcast and the RunDot Podcast — yay, we love collab episodes, we kind of call them the party episodes, all of our athletes together to hear the same talk on the same week. So I'm here, Olympian and your guide to RunDot, Carrie Tollefson, and Andrew is here from TriDot. Yay, hi Andrew.

Andrew: Hey, hey, always happy to podcast with you, Carrie — double the host, double the fun. We've been doing a series on the TriDot Podcast over the last month or so, where every week we talk about how to thrive in triathlon as a different type of triathlete. And for this week, I booked a guest to talk about how to thrive as an easily injured athlete, and I'm gonna raise my hand and say I am an easily injured athlete.

Carrie: Me too.

Andrew: So I thought to myself, you know what, our RunDot runners will probably benefit from this conversation, I invited Carrie to join me, and here we all are. It's gonna be a great episode.

Carrie: Yeah, even though we're talking about injuries, but we're gonna make it fun. And our guest today is Dr. BJ Leeper. BJ graduated from the University of Iowa Carver College of Medicine with a doctorate in physical therapy and rehabilitation science. He's the founder of LAB— Leeper Athletic Bio Performance — and specializes in comprehensive movement testing and injury prevention for athletes. Welcome to the show, BJ! Yay!

B.J.: Hey, thanks guys, glad to be here.

Carrie: That was a fun introduction, I must say.

Andrew: Yeah, and go follow the Leeper Lab on Instagram — BJ, I've been enjoying the posts you've been starting to put out. What's the handle?

B.J.: Yeah, it's been exciting — it's @Leeper_lab. We've been up for a little while now and just starting to get a little more traction. But it's one of those things that it's a blessing and curse to be an endurance athlete and unfortunately go through the rigors of training and often injuries. And it's funny, like our panel here, we've all kind of laid our cards out there, we've all probably experienced injuries to a certain level, and the reality is that a lot of athletes have, and so it's kind of a hot topic and something that's exciting to talk about and be a resource for people.

Andrew: Absolutely. And our goal today obviously is to help people be injured less by the wisdom you get from Dr. BJ Leeper. As always, we're gonna start off with a warm-up question, settle into our main set conversation with Dr. BJ Leeper, and then wind things down by asking him an audience question on the cooldown. Lots of good stuff, let's get to it.

For our warm-up question today, I have what I hope is a fun "would you rather" question that will apply to a triathlete and a runner. So, Carrie, BJ, between the three of us and our audience, I want to know — would you rather have free run shoes for the rest of your life, never pay for a pair of run shoes ever again; would you rather have endless stock in your pantry of your go-to gel, bar, calorie drink, whatever you use to fuel your endurance endeavors, free in your pantry, always there; or would you rather never pay a race entry fee ever again — every race you do from here on out is free for you. BJ, what's this answer for you?

B.J.: Well, it's funny 'cause I'd probably take the free shoes any day of the week, because in my background, I worked at a shoe store in high school and then I was a running shoe rep when I was working in Kansas City for a long time, so I always love a free pair of shoes. But then I was thinking about the free race entries — that's a big price tag, but I feel like if I wasn't financially committed, I may never race again. So maybe that's a tough thing, but I'd go free shoes.

Carrie: I agree. My process was, if I had free shoes, then I would want to have my gels and bars and calorie drinks and things like that, and then I would commit, because I have the equipment to get to the start line and the finish line. So I agree, free shoes.

Andrew: Okay, well I am going to zag where you guys zigged, if that works — I'm gonna zag. You know, the shoes were the one I thought of first too, right, 'cause one, it's always fun to get new running shoes, and we all need a couple all the time. But I think over the course of an annual year — I didn't run the numbers, but just off the top of my head — I think I actually spend a lot more money on the gels and electrolytes I use as opposed to shoes. You buy a couple good pairs of shoes per year, and yes you go through them and need more, but especially living here in Texas, I go through Precision Fuel and Hydration electrolyte capsules like nobody's business — I'm a salty sweater, so I burn through electrolytes like — there can be a training day where I don't have a big workout and I still pop a couple of those, because living in Texas, you just need them, being outside playing with the kids.

So I think I actually spend more on that, and it would just be nice to not — and I always feel like — I don't know, it's fun buying running shoes, so it's like, yes, I don't mind spending the money because they're fun to get, fun to come in, fun to put on my foot and know it's a new shoe. It's not as fun dropping a hundred to two hundred bucks on the credit card for a big box of my favorite gel — it's not as fun, it doesn't feel good having to do that. So I would rather open up my pantry and just have that stuff be there for free, and buy my shoes myself, pay for my races myself. That's my answer here.

We will throw this out to our audience and see — does everybody zig like you guys, or will anybody zag like me, or will anybody take door number three? Let us know if you're watching on YouTube or Spotify, drop a comment right in the comment box telling us what your answer is to this question. Otherwise, find us on the socials, and we'll put this question out in the I Am Triathlete Facebook group and on the social media accounts — let us know which of these three options would you rather have for free for the rest of your life?

