The Hobby Jogger Podcast
Welcome to The Hobby Jogger Podcast, where elite athletes and ham-and-eggers lace up their stories. We explore the common ground that running creates from the world-class runner to the hobbyist hitting the pavement, trail or treadmill. Expect a blend of inspiration, laughter and the shared joy that makes every step count. Join us on this journey, where every run is a story worth sharing.
The Hobby Jogger Podcast
E22 | Exploring Running Injuries with Dr. Bonnie Wilder
Discover the keys to running injury-free with Dr. Bonnie Wilder, a celebrated physical therapist, run coach, and strength coach. Ever wondered why core strength is crucial for runners? This episode promises to equip you with actionable insights and expert tips straight from Dr. Wilder's extensive experience, including her personal achievements like qualifying for and completing the Boston Marathon.
Listen as we break down common issues like IT band syndrome and plantar fasciitis, and share practical strategies for prevention and recovery. Learn the differences between temporary fixes and comprehensive treatment plans, and why understanding the root cause of your pain can make all the difference. With personal anecdotes and professional advice, this episode is your guide to running health and injury prevention.
Thank you for joining us for this week's episode of the Hobby Jogger. I am joined by my co-host, mr Rob Myers. Rob, how are you today?
Rob Myers:I am doing well and I'm very excited to jump into this podcast.
Casey Koza:Yep, absolutely, and are you following along with UTMB right now?
Rob Myers:I am. I got it playing right behind the screen here.
Casey Koza:Former guest Eli Hemming, won OCC Men's. I guess that's the de facto world championship. Our other former guest, jim Walmsley, on course now for the UTMB full circuit. So pretty cool to see those two doing so well. Tabor Hemming unfortunate result slipped injured going up to La Flagiere, I believe. So unfortunate for her, but she was doing really well. Speaking of injuries, we have a great guest today, dr Bonnie Wilder. Dr Wilder, how are you today?
Dr. Bonnie Wilder:Good, how are you guys?
Casey Koza:Doing well. I thank you so much for joining us. And you are a physical therapist, a run run coach, and it looks like a strength coach as well, correct?
Casey Koza:yeah great that's something that we've been emphasizing lately on the show is strength training, and I, I think you know, with something that I've dealt recently with a back injury. I feel like strength training goes hand in hand with dealing with injuries preemptively. The more you focus on strength training, the more or the less likely you are to be injured, specifically with the core region. Is that correct?
Dr. Bonnie Wilder:Yeah, it is correct, depending on the injury and like how far along you are. But yeah, that's, it's a key element.
Casey Koza:Good. So I'm on to something correct for one scrub. I'm doing something right preemptively, you know, not just laying on the couch doing nothing. And Bonnie, you're a heck of a runner yourself. You've run Boston, so you've got the Boston qualifier. You're qualified for Boston. Ran Boston. Your PR at the time was for Boston, I believe three, 13,. You ran three, 11.
Dr. Bonnie Wilder:Yeah.
Casey Koza:Sorry, didn't want to. You know two minutes that's. That's a big deal here.
Rob Myers:I that's pretty fast. Congratulations on that Wow.
Casey Koza:Yeah, I. I hung with the one 30 group at the Cleveland half marathon for about four miles and I was like no moss, that's. That's enough for me for today. So, uh, three, 11, super impressive time. How did you qualify for Boston?
Dr. Bonnie Wilder:New York. So you're in the New York city marathon. I didn't have a qualifier for that one, so I rose. I raised charity in memory of my grandma. Um, hit my time exactly to the second, didn't realize I was going to do that and then told myself I would never run a marathon again. And then two days later I found out the Boston qual, like the Boston application was open and I was like you know what, screw it, let's do it.
Casey Koza:It only took you two days. Usually I say give it two weeks, I was give it two weeks.
Dr. Bonnie Wilder:I was still in bed. I was still not moving. I was in a wheelchair. I was wheeled out of Central Park. It was really bad for New York. I didn't realize how hilly it was going to be.
Casey Koza:Bonnie went full send. I went full send how to do it for my grandma hey, yeah, I mean, when you do it for charity, do it for grandma. That weighs a little bit differently on you mentally, because you kind of you're, you're carrying the weight of, you know, grandma with you. I'm sure I've never done that, so I can't say, but yeah, you're carrying the weight for that. That's a little bit more motivation than normal.
Dr. Bonnie Wilder:Yeah, it was grandma and my dog. They, they both died of cancer. So I raised money for the Memorial Sloan Kettering Cancer Center in New York City and, yeah, I was like, ok, let's do this.
Casey Koza:Oh very nice, well, congratulations. I'm sorry to hear that about the dog and your grandma.
Dr. Bonnie Wilder:It's life, it happens.
Casey Koza:That is correct, you know you got to go through all the phases at some point. So that's a good way to look at it. What got you started to want to run a marathon? Cause that's something kind of where we always start here. Uh, we are the hobby jogger and you know it is our hobby, but I think it takes a big jump to go from the half to the full. I mean, obviously it's twice the distance, but what? What made you want to take that step?
Dr. Bonnie Wilder:Yeah, it was. It was honestly like growing up going to Manhattan, going and visiting my grandma because she lived there. My cousins, they all live there. I've always loved the city until probably like three years ago when COVID started a goal when I was in like probably 11th or 12th grade to run. It Ran in college Division I I was never the fastest on the team. I felt like I had more endurance over the long haul, could hold a slower pace for longer. But then, yeah, the year I graduated a year later, I decided to raise charity for it. So I was still in PT school when I was training for it and then I told myself I would never run another one, like I had just said. I will say that Boston I was not in a wheelchair at the end, so that was an accomplishment for me. That's a big improvement, that's good.
Dr. Bonnie Wilder:Yes, the hills, they get you.
Casey Koza:That's a big improvement. That's good. Yes, the hills they get you, yeah, and it's surprising how many people don't understand that the hills down hurt. I think hurt more than the hills going up I it's a lot of pounding on the quads, a lot more stress, I feel like on on joints. Then, yeah, going up is tough. It's a grind to go up, for sure, it's tiring, but it's not as painful. I think it's going down.
