EP24: Why telling runners to stop running often backfires with Ben Lombard

Jimmy: Welcome to the Physio Insights podcast presented by Runeasi. I’ll be your host, doctor Jimmy Picard. I’m a physical therapist, running coach, and team member here at Runeasi. On this show, we have real conversations with leading experts digging into how we recover from injuries, train smarter, and use data to better guide care. Whether you’re a clinician, coach, or an athlete, we’re here to explore what really matters in rehab and performance.

Let’s dive in.

Jimmy: Ben Lombard, welcome to the Physio Insights podcast. How’s your day going?

Ben: Good. Thank you so much for having me. Busy day in clinic, but excited to have a chat. So we’re really glad that we can make the time work.

Jimmy: Yeah. As was I. And you came on my radar from the Runeasi team. You’ve been using Runeasi for a little bit, so I’m sure it will come up in the podcast. But before we go down that rabbit hole, tell me a bit about yourself.

Tell the listeners about yourself. How’d you get into physio?

Ben: Yeah. So I’m a physiotherapist based in North London. I’ve been a physio for about ten years. I got into physio kind of a classic group, I think. You know, I had an injury as

Jimmy: a child. I played a lot

Ben: of sport growing up, and I actually went to see a sports therapist and did the whole sort of rehab thing. And at the end of that, I remember just being quite sort of enamored with sort of how he got me back from what I felt was kind of debilitating at the time to sort of normal sport and action. And at the end of my treatment course with him, I asked him, you know, how do I do what you do? And he decided, he said to me that, you know, actually, the traditional route is physiotherapy. So go to university, study physiotherapy, and then specialize in something like sports injuries like he did.

You know, this is maybe fifteen or even nearly twenty years ago, where was a sports therapist, and they weren’t so common in The UK at the time. And he advised me that actually if you wanted to be a sort of like a more recognized person within the sort of fitness and wellness space, physiotherapy would be the route to do. And so I did that. And I graduated in 2016 and then worked at a couple of different clinics in London before starting on my own in 2019.

Jimmy: Awesome. Yeah. So ten years ago, you graduated.

Ben: Yeah.

Jimmy: A decade has passed. I imagine a lot has changed in the way that you practice or how you think about treating patients.

Ben: Yeah. I think actually the whole space has moved on so much in that time. I think people recognize what physiotherapists can do a lot more, and sort of are more willing to sort of self refer. And I think actually, generally, practice, yeah, I’ve always been very exercise prescription and exercise based, but that has become more and more popular, especially over the last sort of four or five years. Now you’re seeing so much crossover between sort of strength and conditioning coaches, PTs, physios.

And I think that I’ve taken a lot of that into my practice, and actually, especially the more that I have niched down into sort of dealing with runners specifically, and the sort of need for strength training to supplement and to sort of complement the running that people do. And actually, in terms of rehab goals, Brad, we’ve moved on a lot from those sort of basic three sets of 10 reps with your bands, and now getting people loaded much more. I’m assuming that’s definitely changed a lot about my practice.

Jimmy: Yeah. So earlier, or before that awareness switched shifted to more exercise focused, How, what did it look like before?

Ben: I think it looked easier. Know, there would be, there’d be maybe a bit more manual therapy stuff. Obviously, like the assessment diagnostic skills, you really develop that over a long period of time. And I’ve always, as I say, I’ve always been size prescriptive, but I think that maybe I shied away from the sort of higher end work rehab stuff. And, you know, I sort of saw myself more as a bridge between.

So like, you know, identifying someone’s problem, helping them understand it, beginning their journey of rehabilitation, and then sort of shuttling them through towards someone else to take on the sort of higher end rehab. And that sort of came because one of the places that I worked, we sort of had that facility within the clinic. You know, we had physio, we had osteopath, we had a couple of other bits and pieces, force massage. We also had like a rehab person, and we sort of worked a little it’s like through flow, you know, you kind of like, you see your physio, you kind of understand and get get the journey started, and then you sort of effectively graduate onto those sort of harder things. And whereas now it’s much physios now and maybe, you know, over the last sort of five or six years have really begun to take on a lot more of that.

Jimmy: I see that in The US as well, where when I was a student, I can remember one of the clinics I worked at had what they called like post rehab. And it was as soon as the patient got a little bit better and you could move them on and they left physical therapy and they went to post rehab. And that’s where they got to do all the fun stuff. We had to deal with all the hard part and then the fun stuff they got to go do with the SNC coach or the athletic trainer.

Ben: Definitely. I also think some of that was actually slightly intentional by the owner of the clinic. You know, I think the idea was there wasn’t many of us at the clinic, and we were quite busy. It was trying to get as many people through as possible. So, you know, I think some in their mind, a little bit was, you know, why would we spend the additional time getting the patient above and beyond with you when you could you’re potentially better for the business to bring in more money if you are sort of assessing the patients and then distributing them on, almost kind of like, you know, here’s your physio, this is your consultation, and then triage them to sort of what they need, maybe some soft tissue work, maybe, you know, some physio with you then on to the higher end stuff.

Jimmy: Was this one of the reasons that pushed you to start your own practice?

Ben: Yeah, big time. When I worked within the clinic, you could sort of see you could sort of see the business side of it a bit more, and I think that detracts a little bit from what you feel like in terms of your autonomy for what you feel like you can do as a physio. I felt that I just had more that I wanted to do with my patients. So that’s what led me to be to take the step towards working on my, you know, working on my own terms. So, you know, I could see the patient as many times as I wanted to, and I could then get a bit more involved with the sort of actual return to sport and the the sort of progression from there.

Jimmy: Would you describe your practice style as like all the way from injury to full performance, that whole spectrum?

Ben: That’s the aim. Yeah. I I like to pick up someone who’s injured. I like to nurse them back to sort of full health and then sort of if I can tack on to that, some sort of performance goal, that’s that’s what I really enjoy. And that is something that I particularly enjoy with runners.

Right? And I think that it’s something that you often see someone who’s been dealing with a stubborn injury, and you help them over the injury, and you get them back into running, then, you know, they decide to start training for a race. So they might, you know, it might help them with some coaching, and you’d certainly help them rehab to sort of facilitate the training that they’re doing right the way throughout to race day. I I love that sort of whole journey. It’s like almost like the element of task completion.