Andrew: Now, BJ, I remember before I was working for TriDot RunDot, when I worked at a television network here locally in Dallas-Fort Worth, there was one coworker at the TV station who I found out was an ultra runner — she was a big trail runner, and I went and found her on Strava, followed her on Strava. And at the time, right, I'm balancing swim, bike, run, but at the time I was probably running five to six hundred miles a year alongside my swimming and cycling.

This girl Chelsea, who also worked at the television network with me and was an ultra runner, on Strava, she was logging 2,500 to 3,000 miles a year — and just like clockwork, every single day, a run in the morning, a run in the evening, it was like she was always on Strava running. And I never heard her ever talk about getting injured or having a nick or a niggle, whereas I constantly was feeling something in my body. And so I've always felt like there are athletes I know who just seem bulletproof, and then there's athletes like me who just always seem like something is hurting or bothering them. Is this anecdotal, is this just in my head, or is it actually a thing where some athletes are more prone to picking up injuries than others? What's the science say?

B.J.: Yeah, I mean, I don't think it's luck, but at the same time, everybody's born with a different genetic set of cards, right — and some maybe have a bigger window of what you might call adaptability. I think we all know people — I've got friends, when we're cycling, they can tell if their bike seat is off like one millimeter from their typical setup, it's like the princess and the pea. And then there's others that could ride a bike a hundred miles that's two sizes smaller than their normal bike fit and just be completely fine.

So I think there's naturally some — I don't know if you'd call it genetics or just natural predisposition — to having a wider adaptability platform. But realistically, a lot of us are coming to the table with different cards too. The biggest — we always say in the industry, the biggest predictor of future injury is previous injury. So if you've had a previous injury, we know the odds are higher that you will likely encounter another injury down the road, so we know that risk goes up. But regardless, we all have a threshold — it's just a matter of how hard we're driving that car. So some people might appear to be more bulletproof, but then I've also known a lot of these athletes that probably are a little bit more bulletproof than most, but they're running way past their threshold — they're right in the line of fire constantly, so they're also getting injured a lot of times. So it kind of depends again on previous predisposition based on previous injury, and also kind of how hard are you running that car.

Carrie: But I wanna know if RunDot and TriDot has a way to know if we are injury prone as athletes. Does our app kind of adjust to us? Do we need that coach-athlete relationship for the athlete to be able to help us adjust our RunDot or TriDot program? What do you think?

B.J.: Yeah, so I've had the privilege of working closely with the software development team for Predictive Fitness and the RunDot and TriDot products, and I know firsthand that the engine driving that training platform has an extensive fit-logic algorithm back end — it does an amazing job of normalizing training stress and calculating residual training stress, all these metrics that help guide the training and adjust. But the reality is that movement health is really hard to capture — there's not a great metric for it. We could talk about HRV and resting heart rate and things like this that might give indicators that you might be more stressed or running that red line, but movement is ultimately, I always say, the most critical metric and critical sign.

So as you work with a coach, or even as an athlete — nobody knows your body better than you, so I think you have to take into consideration those things you're feeling, and how it's manifesting itself in your movement, and how it looks, and either having a coach or a movement specialist to help consult with, to guide that part of it — because that's something, to this point, that no AI, no training platform really does a great job of yet. And the time's coming where I think that will be a feature of innovation, but right now, it's really critical to have a coach in your corner to help you with that side of it.

Carrie: I totally agree, because even when it comes to strength training, sometimes I want to just get in the gym and do squats and work on my legs and things, but my knee doesn't track like it used to. So for me to do a squat versus a press, I'm much better off doing a press than a squat, for some reason. And so things like that — that's not even on the run so much, it's just the other things where I would really like to be able to communicate with someone just to say, hey, what's an alternative, or maybe I lay off of the jog down a hill and walk down the hill when I'm doing hill repeats, to keep the pressure off that knee, all that stuff. It's so much better, I think, when you're able to talk to someone as well about what you're seeing and what you're feeling.

B.J.: Yeah, a hundred percent.

Andrew: BJ, the other thing that comes to mind for me within the apps is physiogenomics, right — and anybody who's been a long-time user of our app will probably know what that is, but you actually have to, if you have a genome file — if you've done a 23andMe or an Ancestry.com and you have a genome file, you can upload it to the app, and one of the metrics that's there in your genes is injury predisposition. And I know this because I've done it — and my injury predisposition is high. Yay me. Sweet — it's in my genetics that I am going to get more injured potentially than somebody else. Thank you, TriDot, for telling me that.

BJ, working with the software team, what are the things an athlete might see differently in the app based on what their physiogenomics says, if they've uploaded their genome file?