Dr. Bonnie Wilder:It depends I it depends. I mean, my next one's going to be a downhill marathon. So yes, it's a little scary, but you just have to train a little bit more differently. I wasn't strength training back then. I really didn't have a good idea of what to do. Still in PT school figuring it all out.
Casey Koza:Yeah, that's coach. Uh, david roche had a great insight on that. He's like you got to get a half hour of downhills in a week to to kind of get the body ready to, to be able to handle the pounding on the quads of of of the downhill and the bridges, like the verrazano bridge, probably what goes straight up, straight down right yeah, yeah, but it was the first.
Dr. Bonnie Wilder:That was the first bridge, so you didn't think much of it, you. You were just cruising.
Casey Koza:Yeah, you're still good. I'm originally from Pittsburgh and the Pittsburgh Marathon. A lot of people run it. I thought bridges were flat Bridges. Go up bridges come right back down. Yeah, they can be pretty steep. What downhill marathon are you running?
Dr. Bonnie Wilder:Las Vegas in nine weeks.
Casey Koza:Las Vegas. I didn't realize I ran the half there. That's where I set my half marathon PR.
Dr. Bonnie Wilder:The rock and roll one, the rock and roll. Yeah, this is like a brand new one. It's like the inaugural race. So it's going to be on November 3rd. It's the first time they're hosting it. It starts in red rock Canyon, I believe, and then it ends on the Vegas strip.
Casey Koza:Oh sweet.
Dr. Bonnie Wilder:Yeah, so, and then London will be next, so that'll be my fifth.
Casey Koza:Oh sweet. So London, that's a big, that's a big deal. London, London marathon, it's yeah, yeah.
Dr. Bonnie Wilder:So the goal is to do all six world majors, so that would be my fourth.
Casey Koza:Okay, we have a friend of the show. Caleb Bowen's dad is trying to knock off all the major marathons. He's Tokyo I think he ran last year. I want to say so he's well on his way to getting the world majors. Very cool, tough accomplishment. A lot of traveling, a lot of jet miles, so that's good. That's a big calendar there for you. Any specific thing you're doing? Single-legged quad exercises, sissy squats?
Dr. Bonnie Wilder:things that really burn your quads, as your normal person would say. Yeah, but I was dealing with my own injury after my last half marathon, so I had just gotten over that and then started right into my training block for this. So we're still being very cautious. So I'm still doing my own prescribed PT exercises on the side just to make sure I'm not going to get injured again. I ended up with a sacral stress fracture, so that was yeah, and it took three and a half months to get the MRI back. So I didn't know. For the longest time I thought it was sacroiliitis. No, for the longest time.
Casey Koza:Thought it was sacroiliitis. Yeah, and that's. I know that's put a big damper on a lot of people's running careers and years. Can you describe that injury specifically for us, because I think it goes? I feel like when I read about it, adam Peterman, ultra-runner, was diagnosed with it. I believe that's who I saw and it seems like it goes kind of undiagnosed a lot of time.
Dr. Bonnie Wilder:Yeah, so they didn't see it in the x-ray. So that's why I thought it was just sacroiliitis. But you almost need an MRI just because all the organs and like the gas and volume that's taken up in, like the pelvic floor region, it just obscures the view. So that's why it took so long to find out and it was. It was debilitating, like I couldn't treat in person. It was I couldn't walk. It felt like someone was stabbing a knife into the right side of my back. It was really bad. So I took the time off running Like there was no walking, there was no running. But yeah, it is tough to. It's tough to treat as well, because you just need the area, the area, to like calcify and you don't want it to become like a non-union, which is when it doesn't calcify and it just kind of lingers. But I mean that goes for any fracture in general. It just it's tough when it's a weight bearing joint and your sacrum is like the core of your back, the core of everything.
Casey Koza:That leads me to a question that so I was dealing with in. It was my back and it was on the right side. It was like above my ass but still lower back is how I described it to the chiropractor Like, does that make sense? I guess, glute, we'll. We'll use proper terms here, rob. Sorry the glute. Yeah, come on, we have a PG rating here here. Rob, sorry the glute, yeah, come on, we have a PG rating here. We do have a PG rating We'd like to keep, but that's where I'm coming off a back injury and that's what I heard.
Casey Koza:It was the weirdest thing I've experienced with injury wise, because I couldn't. I couldn't run. There was no chance. I was running for about two and a half three weeks and hurt to walk. Bike riding was okay, so I could take the bike out and still ride. But would that have been considered a? I Googled it and Rob will tell you I Google a lot of things and, yeah, I don't think I diagnose myself well when I go on Google. When should I go to a doctor for something? I think that's something a lot of people struggle with. We're all going to get injured running the volume that we run, whether it's big or low, like people get injured. But when do we? When do we? Do you think maybe we should go see a doctor?
Dr. Bonnie Wilder:I would say if it's persisted over like two, three weeks and you've tried your basic treatment that people are putting out online and it's not working, it sounds like there's something more underlying as a cause and if you can't figure it out yourself, you're just going to do more damage, like running on it as runners do. So just seeing someone getting some help, even if it's just like a few visits in person or just like seeking out to a virtual therapist, that would be like your best bet. I wouldn't go longer than three weeks, because then you start like getting into more of a mental state where you're compensating, you're guarding with other muscles and that can lead to other injuries. So that three week mark is, in my opinion, where you probably should seek help.
Rob Myers:So where do you start? I mean there's different types of therapy out there. I mean there's chiropractors, sports therapists and it seems like there's there's so many different places to start. Where would you recommend your family doctor?
Dr. Bonnie Wilder:Yeah. So if you need a referral, you're going to have to go to your. You're going to have to go to your actual doctor, like your MD, they're not going to have like a good answer for you. They're going to tell you to rest, and what runner wants to hear that? No one does. So I would recommend going to a therapist just because, like a physical therapist, because a chiropractor would do short, short term relief. I work with chiropractors. They're great, but they're more short term relief because they're not addressing the injury and why it's happening. One that has a lot of knowledge in terms of what running requires, they can figure out why the issue is happening, versus just going to see a generalist who's going to give you exercises for your knee pain. Because you come in with knee pain. There's more than just your knee.