And I think in a lot of jobs and a lot of facets of life, you don’t get the task completion. So I think for me, I I like to complete the circle.

Jimmy: I’m just curious. How what made you niche down with runners?

Ben: Running became something that I was personally enjoying. So I mean, I used to work in London right in the city. So I used to see a wide variety of patients. And you would see some runners, but you’d see a lot of sort of like desk based work and a lot of gym goers. But actually, I got into running myself, and you kind of it’s a fairly small circle, especially a while ago.

It’s grown enormously now. But, you know, once you start doing some running, maybe you go to the odd run club here and there. You know, you chat to people, say you’re a physio, you know, see one runner, then they send you a few. And it just started to sort of it was quite like a natural evolution. And, you know, my caseload just became more and more running focused.

And I went on a couple of CPD courses, one really good one by Tom Goom. I did his running repairs course in like 2018, maybe, or 2016, 2017, maybe. And I really, really enjoyed that, and then just was able to combine my passion for the sports and, like, seeing more runners. And I think there’s a little bit of almost like social proof. I think people quite like the fact that I was a runner as well.

And and I and it just became you just start picking up more and more referrals, and I just kind of went head first into it.

Jimmy: Yeah. So I was gonna bring this up later, but since we’re on this topic, you’re a runner yourself. You’ve built a business around treating runners. Do you feel like it’s necessary to be a runner to treat runners well?

Ben: No. You absolutely don’t need to be a runner to treat runners well. And there’s loads of examples of non runners who are fantastic at dealing with runners. But what I will say is that I think it gives a little bit of added context and understanding to what your runner is feeling, the demands of the sport, whether it’s training sessions, whether it’s injuries per se, whether it’s like races having completed marathon blocks or five k blocks, like and I think that is actually quite comforting for the patient. It’s not something that I think makes me better.

I think my patients, they like the fact that I am able to empathize and understand. But you don’t need to be a runner to have an understanding of how the biomechanics works and to understand training principles and all of those things that many non runners runners do for sure. But I would say that because I have done so much running and done it to a fairly high level, I definitely think it’s given me a deeper understanding of how to manage a runner, you know, understanding a bit more about this type of strength training and the intensity they need to be doing or, you know, whether they’ve got a certain goal and how realistic that is and ambition versus reality. Reality. And, you know, even I think it contextualizes a little bit more that sort of, like, load versus capacity.

Like, I know what it’s like to run a marathon. I know what it’s like to a certain time and progress to a certain time. You know, I ran the two thirty nine in Milan this year, but that certainly wasn’t my first marathon. So I understand what it’s what it feels like to progress, and I think that has been enormously beneficial. You know, we’ve just gone through the spring marathon block and treating hundreds of runners since the start of the year.

I do think has helped me, but I don’t think you have to be a runner to to be an excellent running physio.

Jimmy: Yeah. That’s they’re all good points. And I think you look at some coaches just across different sports. It’s like, you see great coaches that didn’t participate in the sport. I think if you look at Bill Bowerman back in the day was an incredible coach, but I don’t I think he was a football player growing up.

He never even ran. Yeah.

Ben: Yeah. Yeah.

Jimmy: But it does help though is what I hear you saying. It helps add context to understanding the training demands, how they’re loading their body. I’m sure it helps with buy in. And you’re asking if you you mentioned this injury to performance spectrum and getting your patients back with heavier load and stuff. I’m sure it helps with

Ben: You’re able to empathize. I think, you know, running becomes a bit of a when you self identify as a runner, right, you know, it becomes a bit of a part of your identity and, you know, your social group, and and it’s, you know, part of the thing that makes you you. I think a lot of people who have come from someone, maybe they’ve come for a second opinion or they’ve ended up on in my clinic room, you know, telling someone who loves running not to run can be quite damaging for their sense of self worth and all these things. And when you understand a little bit more about the demands of the sport, you often find that it’s not no running. No running doesn’t always help.

No running is not always the answer. Sure. You know, if you have something that requires complete rest, you know, maybe it’s a bone stress injury or something like that, then, yeah, there’s no running. But I think that if you don’t understand the sport from that sort of perspective, it can be quite hard to prescribe the right amount of running.

Jimmy: Mhmm.

Ben: But not that you can’t, but I I think it becomes a little bit more easy to be able to under to to give an amount of running that helps the runner still feel like they’re not losing that part of their identity, but also not getting in their own way?

Jimmy: Yeah. So I think maybe like a decade ago or fifteen years ago when I first got into PT, you used to see all these patients that were just straight up told they need to stop running. Felt like it was a very common thing you would see runners being told in your clinical practice. Let’s say like, how often are you telling a patient like, we need to shut this down completely and you’re not allowed to run?

Ben: I would never tell them that they can never run again. Maybe that’s a fault on my end, you know. I’m firm believer that graded exposure works, and finding the optimal load I think is part of the challenge and part of the fun. But I do also think it’s really important to know when to stop, right? Like, you know, pushing through someone’s pain because they love running, you know, that’s them getting in their own way.

So I don’t often tell someone that they can never run. But you know, if I think of sort of clinical example that I’ve got at the moment, you know, I’ve got a guy who has a really, really painful and bad bunion, you know, that he’s been dealing with for years and years, hasn’t really ever done anything about it. And, you know, his routine is that sort of Saturday park run. He loves it. It’s a part of his, like, life and his joy.

But, you know, he just he can’t do it at the moment because it’s just causing him pain. And, you know, I’ve obviously given him lots of things that he needs to do for his rehab, and we’ve tried sort of redistributing the load with different footwear and, know, more of a rocker and various other bits and pieces. So like, I’ll always trial it. I’ll always say, look, you know, maybe we think more of a run more strategy or, you know, things like that, or maybe doing one of the loops instead of all of it, so you can still participate in the event. But, yeah, I I would rarely tell someone that they can’t, but obviously, I I also am open minded to the fact that, like, I don’t wanna get them don’t wanna allow them to get in their own way.