B.J.: Yeah, so just like you were referring to earlier, you're born with a set of genetic cards that you're coming to the table with, that you can't — but it's never a death sentence. I always tell people, there's maybe certain predispositions, but it all comes down to nature and nurture, and likely we know that both play a huge role. So you might have certain predispositions, but — to your point — the training software helps account for those things, and may not initially prescribe higher intensity, or with warm-up drills, higher plyometric-intensity drills for you specifically, because it knows you might need a longer runway to get there. And so you can get there over time, but just like we're saying, everybody's got a different threshold, and your threshold is trainable — it's just a matter of, can you hit it a little bit more spot-on early, and then as the system learns you and adapts to you, then you grow with it. But again, there's all kinds of individuals, everybody's got a different predisposition, but that doesn't mean you're certain to fall injury-prone and fall prey to it.

Andrew: So Dr. Leeper, in your experience, what are the more common injuries you see triathletes and runners dealing with?

B.J.: Yeah, so there's been a lot of research in this area, and actually a lot of the solid research goes back even twenty years, where it first started to uncover — and it might seem pretty intuitive, but we found that seventy-five percent — and I say we, as I'm part of the research community — but in general the research points to about seventy-five percent of injuries to runners and triathletes are overuse injuries. And out of that group of overuse injuries, seventy-five percent are in the lower extremities — so we're talking hip, knee, foot and ankle, lower leg. And it may not be a surprise, especially to triathletes, but seventy-five percent of those injuries are running-related. So we know that they're running —

Carrie: Stop it! Do not give us runners a bad name, Dr. Leeper. Knock it off.

Andrew: And that is why I invited the runners to this podcast episode — right there, that's why we're all together today.

B.J. Leeper: Exactly. And that's why, when we're talking about these things, more often than not, if you pull a crowd, three out of four people have likely succumbed to one of these injuries. And we see this a lot in the data with injuries related to endurance sports, and there's a lot of rationales as to why that might be the case, but for sure we know that the majority of them are overuse and lower limb.

Andrew: BJ, for you personally, do you have a couple of go-to spots on your body that you watch and monitor?

B.J.: Yeah, I mean for me, I kind of fall into this camp where I think a lot of endurance athletes fall — not just triathletes but runners alike — where there's kind of the three main mobility targets, and I'm a perfect example where I struggle: mid-back or thoracic spine mobility is lacking, hips — hip mobility is lacking — and then foot and ankle, or primarily ankle mobility, starts to get tied up.

For me personally, a lot of this is because sometimes I'm at a computer throughout the day, and my mid-back and hips get tight because I'm sitting a lot — that's a pretty common thing a lot of people face, just because we live in comfort society, a lot of us, so we're sitting a lot of times and we don't move like we used to, maybe when we used to chop wood, carry water, so to speak. So hips, thoracic spine, ankles — those are three common areas, and I'm guilty of them too.

Carrie: I think that's funny that you say that, because I find that it's not necessarily the run that gets me — yes, if I go out and try and do 200s with my daughter, I usually end up with a sore upper hamstring or a glute issue, but it's usually from standing at a track meet, or standing out at an event — it's not necessarily the run, or just being a good human being and not running, but it's more the standing, I feel like that's what gets me more hurt now than the actual movement.

Andrew: Along those lines, Carrie, right now one of the most sore things on my body currently is both shoulders. I've had over the years, from swimming — I forget which one, but one of my shoulders in particular would sometimes get sore in the pool, especially when I was training for a longer event and putting in some more meters — but holding our newborn baby all over the house, right, 'cause you're holding her like this, or you're holding her like this, and half the time you're holding her, you're feeding her a bottle, and all of that weight ends up right here in my shoulders. Literally this week I was like, why are my shoulders just so — it's being a good parent, being a loving parent.

Carrie: Can I just say though, do not ask your wife to give you a massage — she's had way too much going on, so just don't ask.

B.J.: Good tip, good tip.

Andrew: Yeah, got it.

Carrie: Suck it up right now, suck it up. Dr. Leeper, I want to know — what are the most common mistakes that we make in our training that lead to injury? You've already talked about overuse, but what does that really mean? Some people are like, well does that mean I'm running hundreds of miles in a week? No, not always — there's all kinds of different ways to get an overuse injury.

B.J.: Yeah, I think the biggest one — there's a couple big ones, but the biggest one I see with endurance athletes is they often try to address a movement problem with a fitness solution. They think by just going out and running, or swim-bike-run training, that's just gonna clear them because they're getting in shape, they're getting more fit, which is a great thing, but fitness doesn't always become the remedy to all those movement problems. So oftentimes endurance athletes assume quality in their movement, and then they pursue quantity — they're always chasing miles, they're chasing volume, but they assume they're coming to the table with good movement patterns or good mechanics, that they can just put all that fitness on function. But the reality is most of us are coming to the table with dysfunction, and when we load that, or just chase miles, we're typically just putting fitness on dysfunction — and then it's not a matter of if you blow up, it's just when.

Andrew: So BJ, there's not like a study for this, but just anecdotally, if ten age-group endurance athletes walked into the Leeper Lab tomorrow, what percentage of them would probably have some form of a poor movement pattern? How many of us are we talking about?