Rob Myers:No, that makes sense, because I don't want to go to my family doctor. It seems like she always wants to give me a prescription for something and it's temporary. It's really a temporary fix, but it doesn't fix the long-term pain. And then, I don't know, after two or three months, sometimes I feel better. I'm like, well, was it because I took the prescription, or just time healed it, or I really don't know. I mean, I feel better most of the time after a couple of months, but you really really don't know really what fixed the problem in the first place.
Dr. Bonnie Wilder:Right, yeah, I would agree with the prescription too. Unless it's excruciating and you can't go about like your work, you might want to take it, but if it's just for running, I would stay away.
Rob Myers:Good advice.
Casey Koza:I'm very anti and I agree with you, rob. I hate when I go in like cause I have to get a referral and he wants to give me a painkiller. It's like I I'm not. I, that's not what I'm here for, I just I want to go see Dr Bonnie, the physical therapist. I just need you the insurance route. I got it, I got it. I got to get gatekeep by you. I don't want a prescription, and it seems like they do.
Rob Myers:They just want to maybe they make money off that. I don't know how the health care system works. So I'd say for me, more than anything, I just want to know what's going on. You know I'll take it easy for two, three weeks and most of the time that helps, but really just in the dark, like I know, I hurt, but I have no idea why yeah, it gets back to it because if you know why it's I, I would think it's much easier to fix.
Casey Koza:If I know why my toilet's leaking, I know how to fix it. Like you know why, I would think it's much easier to fix. If I know why my toilet's leaking, I know how to fix it. You know what I mean. Right, does that make sense? Yeah, you call the plumber right. Well, that's actually what I always do. I call Ben, my buddy, there, the plumber, and it's much cheaper that way.
Dr. Bonnie Wilder:I find that a lot of runners will fixate on asking for a diagnosis and while a diagnosis is important, it's not like the end all be all. It's not going to be your answer, because just take two people who have, like, say, it band syndrome, they're going to have it for a different reason. So if your knee hurts, it's your knee that's hurting. Just figure out why it's happening. But a lot of people will fixate on this idea of oh, it band syndrome equals X, y and Z, exercise to make it better. That's not the case. So that's like something recent that I've been really tapping into and trying to break up. Maybe the stereotype I don't know if that's the right word but just the implication where you need an exercise for that diagnosis. It doesn't work like that, but a lot of runners will feel that way.
Rob Myers:You've just described me and since you said let's go down the IT band rat hole, I mean that is the most frustrating injury. I only went through one time maybe a year and a half, two years in to running long distances. It's just, it's bizarre out of all the injuries I've had. And you stop running, it doesn't really hurt, there's kind of a little bit of an ache, and then as soon as you start running again at least my experience the worst pain I think I've ever felt since I started running and it just takes forever. You think it's healed, you hit mile five and it's back, and then you take a month off and it comes back. Frustrating injury. It probably took six to nine months before it was completely gone.
Dr. Bonnie Wilder:So just a little tidbit on that. That's the reason I even wanted to become a physical therapist. So IT band syndrome put me out of running for six months as well it probably was more. I was just stopped counting at that point in high school, couldn't run it. I felt like therapy was the most useless thing.
Dr. Bonnie Wilder:Now, looking back at it, but in the moment you're like, yeah, this is great, I'm in eighth grade, they're helping me out, but it was just stretching the IT band. And come to know today, that's not a thing. You can't stretch your IT band. It's a ligament, so you actually need to like look at other places. But the therapist never did that. So that's one of the biggest things is, at least for me, like. It band just has this frustration behind it because I understand now how to really help it. And it's not, it's not rolling out the IT band. I hate to break it to you. There's a muscle called the TFL. Like if this is your hip here and like the IT bands over here, your TFL up top is the muscle that makes it tight or loose. There's a few other things that go into it, but that's really the muscle that you need to open up and like release. So ligaments don't stretch, and if they do you're probably in trouble.
Casey Koza:So the key, then, to if I'm following this correctly and I'm sometimes not is the TFL muscle that supports the IT banding.
Dr. Bonnie Wilder:There's a few, but that's one of the major ones. The glute med is another. Yeah.
Casey Koza:Glute. Okay, that's the yes Previously discussed the moneymaker yeah. Yeah, all right, so that makes okay. I've never heard that before. Tfl.
Dr. Bonnie Wilder:Tensor fascia lata. It's a, it's an abbreviation.
Casey Koza:Yeah, see, I take, I take, I take a lot of notes because I learn a lot on some of these, specifically this one. So real quick, broad overview. What is it band syndrome? I? I hear it a lot from other runners oh, it's my it band, it's my IT band, what exactly is it? Because I've, knock on wood, never had to deal with it and I'm not a big foam roller anyway, and after you give this I'll tell you why. But what is the IT band?
Dr. Bonnie Wilder:So quite literally, the IT band is a ligament that goes from your hip to the side of your knee right, almost at like the insertion of your knee and like your fibula. It band syndrome occurs due to usually tightness or weakness, lack of mobility and therefore it almost it pulls on the area and repetitive bending of the knee and friction of the IT band over the knee is the most common. I would say like 80% 90% of runners will have that type of symptom where they have pain at the knee from the IT band over the knee is the most common. I would say like 80% 90% of runners will have that type of symptom where they have pain at the knee from the IT band. Very rarely do people get pain at the hip from the IT band, but it's hard to differentiate if it's a hip issue or an IT band at that point. But most commonly it is just overuse from bending the knee, from other things that are occurring that are causing the knee to bend.
Casey Koza:more essentially, Now could causes of this, like I'm guessing it's very much gait, dependent on a person, how they're gait. If they're maybe not well gaited, things tend to rub the wrong way that they weren't designed for. So it's probably more natural in some people than the other.
Dr. Bonnie Wilder:Yes, so that's something I prioritize as well as like watching someone's gait. So, like through tests, you can figure out what someone's running form looks like, but also just like watching them run. The thing is in person and online. You can't always ask someone to run because they physically can't, because of the pain, so you'll do it through exercise and figure out where their compensations and where they're like lack of X, y and Z is coming from.