And when it needs to be pulled back, that’s when your cross training really comes into play.

Jimmy: Awesome. Yeah. So a lot different than what the runners used to experience, yeah, like I said, a decade ago.

Ben: The runner pass, the GP tells you that, you know, running is bad for your knees.

Jimmy: So off air, you and I talked a little bit about your clinical philosophy, and one of the words that got around was the the biopsychosocial model. Would you mind diving into what what that means for you in practice as you’re working with a runner?

Ben: Yeah. So I I think that running injuries are much more than the injury themself, especially in the context of a runner, and there’s lots that we can dive into there. But, you know, with the biological aspects, you know, you have the tissue issue. So, you know, that’s where you’re looking really at that sort of load capacity issue, looking back through the training, understanding a little bit more about, you know, the training errors that potentially have come into play, you know, how they train, the strength training that they do or don’t do, giving them a bit of understanding of, you know, how tissue capacity works and helping them to understand a little bit more about, you know, the actual impact that running puts through the body in terms of, you know, joint specific and area specific. That’s the sort of like the kind of classic MSK approach, you know, this is the thing that we need to rehab.

But that is not very holistic. You know, it doesn’t you can’t it’s not always a case of dealing with just the physical problem that they’re presenting with. And actually, interestingly, more and more I see the connection between the sort of psychological and the social elements that have a massive impact on how that person is perceiving their pain. And, you know, from the psychological aspects, there’s lots of sort of like fear avoidance and, you know, not wanting to use the thing that’s injured, and, you know, the effect that sort of not running can have on your mental health. And, you know, as I say, people will often self identify as runners, you know, maybe it’s part of their identity, it’s their routine, it’s what how they use for stress relief and all those sorts of things.

And I think all of that really needs to be considered. And then also, you’ve got this other social element, like of, you know, the stress that you have at home and the run clubs that you might go to and the social impact of it, and like the fear of missing out. I think it can often really catastrophize and exacerbate a lot of problems. And I see it a lot with marathons often when people are raising money for charity. You know, they might have a cause that’s really close to their heart.

And I had a couple this year. And one in particular, she’d missed London Marathon in 2023 or 2024 due to injury. She’d missed it again in 2025 due to the same injury. And this time around when she started training blocked, same injury had come back, and the physio she was seeing at the time referred her to see me and actually, like, unpacking. Yes.

She had a problem, the biological issue that we needed to fix. She had patella for moral pain, and there were, you know, I put her through the Runeasi tech, there were things that she needed to work on objectively, which we definitely did. But there was also a huge element of I’ve missed the last two marathons. I’ve I’ve done this this this same thing has happened again and again, and the catastrophizing that has happened because of that. She also happens to be raising money for a charity that meant a lot to her, which, you know, she lost her brother, and she was raising money for that charity.

They were relying on her and counting on her to sort of get through this and raise the cash. And that extra pressure and stress was so involved with her pain. And actually, once we had sort of identified that and sort of unpacked that a little bit and removed some of this sort of, like, pressure off of herself and fear and, you know, was able to prove to her that her tissues were more tolerant. She was able to do more running. I think she’d only got up to maybe sort of 17 or 18 kilometers over the past blocks before having to fall out because of injury.

Getting past that 20 k, 25 k, 28 k mark was allowing each time was sort of like green lighting, oh, I can do this. And then she’d get a bit more sort of like stress relief, and she can do the next bit. And it was not only about looking at increasing the tissue capacity, which is obviously a huge part of it, but there were just more factors at play. And I I think that is something that I see a lot with runners.

Jimmy: Yes. What I hear you saying is it’s not one or the other. It’s all of it. It’s both.

Ben: We you have your physical body, but, know, above your physical body, you have your brain and your nervous system. You know, you can’t feel anything without your nervous system. You can’t move anything without your brain producing the movement. So it seems nonsensical to me to to disregard one.

Jimmy: What what do you feel like is more common? Do people miss the biomechanics, or do they miss the psychosocial component?

Ben: I say it’s fiftyfifty. It’s really hard. That’s a really good question. It’s hard to give you a hard answer. I think when people miss the biomechanics is because I think they have misunderstood the demands of the sport and they have missed things.

Actually, sometimes just quite basic. Maybe it’s like a load management issue that they haven’t quite managed to manage the load and and the mismatch between just like strength training and impact. Right? Like, you can be really strong concentrically, but not very reactive. And, you know, you may have a repetitive calf sprain.

The calf may be able to produce lots of power, but it might not be able to produce it very quickly or to be very reactive. And I think so I think that sort of stuff does get missed and maybe misdiagnosed, you get the occasional thing there. But I think that the psychosocial stuff is missed quite a lot just because it’s not really within the physio worldview. So you asked me how my practice has changed over the last ten years, and with regards to how I treat patients, and even more so over the last two or three years, that element of the psychosocial has become more and more important in my practice, I think.

Jimmy: And the way you described it working with that marathoner is kind of that graded exposure back to running, but then almost like showing her through experience, allowing her to see that her body is tolerating things okay. So you’re almost reassuring her along the way, lot of reassurance. Is that is that a good word for it?

Ben: I I’ve kinda tell them that it’s like green lighting. You know, you’re green lighting that you can do this. You know, once you’ve run five, then you once you’ve run six, once you’ve run seven, like, that graded ex but you can call it what you like, progressive overload graded degraded exposure. But I think that really is understandable from a tissue capacity.

Jimmy: Yeah. You’re almost you’re almost going back into the biology biological bucket and pulling something out of there to show proof that they’re getting better that they can keep confronting things.

Ben: Absolutely. Yeah.

Jimmy: You brought up Runeasi, so like where does tech or things like that come into play to help with that reassurance or validation or whatever?

Ben: Validation is a really good, a really good place to start. You know, someone says, you know, my right knee’s sore. So, you know, you might get them on the treadmill and, know, put them with the belt on or you might get them on the doing one of the jump tests and you see the diminished score on that side. I think, you know, sometimes they see that, and they go, okay, I can understand there’s there’s a weakness there. There’s a deficit on that side.