B.J.: You know, I would say it's pretty high — I mean, there is research to say you'd see fifty percent of the population, but I think it's much higher than that. So if you gave me ten, we'd probably — if you live in America, it's probably seven to eight out of the ten of you are coming to the party with some dysfunction. And that's just one of those things, because we tend — going back to that question — we tend to chase our problems with fitness solutions, but it's kind of like saying — and you see this a lot with endurance athletes — they require ibuprofen and foam rolling to get out the door to even get their workouts in. And if you get to that point where the only way you can accomplish your workouts is to hammer on your foam roller for five minutes and then pop some ibuprofen, you know that's not gonna last. It's kind of like somebody saying, I need to get better with my diet, and they're just searching for the best multivitamin, but every day they're going out to McDonald's. It's like, low-hanging fruit is your whole foods — just like we talk about with movement health, clear your movements before you just start chasing all these ancillary things that you think are quote-unquote recovery and going to help.

Carrie: Well, speaking of that, you just said recovery — I wanna know, when an athlete starts to feel something, when are you saying, okay, full stop, let's take a break, or we can move through it a little bit? I mean, it feels like times are changing a little bit — like one of my constant worries is I'm gonna get plantar fasciitis, my heels get fired up real quick, and I've been noticing that a lot of people are starting to — now obviously talk with your doctor and your physical therapist, but it seems that more medical professionals are saying, let's keep moving through some of these and not just totally take time off. What are your thoughts on that? When do we — talk us through it — when do you say, nope, stop, go see a doctor, or do you keep on moving, give it a couple more days? What are your thoughts there?

B.J.: Yeah, it kind of comes back to the old adage — are you hurt or are you injured? And we all know, as athletes that have trained and done different things with endurance training, naturally you break a muscle down, you're gonna get sore, right, and there's a natural soreness, stiffness that occurs with training if it's hitting you in the right way and actually progressing and building you. So there's that part of it that's normal — to kind of wake up, you have a few aches and pains.

My indicator, or my barometer, is usually — how is it affecting your fundamental movement patterns? We're talking about just functional movement, like squatting, stepping, lunging, balance with the upper quarter, push, pull, lift, carry — things that are just foundational movements, not running a 40 or bench pressing, just foundational things. If you're actually starting to fall down that slippery slope of dysfunction, and you can't move just in a normal way — it doesn't have to be perfect movement, but it just has to be what we call functional — then those are your biggest indicators. Because you might have some feelings of aches and pains, but if it's not really affecting your movement, we're okay to push through — like you said, Carrie, motion is lotion, sometimes that's the adage.

But then there's the other end of it, where you really have to pay attention to your body, because your movement footprint or fingerprint is actually deteriorating functionally, and it's not getting better through just a simple warm-up. I usually use three checkpoints — during activity, or after warming up and during activity, does your symptoms get worse, or do they clear? That's one checkpoint — if they're getting worse, obviously red flag. And then how do you feel — even if you felt good after warm-up, how do you feel later that day, after that session? And if you check good on that, great, green light, move on. But then, how do you feel the next morning after you wake up? Because it's one thing to be sore, but it's another thing to actually have that affect your movement to the point where you're no longer moving functionally. And that's a ticking time bomb, and that's where you have to raise the red flag and have it investigated. Because a lot of us are walking around with that check-engine light on, but we're just kind of ignoring it. But yes, you need to move, but let your movement show you then where you go from there — does it clear, or does it maintain and persist? And those persistent things are usually what you want to get checked out.

Carrie: And to piggyback off that, I think too, as athletes — say we're on the run and the run is what's bothering us, well then we switch to the bike, or we switch to an elliptical or an arc trainer or something. And I think for me, when I was running professionally, I just thought if I was cross-training, I was okay. But sometimes I would get off the elliptical and I would still be kind of limping around and it still bothered me. So you have to be, I think, real honest with yourself to say, is this activity that I'm doing leaving me with less pain, or the same pain, or more pain — that might not be that activity we're doing that's hurting us, because sometimes that cross-training isn't allowing us to heal either. So remember that just because you're doing a different activity doesn't necessarily mean you're healing at the same time.

B.J.: And that's a critical point, especially for triathletes, because the beauty of the sport is you have different disciplines and you can mix it up — if you do have to shut down your running for a period of time, hey, you've got the swim and the bike that you can still maintain progress on. But to your point, sometimes, if it's a movement pattern related to those types of things, you could think you're shutting it down because you're avoiding the impact, but you could just be persisting an issue and not really digging out at the root. So sometimes just cross-training isn't the only solution — again, that's the approach of just adding another fitness solution to try to fix the root cause, but sometimes you need to pull yourself even out of that, to assess the root cause. And then it might be fine to do that cross-training, but you still have to dig a little bit deeper, and not just say, well, I'm just not running, that's fine, I'm gonna move on — sometimes you have to really just dig to the root of and look at that fundamental movement.