Casey Koza:That makes a lot of sense. Now, the foam rolling I I've tried it. I just I always felt like I was more sore in other places afterwards, like I was just irritating the area that was bothering me and I wasn't actually getting anything but short-term maybe short-term pain relief like a massage does. I never felt like I was fixing anything with a foam roller.
Dr. Bonnie Wilder:Yeah, I wouldn't say it's a fix. It's more of a recovery tool. Okay, it's almost like a massage. It's like you're doing what a masseuse would do, except probably to a deeper degree.
Casey Koza:Yeah, I don't know. I always felt like, if my hamstring was sore, that I would then irritate something else, and then I have two things that are sore. I don't know. I could be doing it wrong too, rob. What do you think? Probably user error.
Rob Myers:Yeah, yeah, it most certainly is. Thanks, rob. I I had the same issue for a long time, never used it and had more success with just taking like a cup, like a drinking cup, and then using that as a roller and just very targeted areas and for whatever reason. That worked a lot better for me. So I.
Casey Koza:I use the massage gun that I use a lot. I use that on my hamstrings before I run every day, so I do do that, but I feel like I can target more with if it puts me down to the ground. I know I'm hitting the right spot. I'm like trying not to fall down, and I know I'm on the right air. I don't know, I don't get that with the foam roller. I just feel like I'm more sore. I don't know. User error. Again, I am the hobby jogger, so it's probably user error.
Rob Myers:We're not pros Casey.
Casey Koza:No, no, we're definitely definitely not pros at pretty much anything but getting injured and drinking beer, next injury.
Casey Koza:We have another super common one that I always hear people talking about. Also funny story uh, plantar fasciitis. I had a buddy come into work limping it's kind of embarrassing to say this as an adult. He was like I have plantar fasciitis. I was like, oh man, you can get that burned off. I I just immediately went to thought it was worse. He had like foot warts instead of and he was like what are you talking about? I can't get like you can't burn off a ligament or whatever. I was like, yeah, you just take it, go in, they freeze it off for you and you're good as new the next day. No, plantar fasciitis, I found out, is not warts, that's plantar warts or plant else, I don't know. Lancer means foot. I feel like in some language I don't know, latin could be Latin.
Dr. Bonnie Wilder:Bottom of the foot.
Casey Koza:Bottom of the foot.
Dr. Bonnie Wilder:Yeah.
Casey Koza:So plantar fasciitis super common. Can you please explain to people what it actually is, that it's not warts?
Dr. Bonnie Wilder:It's not warts, that's true. Yeah, it's again. It's a ligament that goes from it's very thick it's almost fascia fascia ligament they're almost synonymous. But thick it goes from your heel to the toes, mainly the big toe. So big toe is the biggest insertion. I think there's a few others if I'm remembering correctly.
Dr. Bonnie Wilder:It causes a lot of stiffness and so typical hallmark sign is like you wake up in the morning and you're having a lot of stiffness, and so typical hallmark sign is like you wake up in the morning and you're having a lot of stiffness and bottom of the foot pain. It can either be more at the arch or in the heel. A lot of people will experience it in the heel and again overuse injury. So it oftentimes will stem from like improper shoes, so someone who's not wearing the right type of shoe, so maybe they pronate more and therefore it's collapsing the arch into that fascia ligament. But then other times it's also just like a weakness issue, not working on foot strength, foot stability, ankles cave in that kind of thing. There's so many plausible causes, but those are the ones I see.
Casey Koza:Can one of the causes be trauma? Like we said, we mostly Rob and I, run trails and I do notice my feet because I don't run in shoes with rock plates that afterwards, like the bottom, like the arch area, that big tendon right there, can be pretty sore. For me Is that last year, before grindstone 100 K, I came down with it and I was rolling my foot out on jars of olives. It was the only can I had to find, so I was rolling my foot out. Is that something that can happen is from trauma as well?
Dr. Bonnie Wilder:That's interesting, it's not commonly seen. Happen is from trauma as well. That's interesting, it's not commonly seen, but you could have it. Yeah, you can have pretty much anything from trauma. What's more likely is that it happened from trauma and then you started using your foot differently to plant on the ground and that would cause a plantar fasciitis.
Casey Koza:What are some? Is there common strength things to do for, because it seems like a tough place to hit strength wise? I don't think there's a machine at the gym for the for the foot. I don't.
Dr. Bonnie Wilder:Nope, there's not. No you. When it comes to the plantar fascia, well A, you have to rule out what's causing it. So it could be coming from the hip, the knee, in which case you would want to address the hip or the knee. But if you're just talking about the plantar fascia and like the surrounding area, a lot of foot intrinsic, so foot intrinsic strength, so those teeny little muscles that aren't really show muscles, you would want to strengthen those. Ankle stability, so making sure that your ankle is not collapsing either outwards or inwards. Calf strength is going to be really good. So instead of using having the calf essentially help you push off more so your foot doesn't have to do as much of the work, all that would be good.
Casey Koza:See, see, robert, I'm gradually learning here, gradually.
Rob Myers:I already have a page of notes, so it sounds like to avoid plantar fasciitis, a lot of it's technique and strength.
Dr. Bonnie Wilder:Yeah.
Rob Myers:Okay.
Dr. Bonnie Wilder:Stability as well, yeah, but shoes like you need to be in a proper shoe If you have a flat foot versus a high arch. The orthotic there's a whole separate topic about orthotics, but I think that they're useful.
Casey Koza:Yeah, I've kind of went back and forth on the shoe insert idea. I don't use them, I just roll with whatever's in there. Some of my shoes don't even have a, I guess, insole, so it's just it's allegedly to prevent blisters. Those shoes are the only blisters. Those are the only shoes I've actually got a blister from, this year, the ones without the insole. I only wear them like super rocky stuff, so I don't wear them very often. I don't think it's a good idea but I'm not a shoemaker.
Rob Myers:So, Well, on that topic, a quick question. Dr Bonnie, are you a fan of the zero drop or barefoot shoes?