And it gives them some sort of, like, tangible marker that needs to increase. And I think there, you know, it’s there for with validation, and that it really helps with buy in. You know, if you give someone I always say to people that exercise needs a purpose or your rehab needs a purpose. And, you know, you can, under the bucket of strength training, you know, you’ve got force production, rate of force production, reactive explosive stability, all of these eccentric, all these different types of strength that you can build and power. And I think having markers for making objective markers where they can see that they can improve those helps buy in an adherence, and also then feeds into that sort of psychological element of, you know, being proud of myself.

I’ve achieved that thing. Awesome. What’s next? That sort of proof.

Jimmy: I just love how it’s all, like, interconnected here. It’s not one piece. It’s all of this stuff blended together and using certain aspects to influence the other. Yeah, definitely that. I was going to ask, so when clinically for you as you went through this journey ten years ago to now, I guess what made you switch gears and start approaching it more with this biopsychosocial approach?

Ben: Interesting. I think when you work with a lot of people and you meet as many people as you and I do, you people fit into kind of categories. Right? You know, you’ve got people who are very nervous and very quiet, and people are very, like, outspoken, and and you meet so many different types of personality. And I think that there is couple of types of personality that require more than just the physical side of your attention.

There are a couple of personalities who are very much like, yeah, give me the exercises. Let’s go. But you also get a little there’s a small subsection of what it’s it’s a growing subsection of people who are a little bit more sort of nervous and anxious about their pain and their symptoms and helping them to understand that that’s involved. It’s just something that I had seen quite a lot and was just interested in. And, you know, social media being so good these days, these things pop up all the time, and you start to almost pull on a thread.

You you you hear something, you watch something, go, that’s quite interesting. I I see that in practice. And you start to read around an area, and, you know, you start to follow some good people in the space. And I think that that’s where my sort of interest comes came from initially. And then I had my own personal experience of it really, really interestingly this year in the sense that last year, I trained for Manchester Marathon and unfortunately injured myself eight days out, overtraining and No.

Drinks classic. And then when I one year later, I’d guide gone to train for Milan as I did. About ten days before my race, I did my last session. And that evening, I was having dinner, and the same problem started to appear on my other hip. And it was it was absolutely mental because I’ve just done a session.

There was no pain during, nothing after, but I could just feel this, like, very small background noise in my left hip, and it instantly reminded me of what happened to to my right hip the year before. And, you know, I I kind of was able to ignore it for about five minutes. I was like, oh, that’s strange. But then it just it catastrophized so badly, so quickly that I had convinced myself that I had done the same problem. Was gonna miss my race and that kind of classic maranoia.

Right? I was paranoid that I’d really done the same problem. I was gonna miss the same thing again. And, you know, the whole being a physio and an injured physio and how it’s bad luck, it looks bad for business, all this all these things pop into your head, the frustration having put in all this time and effort into the training block. And, you know, so I I kind of had to sit with it.

I was traveling to Rome, and I and I did that and traveled to Milan. You know, even so, you know, I told my wife that the night before the race is like, don’t come and watch me from the start line because I’m not sure I’m gonna get very far in. I’m gonna just go and see. So I walked to the start line. I had to jog across the road because there was a tram coming, and I was like, I feel my hip.

So then I sat down in the pen. Everyone was warming up around me, and I was just like, this is gonna go badly. Gun goes off, and I didn’t feel a thing.

Jimmy: Amazing. Like, Like, you know, I I felt

Ben: I was checking it for the first kilometer, and it was like, is it there? Is it there? Is it there? And then just went. And my hip that hip felt better than my other hip.

After the race, during the race, they it was like, it’s not that pain was in my head. There clearly was a problem, but the problem was smaller and I catastrophized it. You know? And there’s also understanding that, you know, during your training block, your cortisol is really high, and it has an inhibitory effect on sort of what you feel. So then you enter your taper and and your the training stress reduces quite a lot.

And, you know, your cortisol as a result begins to reduce, and you start to notice lots more things that are going on. And you become acutely aware and you sort of check, and you scan your body. How’s this feeling? How’s that feeling? So that personal experience has only strengthened my firm belief in the sort of treat the person as a whole.

Jimmy: Yeah. Guess I there’s a lot to unpack there. But two things that I want to talk about is one, that personal experience that you just described has got to have like a tremendous effect on how you treat patients because you can talk to them about that. And that buy in is going to be huge. And so that’s where I think you do get a lot of benefit from having done the things that the runners are going, the runners that are seeing you are going through.

The other cool thing, I’ve never heard somebody explain that, I call it like the taper tantrums. Like during taper, just got off call yesterday with a runner I coach and she’s experiencing some niggles. It’s her races on Saturday, she’s freaked out. But I do feel like that always pops up in those like ten days leading into the marathon or the race. But I never heard somebody describe it that way.

So you said, describe it again with the phenomenon, what’s happening, cortisol levels are high when you’re training high.

Ben: When your training stress is super high, lots of things are going on in your body and, you know, you’re trying to adapt and recover. And one of those things is is your cortisol levels are elevated just due to the training stress, especially if you’re training at a high intensity. And then, obviously, you take a fairly dramatic cut in your volume and intensity. You know, you might drop by sort of 40% in the first week and another sort of 30% in the second week. And the relative stress reduces fast.

And, you know, you get the benefits of that in terms of, you know, hormone levels and your system sort of chilling out a little bit. And then you start to notice things because cortisol has an inhibitory effect on what you feel. It dampens some of those pain. It has a slight analgesic effect.

Jimmy: That’s really interesting. But then another important thing you pointed out there is that you said it’s not all it wasn’t all in your head. That there was actually some underlying hip issue here. It was just amplified because of your past experiences, because of the value that you were placing on that race and probably your identity as a runner, that you said your identity as a PT who treats runners. And I’ve been guilty of that too, where it’s like, oh, I’m a PT, I can’t even get myself to the starting line healthy.

What is that could look like for business? It’s just a funny thing. But then in reality, it’s like the experience that we as clinicians get from dealing with those injuries, I think speaks volumes clinically when you’re working with a patient who’s going through something similar.