Andrew: Yeah, BJ, at what point — that's super interesting — at what point do we say, okay, I'm feeling some pain in the run when I go out for a run, I don't feel it in the bike, but I also feel a little funny on the bike — at what point do we say, okay, I'm seeing this in one session, two sessions, three sessions, four sessions, I'm seeing this in one sport, two sports, strength workouts, day-to-day life — when do we say, okay, it's time to not only back off training, but it's time to actually see a specialist and/or doctor? When do you make that recommendation?

B.J.: Yeah, that's a great question, because it really is different for different people. But if it persists — it's almost like I use my car with a check-engine-light analogy — if that car check-engine light pops on and it's there for a little while but then it clears, you're like, well maybe it was just a glitch, but then if it keeps coming back — persistent symptoms are really the biggest indicator.

So usually I tell people, despite your best efforts to use the three-times check we talked about — during activity, later that night, the next morning — if you can check yes, that I feel that on all three of those counts, that's one indicator. But then the other indicator is like the three-day indicator — despite your best efforts to try to modify your training or do some corrective work, maybe you learned a few drills you think could help and you're trying those things — if your symptoms are persistent past the three-day mark, despite your best efforts to remedy that, that's when you'd want to pursue help. And ever — don't ever hesitate — if you're on that edge of when in doubt, we always say when in doubt, don't — meaning, when in doubt, don't just keep — it hurts when I hit my finger with a hammer, don't keep hitting it with the hammer, pursue that resource — it may be nothing, but it definitely could be something.

So it's really hard, but I would say, when in doubt, don't, and pursue a resource to help you.

Carrie: It's really hard to use common sense when we're all driven like we are, and we all just need some air — we just need to get out and get away for twenty minutes, you know, there's a lot of things — I think all of us just love a bike, for me it's my social time, I don't go out a lot, I don't go and do things besides go to kids' events right now or work, and so I love that short run that I get, and it's so important to me. But there are different things we can do to help support our body, help us get out the door, get in the pool, get on the bike, whatever — stretching, dynamic exercises, movement drills, all the things you've kind of been alluding to. What do you think is the most helpful way for us to continue to do what we love and to stay healthy?

B.J.: Yeah, and I think that's a great point, because there's the psychological element of getting out there and moving. So it's not always, if you're encountering some injury signs and those check-engine lights popping on, it's not an automatic "you need to train less." But a lot of it is, what are you focusing on in terms of management? If you're not doing anything different, and you're just maybe thinking, I just need to back off — the reality is that probably won't change your equation. Unless you're a super young individual where you haven't had much predisposition to dysfunction, maybe just shutting it down for a few days or minimizing your training intensity a little bit could help flip the switch, and then you get back online, so to speak.

But for most of us, if we just stop — and this is kind of my soapbox I get on with modern medicine — oftentimes we go to providers and they say, yeah, it's your foot, we're just gonna shut your foot down, here's a boot, or don't run for the next two weeks — but no prescription is actually given to dig out the root of what the predisposition might be that's causing it. So we just think by simply resting, we're gonna find the answer to our problems and it's just gonna naturally resolve itself, but the majority of the time that doesn't really do it. So then we get really frustrated, because we've shut ourselves down, we've been in the walking boot for four to six weeks, and then we come back, and it's not a matter of if it comes back, it's just when it comes back, because we really haven't changed our patterning. And that's when it gets really frustrating.

So I think the biggest thing, as far as managing things, is just really trying to make sure you're with a resource that can help you explore, and then make sure you're finding the right tool for you to help dig out that root, instead of just brushing it aside, or plucking the weed out at the flower where it just comes back automatically. Trying to find somebody who can help guide you, because there's all kinds of tools — we all talk about them all the time, with foam rollers, recovery boots, massage, all these recovery options, and everybody's always like, well what's the best one? And I always tell people, well the best one is the right one for you. It sounds like a cop-out answer, but you just need to find the right one for you and not waste time on all the other things. And the problem occurs a lot of times where people just don't explore any solution outside of just the fitness solution — and if the fitness solution isn't working, well maybe I just need to back down the fitness or stop training. But that doesn't always have to be the case, and that's hopefully encouraging for some people — that I don't have to give up my training altogether, but maybe instead of that sixty-minute run, maybe I just do thirty minutes, and before I do that thirty minutes, it's a little prep movement, priming movement, and corrective exercise strategies for the things that matter, and then my thirty minutes feels a lot better.

Andrew: Yeah, something I've learned, BJ, just from several episodes with you over the years, is that often — not all the time, but oftentimes — what's hurting is not the root cause of the hurt, right, like you just said. And so, just real quickly, to give people a concrete example of that in this conversation — I had a season where my left knee was really bothering me, particularly when I was running, and particularly when I was running up and down even slight inclines. So I went and saw an orthopedic specialist, they did some imaging, and what he found was my kneecap had — it was actually being pulled towards the outside of my knee, and thus rubbing against whatever connective tissue was there. And he was like, the reason that's happening is because your IT band, rubbing all the way up to your lower back, is all very tight all of the time. He gave me a series of things to do a couple times a day to help alleviate that, and as long as I do them, my left knee stays happy. But the issue wasn't caused by my knee — my knee is just where it was hurting, and it took going to a specialist to find what was the root cause of that knee hurting, whereas I just thought, my knee hurts, I need to give it a week off and then it should hopefully be fine. No, I had to do some things.