Dr. Bonnie Wilder:No, not. No, I'm not. I know. I know a good amount of people of people are ultras. It's gonna put a lot of stress on your on your calf and it's interesting because I made a post about this and, like with Achilles, I'm sure we're gonna talk about Achilles tendonitis. But if you're having Achilles pain, calf pain, the last thing you want to do is put yourself into a zero drop shoe, because if your shoe is like this versus that, because you have maybe eight or twelve millimeters of drop, it's going to put less stress on your achilles and your calf. If you're at a higher drop, that's exaggerated, but it's a lot better than this because that stretches the calf and the achilles way more. So it's just easier for long distance runners to be in a four plus a millimeter drop shoe, which I think Hoka's are at four. I wouldn't recommend a Hoka either, but just in general, above four millimeter. Yeah, I have a lot of opinions on Hoka.
Casey Koza:Oh, I like that. I like that. Did the zero drop crowd eviscerate you for saying that? Cause they're pretty passionate Like the barefooters. The zero droppers are very passionate about their belief of that which I don't know enough to have an opinion. Actually, I do have an opinion I wouldn't wear them.
Dr. Bonnie Wilder:It's hard, it's harder.
Casey Koza:Yeah, it's exactly what you said makes complete sense of why I don't wear them. But did you get eviscerated? Did people come after you for that hot take?
Dr. Bonnie Wilder:No one person said the opposite and they were like no, if you have Achilles tendonitis, you want a zero drop shoe. I'm like really.
Casey Koza:Oh wow, I'm surprised.
Dr. Bonnie Wilder:Actually, I think a few people said that I'm like no, it's the opposite.
Rob Myers:I just went through that. I was an ultra fan for years and I stopped wearing them about a year ago because my calves kept cramping up and it wouldn't go away. Like mile five to 10, they'd cramp up the rest of the race. It would keep coming back every couple of miles. It didn't matter what I did. And then as soon as I went to a different shoe with I think it was four or five millimeter drop problem went away.
Dr. Bonnie Wilder:Yeah, that's. That's real life proof.
Casey Koza:Now you, you brought something up, uh, hoka's. Is your issue with Hoka's? The stack height?
Dr. Bonnie Wilder:No, it's, it's, it's more so the rocker.
Casey Koza:Okay.
Dr. Bonnie Wilder:It's the rocker it is. The stack height is very big. It's a little unnecessary. I understand people who maybe are on like maybe the heavier side and need more cushion. That would be a good thing for them. But it changes your running form and there's been a lot of research on that as well. Specifically, it's interesting my podiatrist showed me a research article about HOKAs causing a lot more lateral ankle fractures because you don't land straight down, you land like almost to the side. It just rocks you on the side. More so, whenever people come in in person and they're wearing hokas and they're injured, I always ask did you just move from like maybe a Brooks or more of a traditional running shoe into a hoka? And usually like 70% of the time they say yes, so we're moving right back out.
Casey Koza:Okay, I mean that makes sense. So what about, is it? Just because it's a more pronounced rocker? I know I always had the belief that you want it to stay as close to your natural gait as possible. So the more pronounced rocker, I guess, would throw you off of that into something a little bit unnatural for you.
Dr. Bonnie Wilder:Yeah, it's less natural, like if you've ever ran in like a Brooks versus a or like your traditional Asics not the Nimbus or their new stuff, but like a Brooks versus a Hoka. There's such a difference in what your gait would look like and Hoka almost pushes you outside more. Now, this is not for everyone. There are people who do really thrive with Hoka, but people who are more injury prone wouldn't be best for that shoe. Plus, the millimeter drop is four, like I think that's standard on all their shoes, if I'm not mistaken. There might be an exception, but most of them are four, like they're Clifton, they're Bondi, they're all 4 millimeter. Again, that's pretty close to 0 if you've been used to running in like a 12, which Asics and Brooks are mainly 8 to 12.
Casey Koza:Yeah, that makes a lot of sense. I mean, I've never heard that before, but good information to have I do well. Yeah, I wear a lot of Hocus. Yeah, I got a couple boxes sitting here that I haven't even opened up yet.
Dr. Bonnie Wilder:Maybe return. I'm kidding.
Casey Koza:I'll see if I can. What shoes do you wear?
Dr. Bonnie Wilder:I wear currently. I have a few. I rotate. I really like Saucony. I haven't had much luck with my easy runs being in Saucony, so I really like the Endorphin series. I'll run the Endorphin speeds for track workouts, for racing typically the elites. For easy days I've been going for the Asics GT 2000s.
Dr. Bonnie Wilder:I pronate, I have bunions, I have a flat foot. I have everything. I was born with it. It's wonderful, but I figured out how to adapt and light stability is typically best for me. Another question I get a lot of is do I wear a neutral shoe or do I wear a stability shoe? And I used to work at Fleet Feet. So something that I would see is we would over-correct people who have flat feet, whereas you would put them in a stability shoe and then put like a low profile insert in the shoe and instead of them being now flat with the ground, now they're like almost supinating a little bit. So you want to. If you have flat feet, you, if you're going to use a stability shoe, you don't really want to wear such an aggressive insert. So I'll see a lot of injuries from that.
Casey Koza:A lot of questions for me on the shoe, the shoe front injuries, I, I, we can talk about that, for we can probably do a whole episode on just shoes and injury, so we'll steer away from that for the moment. Our next injury that I want to discuss is it's probably a little bit more. Well, it's everyone but trail runners probably get more ankle injuries Because you just step off a route just a little bit. Next thing, you know, know your ankles on the ground and you sprained your ankle. You're swearing in the woods and it's a bad day for you. We all know what a rolled ankle is, the sprained ankle, but what's kind of your go-to for recovering from that? Because it's it seems very tricky and I also want ask is it cumulative or ankle injuries? Cumulative over a career of an athlete?
Dr. Bonnie Wilder:Cumulative, I think the laxity stays. So the laxity of an ankle will continually deteriorate. It's not like you can build up the strength of a ligament per se, but instead what you do is you want to strengthen all the muscles around the ankle. So, yes, it's cumulative in a sense, where the ligament isn't recoiling like a muscle would if you strengthened it, so it's not going to get tighter and support you more. Instead, you just need to prioritize strength more. So peroneals like the side of the ankle, calves a lot intrinsic foot strength. If someone is unable to weight bear because it's so painful to do so and it's very inflamed, has endema. Non-weight bearing is best, but the biggest thing also is range of motion, so making sure that they have close to 30 degrees, because that's what's needed when you're running of dorsiflexion.