Ben: I see. So it just contextualizes that a lot, you know, if you’ve had an injury or had an experience that your patient is dealing with, and you’ve somehow managed to overcome it, I think it really does help to reassure people.

Jimmy: Yeah, to reassure them and then you really, you know what you’re talking about. To piggyback off of that example of you leading into that marathon dealing with an injury, we talked a little bit off air, and you talked about it earlier today about, like, how do you deal with a runner who comes into your clinic and they’re three weeks out from their goal race and now they got an injury and they want a race? How do you deal with those runners?

Ben: You have to deal with the runner. It hugely depends on the injury, right? Like, you know, if it’s a if it’s a nonstarter, it’s a nonstarter, that. But there are many people who come in that, you know, the marathon really peaks in intensity and volumes around those sort of six weeks out, four weeks out, three weeks out, and, you know, as people are going through their peak mileage weeks, and that’s a lot of the time where people run into tissue capacity issues. So you need to understand how they’ve trained and how long they’ve got left.

You need to look at sort of, you know, whether they need more they need to build some fitness, whether they can actually do any running, or whether they have to go solely on to cross training. But I think this is where sort of understanding, like, the training principles then becomes really useful. You’re like, if that person cannot run because they’ve got a problem in their their hip, that means that they can’t run. Can they cross train on an elliptical? Can they cross train on a bike?

You know, are those two things pain free? You know, I often explain to them that, you know, they’re not the same, but your heart hasn’t got a clue what you’re doing. You know? It knows beat fast, beat slow, you know? So you can still do threshold work.

You can still do v o two max work. You can still build an aerobic base on a wide variety of equipment that doesn’t stress your injury, which will allow your injury to relatively settle and calm down, and you can do your rehab alongside that as you do. But you don’t have to derail your fitness. Know? Yes.

You might lose some of the neuromuscular sharpness and coordination because you’re not running regularly. But if that person’s got time to settle the injury, replace those runs with effective cross training, and then do a few runs in the lead up to it, you know, that’s a perfect situation. And I I’ve seen that countless times over the last six months, over the last five years, where some some of these injuries, again, they’re catastrophized. So they if if they’re not as bad as they may seem, that person may need a little bit more of the sort of psychosocial help. And if the injury is bad enough that they can’t run, but they can cross train, but will settle in time, often it’s just knowing when to course correct and and convincing them that actually you don’t have to run loads to to maintain that fitness.

You know, a short succession in your running, you’re not gonna lose any meaningful fitness. You know, you you might you’re gonna lose sharpness, and that comes back fast.

Jimmy: How do you deal with the confidence issue? Because I think that is a big when a runner gets injured that like, close to the race, and you’re telling them they need to cross or they can cross train to kind of maintain that fitness. I think one of the big hits that I see that the runners taking during that is a hit to their confidence. Like, oh my God, I can’t run. I can’t do I’m not gonna be able to do this race.

I don’t care if I can stay fit on the bike. Like, how am I gonna do this? How do you deal with that?

Ben: It depends on the type of runner that you’ve got. You know, if you’ve someone running their first marathon who’s not goal orientated, it’s a little bit easier. If you’ve obviously if you’ve got someone going for a specific goal and that then you’re juggling the ambition versus the realism, sometimes you have to be quite firm in the sense of like, you know, you’re no longer training for a sub three hour marathon because you’ve missed four weeks of your training block. You know, your training plan has gone to plan. You need to have an understanding of adjusting your goal.

But, you know, let’s say you get one of those good examples of someone who’s done really good training and, you know, you can get them back on track. I think storytelling is really a really valuable way of communicating and being able to reel off the genuinely countless stories and examples of cases like this, I think, can be reassuring. Using either personal experience, you know, I’ve had needles and things, and had had to miss workouts, even in this block. I had a small irritation of my hamstring. I did a half marathon five weeks out, and then did a big fat marathon workout the week after, and my hamstring was a bit sore.

So then I missed my hard workout the following week. I cross trained instead, and then was able to carry on the week after. So it’s like, I think storytelling, personal examples, and and examples of similar people is really important for that.

Jimmy: Yeah. Just showing them examples so that they calm down a little bit. You’re trying to, like, talk them off the edge. I’d like to take a moment to thank our sponsor Runeasi. Runeasi is

Jimmy: a running and jumping analysis tool that helps provide objective data on things like impact loading, dynamic stability, and symmetry. I’ve been using it in the clinic for the past three years and I love how easy it is to add to my evaluations. Not only that, but it backs up my clinic reasoning and helps me with my decision making process when I’m doing exercise prescription. So if you’re a physical therapist or running coach, I book a demo. If you’re lucky, it will be with me.

Jimmy: If we go back to your influences, that you said over the past decade how you’ve changed, but were there mentors you had along the way that helped you through this process or clinicians at the courses or books you read?

Ben: Again, I get a lot of information. Having been self employed for so long, there are people who I follow online whose courses I’ve gone on. I was going to say even people like Jack Daniels is probably one of the, in terms of like training principles, following Jack Daniels reading, I’ve listened to Jack Daniels, his training principles book a couple of times. It’s a great one if you’re if you’re on a long run. So people like him might use, like, the the the style, like, you know, the training principles sort of concepts, I think, really good.

People like Tom and other physios who are really good. There’s lots of podcasts out there, but also just like peep other people who are maybe slightly less known within the sort of strength and conditioning world than just other physios, you know. There’s some really amazing content on social media that you can really pick out some really good bits, and that can drive curiosity for you to read and and to learn more.

Jimmy: Yeah. Speaking of social media, you have, like, you have quite the following on social media. How big of a role does that play in your business?

Ben: It’s helpful, for sure. I definitely get quite a few patients through it. So it’s definitely a very useful business tool. But I don’t really class myself as like a, know, I’m not an influencer. You’re not going to catch me, you know, come with me on my day whilst I do this thing.

Know, the content that I use and post is a little bit more sort of like educational. It might be a video of someone running on a treadmill and being like, What can you see? You know, or Look at this person’s hip, look at this crossover gate, and you know, This person’s been dealing with IT bowel syndrome, or whatever it is, and kind of giving a little bit of understanding around, like, low level biomechanics sort of stuff to people and strength and conditioning rehab specific to runners and, you know, information around, you know, fueling and how people kind of mess those things up. So it’s more educational content rather than sort of like, I’m an influencer, follow me because I’m amazing.