B.J.: Right. One of my favorite stories, real quick, that I love along those lines was an athlete we worked with in Kansas City — he was a big-league pitcher, pitched in the majors for several years, and he was working with a group of strength and conditioning coaches, and they were noticing he was having a hard time with his overhead squat and his catch, and his arm slot when he would deliver the ball — he was having issues with his shoulder. So they were exploring everything around the shoulder, and he was seeing specialists, they were cranking on his shoulder trying to figure out what's going on with this guy's shoulder.

They brought him into our group, and we did just a full movement screen, head to toe, looking at things, just looking for any low-hanging fruit they hadn't considered with this guy, because he'd seen a lot of specialists. And what we found — he was a right-handed pitcher — what we found is his left ankle was completely locked up as compared to his right ankle. And we cleared his left ankle mobility, and his arm slot issues with his shoulder completely went away. It was the most disconnected areas of the body you could imagine, but yet his pattern — it was more of a software issue for him. So when his left foot would hit the ground when he was in his delivery motion, his brain would sense that stiffness in his left ankle, and it would put on the parking brake for his entire body, and it would cause his right shoulder to become tight.

Andrew: Ankle to arm.

Carrie: Interesting.

B.J.: And it wasn't a mechanical issue, it wasn't a hardware issue, it was a software issue. But I always use that analogy or anecdote to share with people, because you may think it's the area where you hurt, but it could likely be somewhere completely unrelated, or not directly connected, that you might think is unrelated to that spot.

Carrie: So okay, because I am now visualizing the body — and correct me if I'm wrong — but doesn't your fascia sort of cross, so the right side connects to the left side and the left to the right? Is that right?

B.J.: Yeah. Your body was made in a creatively designed way that allows us to move like we move, and you've got fascial slings in the body that actually make movement as efficient as it can possibly be for a human being. And so those fascial envelopes all intertwine together to a certain amount, and you're right, they do have kind of these cross slings that allow us to be able to push and pull and lift and carry in more economically safe positions. So there's a lot of efficiencies within our body. But if there's something that breaks down, like I was saying earlier, it doesn't necessarily mean the body just comes back online without a little bit of encouragement, a little bit of help — and that's where resources like our group help people kind of explore and evaluate those things, to make sure that not only is your hardware looking okay, but your software is actually functioning properly too.

Carrie: So interesting. And that's why we need you.

Andrew: Hey BJ, I dare you, BJ, to quit your day job, start a punk rock garage band, and call yourselves the Fascial Slings. I dare you. I've never heard that term before — it sounds so punk rock, in a medical way.

B.J.: I like that. The Fascial Slings — yeah, that sounds hardcore.

Carrie: It's a good one. And how come I'm like diagnosing my husband right now? I'm like, maybe his left heel is because of his right shoulder — it's the opposite of that picture.

B.J.: Yeah, you just tell him when he gets home, hey honey, it's your fascial sling, trust me.

Carrie: Okay, I would say that — he'll be like, what sling?

Andrew: So BJ, to bring us off of fascial slings and back to our run sheet — hopefully most of our athletes watching today are healthy and training happily, and we've talked a lot about what to do if you are feeling injured, or what things to look out for, where injuries might occur, how often we get injured. But if an athlete, like me, who maybe gets injured from time to time and knows it — if they are happy and healthy right now, what are some things they can be doing in their day-to-day run training, their swim-bike-run training, their day-to-day fitness regimens? What can we be doing to hopefully remain healthy before it even goes askew?

B.J.: Yeah, I mean, that's great — a lot of people are feeling fine, and that's awesome, but I think we need to be proactive in our approaches, right? And I always think about the model of dentistry — I've mentioned it before on one of these podcasts — most of us that have dental coverage with our insurance, it covers a couple of prophylactic visits every year just to go in and check and make sure everything's looking okay. And it's funny, because in dentistry, as a patient, we never get upset that the dentist is looking at every single tooth we have and looking at our entire set of teeth — we're never like, hey doc, why are you checking out all my teeth, these are my main teeth I'm chomping with. But it's funny, because in the musculoskeletal world, we don't often pursue things that way — number one, we don't even pursue someone to help us evaluate our movement until there's a problem. But even when we do go in when there is a problem, we sometimes would raise an eyebrow at a provider that might be asking to check our ankle when our issue is on our shoulder, right — but the reality is we need to explore all those things.

So to your point, if you are an athlete right now that's feeling pretty good and training without too much issue, that's great, but I think the main thing is make sure you've got a flow that you can go through, or a way or standard operating procedure that you can evaluate how you're moving from head to toe. Because as runners especially, and as even triathletes, even though we're mixing up with different disciplines, we all know — I would say it's like hoarders of movement, we tend to hoard just a certain pattern. And you envision this person that hoards things, and you go into their house and they've just got certain wear patterns through their house of where they only move, and meanwhile all the trash and junk piles up in the corners.