Casey Koza:Gotcha, because that's something I feel like. I see people that continuously have the same ankle injuries and then some people never have it Like it's.
Casey Koza:it's not something that you know. I can turn my ankle in the woods, run a quarter of a mile in front, but there's other people that's like the end of their day and it's just. It seems like that's an injury where it's very I don't know like it. It's the one that I think affects some people greatly and some people not at all. Do you see that in your practice at all, like where some people are just fine with the ankle, doesn't matter, they're basically bulletproof and other people step off a curb wrong and they're done for six weeks.
Dr. Bonnie Wilder:Yes, yeah, but that also is almost for any injury. I find especially the knee where people really can't tolerate anything that is the slightest bit discomfort. So I find that the knee and the ankle almost act similarly, where I call the knee a dumb joint, like it just follows whatever the hip and the ankle do. But the ankle also is essentially a dumb joint where it has to follow everything up the chain does so it doesn't have a mind for its own. It's hard. It takes a while for the ankle because it is almost the first line of defense when you're walking, like that's the thing that's going to absorb the force first.
Rob Myers:What about flexibility? Flexibility with the ankle. It seems like the people I know that are prone to ankle injuries they're just not very flexible, especially their ankles, like they barely bend and you know they're out for a week. And then others I've been behind them in a race. It looks like they can see the bottom of their foot when they turn their ankle and they're fine.
Dr. Bonnie Wilder:Yeah, that's really important as well. The flexibility flexibility is different from mobility. I think both are really important, but, yes, keeping keeping the area like loose, like you just want to be able to hit the degrees that you need when you're running, which would be 30 degrees of dorsiflexion, but a lot of it is like stability, so you're not collapsing or unwanted movement.
Casey Koza:Yeah, I think that was. I think that's the only thing I have flexible in my body is is the ankle where I just it felt like I got shot, but then you know, I could just run it off and be okay. So I've been very fortunate with with ankle injuries. But I know some people have not and it's yeah, it's another tough thing to deal with. I mean, it's we're going through a lot of tough injuries to deal with, so it's it's right there with them well, casey, that means the the ankle yoga is finally paying off, right yeah, yeah, it's paying off dividends, dividends.
Casey Koza:Yeah, the ankle yoga, I do, uh, see if I have it. I do have it over there because we're going to get to the next topic and I believe maybe it is, I don't know, I got it from knees over toes guy. Um, shin splints something everyone I've never dealt with it again, knock on wood, but a lot of people have to deal with it. I had an old soccer coach who said you only got chin splints because you were out of shape. That's why you got chin splints. I don't know if that's true or not. That was in the 90s, and those coaches told us a lot of things in the 90s that ended up not even lasting a decade. I don't think. So shin splints what exactly is it? Because I'm not sure. And how do we get around it?
Dr. Bonnie Wilder:Yeah, good question. Shin splints is an umbrella term, so there's a few things. You can have inner shin pain or outer shin pain, two different muscles. So you have your posterior tib, which is commonly known as your inner shin splint. So some people can feel it more at like the bottom of the knee, some people feel it more at the ankle. That would be posterior tib tendonitis. That is another way of saying shin splints. The other shin splint would be your peroneal, so overusing the outer part of your shin, not the inner. So those are the two different types. It's an umbrella term. Shin splints can mean a few things. And then your second question was how to help it.
Casey Koza:Yeah, how do we kind of relieve pain? Because I know what they used to have us do in soccer when we got them because we were out of shape Freeze like a small Gatorade cup of water and roll that down the area that hurt.
Dr. Bonnie Wilder:Yeah, well, first of all, you want to work that muscle. You want to make sure that maybe isometrically, so without the length of it moving. But if it's already super inflamed, you don't want to work that muscle in particular, yet you want to build everything around it so that those can work harder and the muscle that's at fault doesn't have to work thus as hard. So doing that, and also shin splints again, it can come from anywhere in the lower extremities. So, figuring out where it's coming from, maybe it's from the hip and your hip flexor, like you're not bending your hip as much as you should be when you're running and therefore you're lifting your toe up off the ground more and that would irritate some of it, so working your hip more. In that instance there's so many causes. But if you want to target the shins, that's how I would do that.
Casey Koza:Gotcha and that's why I have this device here, but it's basically my foot goes in here and I do tip raises while I work it. Definitely I feel like I've gained a lot of strength since I started doing that. I got it from knees over toes guy internet YouTube video but I'm sitting here working. I can just, kind of, you know, knock out 10 of those on each foot 20 minutes later, knock out 10 of those, but I feel like I've definitely strengthened possibly, those muscles which have helped me not get shin splints. Is that? Is that something that I could have been doing correctly?
Dr. Bonnie Wilder:Yeah, toe raises are going to be really good. That's going to help with the shin muscles. It's not going to specifically target the posterior tib or the peroneals, but it is good. It's also going to help with like knee pain. So working the knee cause. That muscle also runs under the knee. It's going to help the tibia anterior. So the tibia anterior is like on the top of the foot, runs up to the knee. It's going to make your runs a lot better as well, but that's a good one to do.
Casey Koza:I like that. Yeah, it definitely seems like it's. It's helped. I never gave you that tidbit, did I, rob? Did I do tib braces all day, every day, while I work?
Rob Myers:No, I wish you would have a long time ago.
Casey Koza:I did. No, I did that's. I mean, that's I just I don't know. I happened to be watching a video on it and this guy was like you know, I, I can't really jump or anything, everything hurts in my knees. And then he said he did some tip raises and now he's dunking. So I was like, well, I want to dunk a basketball, like that'd be really cool. I've tried. I doubt I can dunk. I never really could jump that well, but that's why I started doing them.
Dr. Bonnie Wilder:I like it, I approve.
Rob Myers:What about a standing desk? Would that? Would that help as well?