Jimmy: Yeah. And when you say educational content, are you gearing it more towards the injured runner, just runners in general, physical therapist?

Ben: Runners in general, I would say. There’s definitely content for injured runners. There’s content for those that are not injured that wanna increase their performance and just kind of enjoy it. But so I think I think that’s a fairly wide spectrum of it. But, of course, you know, social media is a bit of a game.

You know? I can post content that I think is really valuable and information heavy and really useful, and it can get terrible engagement. Whereas, you know, I can post that I ran a two thirty nine marathon or a one twelve half marathon and get half a million views. So there is definitely sort of sensational there’s that sensationalism. Like, they they call it runflation.

You know? The standards of running have come up so far, and it because I’m a normal person, people go, oh, he’s he’s a normal person. How’s he run two thirty nine? I wanna you know? And it’s it’s not normal.

Jimmy: Yeah. It’s such a hard code to crack for, like, small businesses. It’s something that I haven’t done a good job with personally. Yeah. That’s for another day.

If we go back to you in the clinic, I’m just curious, like, what are you what kind of cases are you seeing a lot of right now?

Ben: Lots and lots and lots of tendinopathy. That’s probably the most common that I am seeing at the moment. Proximal hamstrings, Achilles, patella. Seeing seeing quite a lot of tendinopathies. As all running physios, you see a lot of patella femoral pain.

That’s quite common. A lot of glute tendon stuff. So but I think at them at this very moment in time, because now the racing season has sort of curtailed slightly, I’m seeing a lot of sort of a lot of people who maybe were dealing with a niggly tendon during the race, did the race, didn’t recover quite enough afterwards, and have now kind of crossed the threshold. Whereas if you had asked me six weeks ago, it would be a lot of sort of, like, urgent care marathon, a pre race help me situations.

Jimmy: Yeah. Yeah. Yeah. And then what does treatment look like for you when you see one of these tendinopathies?

Ben: First things first is always load management and sort of education. I think, again, that’s something that, you know, changes you when research comes in and kind of changes how people view things. And tendinopathies, I think, is a big one, you know, changing from tendonitis to tendinopathy because, you know, the inflammatory markers in a tendon when it’s inflamed are not the same as if in your tonsils when you have tonsillitis. So they change the it is to tendinopathy. And there’s a little bit of more neural nerve involvement.

So I think education around tendinopathies is really important and helping people understand the sort of process it goes through, you know, starts off as normal, you might get excessive tendon load, you might get a reactive tendon or end up with tendon disrepair or degenerative tendon, but all of these can come back up to a normal tendon. You want to end up in that cycle of like optimized load and adaptation and getting stronger. So I think helping people understand that wherever they are along that journey, they can get to somewhere is really good. But on but also really, really managing their expectations in terms of time. You know, tendons are load adaptive.

They need strain to actually get better. So helping people overcome that sort of fear avoidance of triggering that pain, you know, explaining to them that the strain is necessary. It’s not going to be pain free, but as long as it is well managed and controlled. But that time frame context, I think, is super important. There’s this graph that is basically, I may as well have a printout of it on my wall, which has different types of tissue in the body and how long in terms of weeks so that you start to see meaningful adaptations in them.

And, you know, things like your nervous system is super fast, and then your muscle tissue and bone, and it starts to come back fascia, and they start to get, you know, ligaments. And down at the bottom are your sort of tendon and cartilage because they just take a long, long time to adapt if they’re gonna adapt at all. And I think that is sometimes helps people managing their expectations. You know, they they might have a full blown Achilles tendonitis, and they still think they’re racing next week. So I think the first port of call is always load management.

Let’s settle that thing down because otherwise, your your rehab’s not going to be accepted. Helping them really understand what it is, the type of tissue that it is. Sometimes I go into quite a lot of details, you know, helping them understand that, you know, the tenocytes, the little cells inside the tendon, they need encouragement, and it’s strain that produces the adaptation by getting them to lay down the collagen. It does it slowly, sort of helping them manage the timeframes. And then I will work through various different things, you know.

For some people, they need isometric work so they can load the tendon without causing too much irritation or bite back afterwards. And that’s if it’s quite inflammatory, then I might move them to some sort of eccentric and build them up to plyometric stuff. But sometimes you get one that’s actually not so bad, and you can actually do a little mix of the two. You might start them with a bit of isometric, but already kind of move them onto the dynamic eccentric stuff quite quickly, and then just impress upon them the importance of progressive overload that, you know, that that tissue being load adaptive, it needs more and more and more load. And then the stuff needs to be sport specific, and that’s where the elastic recoil or the energy store and transfer of plyometrics and the reactive strength comes into play.

And especially if you want to start running again and you want to take lots of plyometric steps thousands of times, you need to include some of that in your rehab.

Jimmy: Yeah. So you kind of lay the foundation. The foundation is the education and setting the expectations that this is not going to be instantly better, that it takes time, tendons take time. I think Chris Johnson said that. When you are in that mode, you’re educating the patient, what do you tell them timelines?

Like they got a cranky Achilles, what do you tell like?

Ben: I typically don’t tell them timelines. I actually try to cut I often tell them not to worry or not to try not to focus too far in the future. I kind of tell them let’s go two week by two week because actually if you focus about how long something’s gonna take you, you’re gonna struggle to remain consistent, you’re gonna get frustrated. So I pull away from giving them timelines, but I often tell them that it’s, you know, it’s months instead of weeks. I think that is good to understand, but also it’s important for them to understand that it doesn’t have to be pain free for you to start running again.

You know, your body doesn’t have to be pain free. You you are allowed to be nursing a niggle or an injury and have a version of running within your life, that’s the sort of whole load management. Right? That might it might be very little running at the beginning, but let’s say you’ve got someone who’s just been able to start tolerating all their eccentric stuff, and their range of motion is actually quite a lot better. Let’s say it’s a proximal hamstring tendon, and actually, they’ve been doing some very gentle plyometrics with the legs under the body, so there’s no load really going through that proximal hamstring.