So really where I'm going is, you need to take opportunities to explore the junk in your corners, or potential junk in your corners. And if you're clearing those things — like for some athletes, they love to do that through the flows of yoga, and they pursue kind of uncovering those areas or checking those boxes through pursuing that as their way to evaluate how they move, outside of just going out for a run or going out for a ride. So I just encourage people to have some procedure, and if you don't know what that could look like for you, or what it should look like for you, that's when you'd want to pursue a professional who could help guide you in that.

Carrie: But how do you help an athlete as a coach — like just an everyday workout, before they're even seeing somebody in the medical world — how do you kind of coach an athlete to stay healthy, stay on top of it, to make sure that they look at their injury past and see what's going on there?

B.J.: Yeah, I think the biggest thing is exactly what you said — getting a history on where that athlete has been and what they might be somewhat predisposed to. But then also, in natural conversation of communicating with that athlete — how are they sleeping, how are they moving, just living life, are they having shoulder issues when they hold their babies all night — things like that, that you start to pick up on, in addition to just looking at their training data, where you're like, okay, there's some things I'm noticing.

And just having a few simple things you can take them through — can you touch your toes, can you squat rock-bottom, butt to heels, without letting your heels come off the floor — do these things make you feel like you're gonna pop, or do they feel like, yeah, after I do a few, I clear and it's no big deal. So there's certain things like that you can easily pick up on, even as a coach, not having to have a medical background, just to say, hey, are we noticing any changes in your daily living, just simply as a result of your training intensity ramping up a little bit?

Carrie: I wanna try it right now to see if I can do a squat all the way down with my heels touching the ground. Can you do it, Andrew? I'm doing it right now — I'm gonna see if I can do it right now, ready? I can do it! I did it! Yay, okay, good, good.

Andrew: That is a movement pattern I think I can do. Yeah, I got that one, I got that one. Don't ask me to do very many more of BJ's movement patterns, but I can pass that one.

Carrie: Or those ones where you're supposed to cross your legs and stand up, you know, those things — those ones are hard. You need to be there because you're the youngest on this call right now.

Andrew: I'm out — that's a no, that's a huge no for me. We're on the floor all the time with our kids and we feel it, we feel it.

Carrie: There you go, there you go. And also, can I just mention — after we've been chatting today, that there is a certain time sometimes in life, and I'm looking at you, Andrew, because you are in this young stage of being a young parent, and you are so busy, that adding to your physical load of trying to get out the door and working out, then doing strengthening and dynamic movement, it gets overwhelming. Sometimes we all just need to remember there are phases of life where we are gonna have more time to do that eventually, but right now you're in the thick of it, and be thankful that you have those sore shoulders — you will be able to go and find Dr. Leeper and all of his people, it's just a moment sometimes. And unless you're getting paid to be a professional athlete right now, sometimes we have to just be a little bit kinder to ourselves and realize a day off here and there is okay.

Andrew: Yeah, I've never been more stiff in my body, head to toe, than I am right now — that's a fact. And guess what, because of that, I know I'm not gonna go down to a local sprint triathlon and set a PR. And that's okay, right — I can go finish and participate, but those PR days are hopefully a couple years ahead of me and not right now.

Carrie: Sorry, I thought we already did it, let me see. Okay, all right. So Dr. Leeper, we are getting close to the end here, we're on our final lap. So let's put today's conversation into practice — tell us a time when you've coached an athlete who is more injury prone, and what did the two of you do, as coach and athlete, to set the athlete up for success?

B.J.: Yeah, there's been a lot, right — a lot of us have come to the table with feeling a lot of brokenness and having issues. One that stands out, just recently even, was a younger individual, great athlete — he was a powerlifter, and he was getting into running, and he was really getting the itch, and had started doing half marathons, was pursuing longer distances, but he was getting blown up consistently with shin splints — he was just having chronic shin splints on both legs, and really frustrated, not sure what to do. He had chased orthotics, he had chased new shoes, and really couldn't find a solution, and was almost ready to just give up on the running altogether.

So we were just working virtually together — I had him do some simple patterns to clear his ankles, and he found that he had a lot of tension through his calves. We gave him some simple correctives to just clear some of that — what we call tissue extensibility dysfunction, just his tightness he was fighting — gave him some simple tricks to clear it, and it was within a couple weeks he got his running back. It was crazy, because he had been down this road of feeling defeated, chronic pain, and really not thinking he would get back into the running he was really growing to love. And I always tell athletes, sometimes you don't know what you don't know — so for me it was really easy to walk him through and guide him into some simple correctives, but he had no idea to even check that box.