Dr. Bonnie Wilder:I mean standing desks, I know they're, they're gaining in popularity and Casey and I both sit in front of a computer all day for a living, oh to have a sit stand desk you mean yeah, oh, yeah, I've got one myself, they're great. Yeah, you don't want to sit too long because everything just shortens. I'm not going to say it's going to help with an injury, but it's going to help keep you less stiff at the end of the day.
Rob Myers:Nice, definitely need that.
Dr. Bonnie Wilder:Yeah, costco has great ones.
Casey Koza:Costco does.
Dr. Bonnie Wilder:Oh yeah. Yeah, they're really nice, they're modern looking as well. They tell you like the degree. So if there's like a specific degree that you like it being, or like I don't know, something can fit under your table at a certain height.
Casey Koza:Costco is just this incredible, incredible place that anytime we go in there it's dangerous because we're texting our neighbor. Hey, they have a dragon slide. If you want to get one for the kids, we'll pick it up for you, no problem. Like it's. Yeah, I like costco, I'm a fan the essentials, the dragon slide yeah, you gotta have a dragon slide. There was a, I really did. I tried to talk my girlfriend into getting one. They have like a little outdoor bar that they'll deliver to your house, I guess. And I I don't know why I need an outdoor bar when I I have a fridge here. But I was like, let's get it. Come on, we need an outdoor bar, you do? I approve? Yeah, I was like Rob approves, I'm sure Dr Bonnie approves Didn't go over, we do not have an outdoor bar. Now that'll take us to our next topic, which is runner's knee, another one I have personally never dealt with. I don't think it's not a meniscus, unless it's meniscus, but runner's knee Very common. You always hear people talk about it. What?
Dr. Bonnie Wilder:exactly is it? Runner's knee is also known as jumper's knee, patellofemoral pain syndrome. It's essentially the patella tendonitis, or, sorry, it's knee patella femoral pain syndrome. It's essentially the patella tendonitis, or sorry, it's the patella and it's inflamed, so it'd be called patella tendonitis. It's all the same thing, essentially Again, overuse patella tendon, patella tendon becomes inflamed and then you have pain at the bottom of your knee. So, repetitive bending of the knee to compensate for something else, weakness of the quads, weakness of the hamstrings, that's like, in a nutshell, what it is.
Casey Koza:So another weakness of things you can build up through exercise and strength training.
Dr. Bonnie Wilder:Weakness, or again immobility, so like not having enough range of motion at your hips or ankles. Weakness, or again immobility, so like not having enough range of motion at your hips or ankles and therefore your knee is doing most of the work. It can also occur from like having from like your knees caving in when you're running, which would be glute med or just abductor, hip abductor weakness. So it could be those. When I'm listing all these out, usually like a program would figure out what your most essential aspect is as to why you're having the pain, tackle that and then trickle in the other little parts, so it's not like you're throwing a ton of things at the patient all at once.
Casey Koza:That brings up something that now I'm curious of how do you, what do you first look at when you want to die? Someone comes in? Hey doc, I got runner's knee. What do you first look at when you want to die? Someone comes in? Hey doc, I got runner's knee. What do you look at first? Like, is it like the gate? Is it you know other symptoms that they have what, what? How do you get to that diagnosis?
Dr. Bonnie Wilder:Yeah, so I always walk. I always watch the patient walk in, so that's like almost your first test. They don't know you're watching them, but when they walk in the clinic, watch them there If they can. I would watch them run as well on a treadmill, virtually. I would have them send me a video behind and to the side and then from there I'm really looking at above and below before I attack the knee itself.
Dr. Bonnie Wilder:So, looking at the hip, maybe back. A lot of times they don't just have knee pain, they also have like ankle pain or something else that's also caused by the same reason. So, looking at the hip, looking at the ankle, clearing that, if that's clear, then okay, you know that it's a muscular issue and it's probably at the knee. So then you can dive into the knee itself. Everyone takes a little bit of a different approach. It also depends on the person and, like I pretty much only work with runners at this point. So most of them, their goal is just to get back to running. So, really looking at their gait, because these injuries don't just magically appear. There has to be a reason for it and you can usually figure that out if you're good at analyzing gait.
Casey Koza:So that's a pretty common theme here is at analyzing gait. So that's pretty common theme here is is that your gait impacts a lot of these different, different things, which definitely makes sense. I mean, if you're running a little bit crooked, knees going to be crooked, the hips going to be crooked, just goes up the the posterior chain, I believe.
Dr. Bonnie Wilder:Yeah.
Casey Koza:That sounds like a good term that I've heard Might be relevant here. I don't know, rob, did I get that one right? I think you did.
Rob Myers:Proper use. Great, dr Bonnie. I'm looking at the very, very long, impressive list of awards on your website and I have to ask when would one need dry needling from someone who is dry needling certified?
Dr. Bonnie Wilder:need dry needling from someone who is dry needling certified. Yeah, that's a good question. I needle everyone in person and the reason is because it works. You get better a lot faster. So I'll needle myself as well. I actually did just like two hours ago. If anything is like coming up where you feel like an injury is coming on, I'll needle that area just to help. A lot of times when you have pain there's also obviously inflammation and then with inflammation also comes knots. So with the needling I'll get rid of those knots. It feels weird. It feels like you're having a twitch inside, like a muscle is contracting beyond your will, involuntarily. I ask everyone do you wanna be needled? But because I work mainly cash and at a network in person people just if you tell them it's going to get them better, faster, they will do it and about 99% of the time it does.
Casey Koza:Right, okay, I've, I've. I've definitely heard of dry needling, does it? How painful is it?
Dr. Bonnie Wilder:It's not painful. It shouldn't be painful. I mean it might be upon insertion of the needle, but usually it's a pretty smooth, just like tap it in. You don't feel it, it's in like a split of a second. It's more so the weird sensations that go on inside. So if you're near a nerve you might get like almost like a shooting sensation of like a nerve shooting down your leg. I use a piston technique, so I just like tap in a few times and I'm out of there. It's like two to three seconds max. Some people will use what's called like a baking technique and the baking technique is like you keep it in there for a few minutes. I only do that for headaches or like low back pain.