But you go, okay. Well, you know, you can’t sprint right now. But actually, if we increase your cadence and shorten your stride, get the foot under the body, and maybe start you with, you know, two minutes on, one minute off five times, we can start to use the graded exposure of running as your rehab. So I tried to not give them time frames. I’ve tried to have sort of milestones of kind of reintroducing, and I’ve tried to get a version of their their running back in as soon as I can.

But it’s important to explain to them that the version of their running is maybe different to what they are expecting it’s gonna be. You know, a of people think the smallest run you can do is a five k, but actually, you know, a walk jog interval for someone with a on that return to run from a tendon is where they have to start. Twenty five to thirty five minutes might be way too much for that tendon. You’re just gonna exceed the capacity and and flare the injury.

Jimmy: And there’s something you said early on as you started talking about this about two week snapshots. So tell me about that.

Ben: So I get I try to get them to think of it in sort of shorter time blocks rather than to have them focus on the end goal. Even when I see these patients, unless someone really needs to be seen really, really frequently, it’s the work they need to do. So I don’t typically try to overtreat these patients at the beginning. I don’t try to see them weekly. I try to see them close to weekly because that’s what I find in experiences.

It’s they need to have done enough of the work to start to notice any of the improvement. You know, let’s say you’ve given them some isometric stuff to begin with. You know, they have an inhibitory effect, so they’re trying to dampen some of the pain signal and start to get some strain to the tendon. But if I see them today and then see them next week, and they’ve only done them three times or maybe four times in the in the interim, they are gonna come back into that session probably feeling slightly disheartened. And actually, longer frame time there, you know, maybe by that sort of sixth or seventh time they’ve done them, they’ve come and seen you on that that two week time, they start to understand a little bit more about what they’re likely to see.

Jimmy: So check ins help set expectations. I often tell people, like, we get in the habit of like judging progress day to day. And for some of these pesky tendinopathies, it’s like, you fall into a trap of just feeling like you’re not making any progress when you do that. But if like you say, you zoom out and we say like, all right, how do you feel two weeks from now? Like, that’s what I care about.

And then two weeks from that. So you have this like rolling two weeks, every two weeks you’re just checking in. Have I made progress? And sometimes progress looks like the pain is exactly the same, but I’m doing more now.

Ben: I think that’s a huge one. That that is a principle that, again, you I have to explain to people all the time. It’s like, if your pain is five out of 10 or whatever it is, and in four weeks’ time, it’s still a five out of 10, but you’ve gone from it coming on at mile one to it coming on at mile 10 or mile five. You’ve you’ve gained all that amount of work for the same amount of discomfort. You know, pain isn’t attached to tissue damage.

There’s no exact, you know, you’re this damaged, you’re in this pain. It’s very perceptive. You’ve got to understand the biopsychosocial model as well. These people might be missing out and worried and fearful. So it all comes into play again.

But yeah, I think that’s a huge one is the is helping people understand that actually getting the pain, but doing more to get it is a really brilliant way to progress.

Jimmy: With these tendinopathies, you’ve talked a lot about load management education. Where does something like a gait analysis fit in for those patients?

Ben: It wouldn’t really fit in until I have got them back into running, mostly because it would just give me invalid data. So, you know, if you’ve got someone with a, like, a painful, like a proximal hamstring tendon, and they can’t stride like they would normally, or they’ve got an Achilles problem and they decide to redistribute the load more towards the back of their heel, you know, it doesn’t really come in, in my opinion, until that patient is able to run. And you can either then do one as a benchmark and then one in a sort of four, six week period of time afterwards. And that can be quite nice to be quick, again, as long as you kind of use it with your other testing as well, get some objective data. But I think, yeah, doesn’t really, it’s not very useful diagnostically, whereas with other issues, it can be quite useful tool diagnostically, especially with stubborn things that are, you know, don’t present in like typical ways.

But, yeah, so with with these, gain access comes a fair bit later down the line for me.

Jimmy: And then once once they reach that point where you decide, yeah, I wanna take a look at your running, are there specific things you’re trying to look at when you look at their run?

Ben: Again, depending on what depending on what issue they’ve got. But, like, I generally how I do get a nice is I do a sort

Jimmy: of, like, top to bottom approach. I look at

Ben: sort of, like, head position, whether they’re vertical oscillation or, you know, bobbing side to side. I’ll look at sort of shoulder rotation, trunk rotation, arm swing, whether it’s, you know, one aptitude, whether there’s any conversation or asymmetry or or any particular direction of movement. Obviously, looking at your pelvis, your sort of drops and and differences there or trunk shifts across knees, feet, ankle. I kind of do a sort of, like, back view, and then I’ll always do a sort of side view. I I always film when I do I will always use filming and the device.

I I like to have the sort of multi view option. But, you know, then it depends a little bit about what the problem is. If it’s an Achilles, you know, whether they have the calf capacity and how they push off, how much hip extension they get, you know, how much they are using or where they strike their foot on the ground, whether it’s if it’s a proximal hamstring, you know, things you’re looking at may might be a cadence issue, might be an overstride issue causing compression in in the sort of early stage of swing phase. So, yeah, there are it very much depends on what’s the what the problem is that you’re dealing with.

Jimmy: Some of the things you described there sounds like maybe looking for clues into how they’re loading or overloading the the cranky tendon or depending on the location.

Ben: Definitely.

Jimmy: And then you’re tying in both visual data with slow motion video and then some tech with Runeasi. And then kind of put all those pieces together.

Ben: Yeah. Often I’ll sit down then with the patient, I’ll have the data, the Runeasi data, and I’ll show them the video and I’ll slow it down and I’ll screenshot it and draw lines on for them if they need it. And just so I really again, education becomes hugely important there. People are also just not aware that they’re doing these things. You know, the overstride is a classic one.

People don’t feel the overstride. Mhmm. And they don’t necessarily ask someone, are you a heel striker or a toe striker? They’ll go, I don’t know. And it’s not because they it’s just because they’re unaware.

It’s not because they don’t know what they’re doing necessarily. They just have never really thought about it. A lot of people who run have just kind of picked it up. They’re not runners. They’re not elite training people.