For him, it really was eye-opening, and now he's empowered, because he can also assess himself and know how he's tracking, come back to that himself to know — he doesn't need, you know, a physical therapist watching him to say, hey, that looks like junk — he knows the checkpoints for that, and knows if he's getting tight, what he needs to do to clear it. So that was really an encouraging session with this guy, working through that and being able to help him just do what I do day to day, but for someone like him, going from feeling devastated to feeling like he had his life back was pretty cool.

Andrew: Well, what I love about that too, BJ, is it's so easy these days — and shin splints is such a good example, right, so many people face that affliction in their day-to-day running — and so they go to the internet and Google, how do I get rid of shin splints, and they're gonna see blog articles from fitness influencers, they're gonna see social media reels, they're gonna see Reddit and Facebook threads, forum threads, and people are gonna give their two cents on, this worked for me, that worked for me, this didn't, that didn't, try this, try that. There's so much power in somebody actually being a professional at something, right — and it is your profession, and it is other physical therapists like you, orthopedic specialists — their profession is treating an athlete properly, right.

So this is an example of an athlete who is facing something many people face, and many people just take shots in the dark of, what at-home remedy is going to solve this? And working with a professional like yourself, he was able to solve it, and I absolutely love that.

And you actually, BJ, right now — you've worked for Predictive Fitness for a number of years, but with the Leeper Lab, you are starting to do virtual consultations with athletes, to be the professional that helps us thwart whatever we're going through and troubleshoot whatever we're going through — for our listeners, both our runners and our triathletes, how can they work with you directly if they want to plug into the Leeper Lab, get a virtual consultation, and have you specifically help them figure some stuff out?

B.J.: Yeah, no, and it's been a really fun endeavor. It's funny, because I've been with the Predictive Fitness family for so long, and working closely with the TriDot and RunDot teams, and it's funny, even over the last five years, I can honestly say there probably hasn't been a week that's gone by where I haven't gotten a question from an internal team member — especially as our group has grown — whether it's them themselves or a family member of theirs, where they just reach out wanting to have another set of eyes, or just somebody to bounce some ideas or questions off of.

Andrew: I try not to — I try not to, because I don't wanna abuse my friendship with you, like, BJ, can you screen my shoulders, help fix my shoulders.

Carrie: Can you fix me? Fix me.

B.J.: I know, I'm not gonna name names, but Andrew's definitely been one. And I love it. And so it finally came to a point where I wanted to be a resource for people, because one of my biggest mantras has been for a long time that you matter, and you have what it takes. Because within the realm of what I do in physical therapy, a lot of people are coming to the table broken, and they feel like their bodies are broken, and they're kind of feeling hopeless — and let alone maybe they've gone and sought out help, and looked for a provider to give them some direction. But in our society today, unfortunately, our medical system is flawed in a lot of places, and people don't have the time, or don't take the time, to listen.

So a lot of what I wanted to be able to offer is just a platform for people to ask questions and just take the time to listen to their stories and what they've been dealing with, and help them get to that place — like I was sharing that story before, of they felt defeated, but their bodies weren't broken — and getting people to that place. So we started the lab, LAB — Leeper Athletic Bioperformance — and you can search it online, it's LeeperBioperformance.com. We've got a great virtual platform, we do one-on-one video consultations and just take some time to help people, guide them, and help point them to the resources they need — more specific resources to help them out. So yeah, I love what I do, and it's pretty cool to be in the camp working with a lot of the coaches in the TriDot and RunDot communities.

Carrie: That is so cool, I love it.

Well, it's time for the cooldown — I think most people, this is the favorite part of their workout, but some people really do not love the cooldown. I do, because we have a really good question. This question today is coming from our audience — Benji from Calgary, this is a long ways away from me here in Minnesota, but I know they sound a little bit like us Minnesotans there. He says: "I saw a YouTube video from a run influencer showing his daily foot stretching routine. I do my run warm-ups and typical strength and body maintenance stuff, but have never done something specifically for my feet. Is this helpful, or is it just another influencer looking for content?"

Andrew: Yeah, good one.

B.J.: Probably just an influencer looking for content — no. It's honestly one of those things where just because an influencer recommends it, it doesn't necessarily mean, or automatically mean, that you need to add foot stretching — it really kind of depends on what you're coming to the table with. Somebody that's already got a very hypermobile foot, the last thing they probably need to do is just be over-stretching an area that's already hypermobile.

But I do happen to think the feet are often overlooked, and a lot of people do benefit from more focused foot mobility work. And to be quite honest, a lot of endurance athletes — we've got this fancy tech, we've got these amazing shoes nowadays, and there's some people that never set foot outside without, you know, forty millimeters of cushion under their feet —

Andrew: Carrie —

Carrie: That would be me.

B.J.: — and that interface, where the foot meets the ground — there's so much rich sensory input, and so much benefit to being out in nature barefoot and doing different things like that, whether it's foot stretching, foot mobility drills, different things — to just again explore that area of the house that doesn't often get explored. So I would say that likely people would benefit from exploring some of that, but just because an influencer is mentioning it online doesn't mean you need to add it to the arsenal — it's only needed to be added if it really needs to be added for you, right?