Casey Koza:The term pistoning does not give me high hopes for it not being painful for me this pistoning does not give me high hopes for it not being painful for me.
Dr. Bonnie Wilder:It's quick, it's quick, yeah. It essentially just means like I'm going in there looking for a few muscular responses and then getting on out. I don't need to be in there long, so okay, well, do you do what's it called?
Casey Koza:I believe cupping yeah I remember that was a hot thing michael phelps would come out in the olympics with cups, cup marks all over his body I do cupping, I do grass and needling.
Dr. Bonnie Wilder:We got theraguns. We have all the norma tech compressions, everything like a runner would want we've.
Casey Koza:We've got it one-stop shop sounds like pretty much come to connecticut one thing I wanted to ask you about was injuries and how they relate to super shoes. We talked briefly before about shoes, but now with the new foams the Piba-based foams, and the plate that sits on top of that in between those two, doesn't propel you, but it makes you a more efficient runner. Have you seen more injuries? Specifically and I, anecdotally, I have like cause we talked about the Achilles earlier, where I've seen people that run a lot in these shoes that have developed Achilles injuries. Is that something that you've noticed? Is there any science out there that maybe dispels this or confirms this?
Dr. Bonnie Wilder:Not in, not in particular, the Achilles um more like bone, like bone stress, fractures or bone injuries. I know people who wear like carbon plated inserts. They'll have similar issues, because I did a little bit of research on this too and just based on, like my experience in person with people and myself, or like like Newton's third law, every reaction has an equal and opposite reaction. So when you're taking a step forward and you're being extremely and the shoe is like basically basically propelling you more so that you have more responsiveness, which is essentially what the shoe is doing it's making you faster by giving you like a boost. That's a lot more stress that's going through your body. So you're already at. You're already at like a downfall or like a deficit of being injured because of that. So there's more stress going through your body. It's not a good idea to train in these like regularly.
Dr. Bonnie Wilder:I know a lot of people I'll see, like in the airports or like walking around town with the vapor flies on, and all I want to do is say, like why are you? First of all, they're expensive, why are you doing that? But second of all, they're not meant for you. That's like number one. So they do cause more stress, but oftentimes what I found and that's why I don't really recommend the Nikes the Nikes if you've ever looked at someone running from behind, they all like, look like this. They're all collapsing in and what that does is now it's putting the force more in angle. So instead of just going straight up your body, now it's going like at an angle and that can cause a lot of other different types of injuries and it might look different on a person to person basis, but it's at that angle of where they're feeling the stress. So it depends on the person.
Dr. Bonnie Wilder:I've never, knock on wood, had an injury from running in carbon shoes, but I also don't train in them. I'll trade in the nylon plate instead and save them for race day, but you always want to break it in, so wearing it once before the race although they don't really need to be broken in nowadays but just getting a sense of what they feel like a lot of the times navicular, the navicular fractures, which is on the top of the foot. The navicular is like one of the more protruding bones in the foot and a lot of people have stress fractures there from the carbon chew. But that's what I've seen especially on the trail side.
Casey Koza:I know, like Western States, this year nine of the top 10 had some form of super shoe on. So when that happens, you see everyone else start to start to get them, and I do. I've just seen. I've seen people saw a guy benching like 350 the other day and at the gym and vapor flies. I was like yeah, I don't think you need $ 275 shoes to bench press bud.
Casey Koza:But no that's a very nice form, good job, um. But yeah, you see them everywhere and I just, I don't know. I, I'm, I'm of the assumption we've talked about a little bit that it changes your gait, and when you change your gait, things tend to get injured and that's a common theme yeah, when you do it so repetitively every day, like you said, hey, wear it for the race, you'll get your three percent.
Casey Koza:That's fine. They are lighter. They do give you more efficiency. But people like I see people every day on the, on the. I have the towpath right behind me where I run. Every day I see vapor flies and like hogan, rocket x2s and it's just like what. I guess you have a lot of money to spend on shoes. That's good for you, I guess, but I don't. I just I don't know. I'm kind of convinced that they do cause some injuries. They do.
Dr. Bonnie Wilder:Yeah, you're right.
Casey Koza:I don't hear that very often, rob. No, you don't. No, it's good to hear.
Casey Koza:But thank you so much for that. I know you know it's it's kind of a hot topic right now and we're only going to see more. I do know a very prominent runner that did tell us how much the foam matters and to train in the foam is good because it does absorb more impact on your legs, but the plate if you can do it without the plate feels it's a little bit better for the body. So take that for what it's worth, that in five cents we'll get you a pack of gum yeah, we'll definitely know more because they are gaining in popularity yeah, yeah, we'll see.
Casey Koza:Well, dr bonnie's gonna see it much more here. I I got a. I got a feeling in the in the upcoming years, of runners with probably bad overuse injuries from running in them every day and like people are proud of that. I guess I don't know Strange to me but I run in just regular, you know training shoes I when I hobble about out there and gamble about as they say so, but that's all the really everything I have. I know we went through it kind of quick because I wanted to hit a lot of different things with you. It's not often. Well, we've never had a doctor on, so someone you know, like yourself, that can explain things to in terms that Rob and I can understand.
Rob Myers:Yeah, we definitely needed it. We've had a lot of smart people, but you still you never know. You have to do your own research. But with you it looks like again your awards list. You're certified or have a degree in many things. We appreciate you being on the show.
Dr. Bonnie Wilder:Yeah, thanks for having me.
Casey Koza:That's why we like to have smart people on the show, because Rob and I get to learn and hopefully other people get to get to learn as well. But real quick, tell us where people can find you, dr Bonnie.
Dr. Bonnie Wilder:Yeah, so I am actually just. We're just opening up me and a chiropractor. A chiropractor and I were opening up a clinic in Connecticut. So I'm in central Connecticut, but I've been working a lot virtually as well. So on my Instagram, that's how people most of the time reach out to me. Yeah, so, either virtually or Connecticut, that's pretty much where I pull from.
Casey Koza:Your handle on Instagram is a Bonnie Wilder dot DPT. Thanks once again, Dr Bonnie, and we really appreciate your time.
Dr. Bonnie Wilder:Yeah, thanks for having me again.