These people have just sort of begun running as a hobby and maybe gotten better at it and done it for five, ten, twenty years without any thought other than just like, oh, I’m going for my run now. So I think helping people Yeah. Standby mechanics, you know, is really interesting. And like some of the compensation patterns you see are so interesting, you know, there might be a trunk shift out to

Jimmy: the side and an arm comes out to the

Ben: side and they can’t feel that. So, you know, they’re landing on the leg and and they compensate, but all they feel is is just running.

Jimmy: So you use that, you’ll show them that and kind of educate them on this is how you’re compensating.

Ben: Yeah. I think it’s important to help them. The body has natural load redistribution, sort of these are subconscious. Right? Your body won’t naturally just let you run into pain, and you you all that sort of pain in an area will cause a subconscious shift off of it, an unloading pattern or a loading pattern.

And I think those are quite used

Jimmy: Mhmm.

Ben: With sort of like chronic injuries as well. They’re really good, and like helping people identify less so with tendons, but, like, an issue that someone’s had for years, and they’ve maybe tried lots of different therapies and physios and bits and pieces. And they can run, but they don’t know why at 20 k, this problem always starts to appear. But you could begin to show them that actually they’ve got this quite subtle load redistribution pattern and compensation that actually after Mhmm. A k’s worth of volume has been done 15,000 times.

And they’re

Jimmy: like Yeah.

Ben: Makes sense. It’s the capacity of that has been read.

Jimmy: Yep. Yeah. And we talked a little bit off air about, I think one of my patients where it’s like, yeah, using data like in tech, like Runeasi, where you can kind of show them, show the patient, like, to validate that experience that they’re going through. Like, you’re you have chronic right hip pain or right leg pain, I can show you with data some visual that you are loading that right side differently.

Ben: Yeah.

Jimmy: So that’s tendinopathies. Guess one last question I have for you. What are like some of the hardest cases that you see in the clinic? Are they if it’s you’ve seen a lot of tendinopathies, I’m sure we see a lot of bone stress injuries, but are there any patients or type or cases that you kind of feel like are just really hard?

Ben: Sometimes you can’t tell where the pain’s coming from. There’s the odd occasion where something’s just very unusual. They might get pain. Like, I’ve I’ve got a case at the moment that’s quite interesting in the sense that she has a sort of lateral knee pain, and it only comes with running. And it doesn’t take much tool to bring it on, but she can do loads of other things.

She’s had MRIs. Everything’s clear. It’s not an IT band issue. It’s not a fat pad issue. It’s not a meniscal issue.

And so like everything is clear on scanning. She’s tried several different physios. I’m like the third person she’s seen. And so you sometimes you just get a real head scratcher where it’s like, it’s not obvious. And I think they sort of and I’ve only seen her once.

I’m seeing her again next week. And one of the things that I remind myself is like, some issues require turning over more stones. Right? So like, some things are dead obvious, right? Lot of our job is pattern recognition.

You’ve got a training error, tissue capacity, but you’ve done something silly, simple. But you do get the occasional person that is just presents abnormally and, you know, pain that can be referred or transferred from other things. And actually, you know, she’s done a gait analysis, we did some strength testing, and actually, she she scored really well. But she just took this pain, you know. So I I I think that the ones that kind of stump me are those ones, but that that’s gonna require me to do a lot more objective stuff and subjective digging and kind of you know, so we’re gonna go through a lot of her sort of, like, training history together in more detail and the strength training.

We’re gonna go over a lot of her technique with with the exercises that she does. And, you know, we’re

Jimmy: gonna look at

Ben: her running again and sort of like see see if we can trigger that pain and sort of like really kind of get to the bottom of it. But, yeah, think so those ones are trickier.

Jimmy: Yeah. Well, it sounds like a lot more uncertainty involved in that case where Yeah. The scans come back clean. Yeah. She’s probably more stressed about that because it still leaves all this uncertainty as to what has actually going on.

Yeah. At what point with a case like that, do you say like, man, we just gotta start get get you moving?

Ben: That’s that’s what she’s doing. That’s what I have kind of instructed her to do this week. It’s like, let’s let’s just actually just let’s sit with that pain. Let’s actually get you moving and let’s get you running. Let’s see how bad that pain actually gets, you know, during a couple runs this week.

We can, you know, and see if the pain develops the more you push it, just to kind of see if we can really get to the bottom of it. But also, I’m not afraid at all to sort of bring someone else in. I think sometimes getting another pair of eyes can be really useful. So there’s a couple of physios that, you know, I might consider sort of asking to take a look if I feel like I am not quite there with it. And there are those that are, you know, more biomechanics focused, more psychosocial focused, you know, combination, more focused.

So I like, you know, I said to this person that, you know, we’ll get to the bottom of it. It might, you know, we’ll we’ll turn over all the stones, but we’ll get there.

Jimmy: And don’t be afraid to ask for help is what I hear you saying, if you feel like you need to.

Ben: Definitely. But, know, I’ve been in seven for seven years and, you know, I you know, a lot of pride in sort of being able to do a lot of things on my own, but actually, you can’t do everything on your own. And actually, it’s only really when people start asking me for help, was like, oh, yeah. That’s actually a really good idea.

Jimmy: Yeah. No. It’s one of the the pros and cons about being self employed. Yeah. It’s like, you’re in it by yourself, and sometimes it’s nice to have those other clinicians to reach out to and to bounce ideas around.

Yeah. Definitely. Well, Ben, I want to be respectful of your time. It’s been great. I really appreciate you coming on here, talking to us about all things running related physio.

For the listeners that want to learn more about you, where can they find you?

Ben: Find me on Instagram at benlombardphysiotherapy. And if you are in London, you can find me in Finsbury Park or in the city.

Jimmy: Awesome. Yeah. Well, go check Ben out. Follow him on Instagram, and till next time.

Ben: Yeah. Thanks so much. See you.

Jimmy: That’s it for today on the Physio Insights Podcast presented by Runeasi. Would you like to share an interesting case, insight, or have a thought about the podcast? Comment below and don’t forget to follow us for more episodes.