Five Running Injury Myths and What to Do Instead

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Go check it out. You'll love it. Now onto the podcast. You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. And now, your host, Dr. Sebastian Gonzales. Hey guys, this is Sebastian with the Restoring Human Movement podcast. Thanks for joining the Movement Movement. This is your first time on the show. Welcome. You've missed a lot, probably about 250 different episodes, which cover a lot of different topics of different parts of the body, the hip, the shoulder, the knee, the low back, the foot, you name it. We also have interviews with different people as we're going to have one today. So this is Sara Van Dyke.

Hello. This is Sara Van Dyke. She works with me and she works with a lot, a lot of runners. And so I thought today we'd have the opportunity to learn a little bit more about, we're going to cover the topics of five running myths, right? Yes. As they pertain to injury. As they pertain to injury. So we're not going to go over like, should you drink your electrolytes before or after the run or something like that? Okay. So we're basically going to cover those five things. I might just prod her a little bit to see how much more information I can get out of her. But this is intended for general population, for everyone to get a good idea of what are some ways they can improve their musculoskeletal health as they're trying to recover from a running injury. If there are clinicians listening to this podcast, there's another premium version of the podcast just for you. We cover all the clinical tests as well as clinical reasoning and dah, dah, dah, all the stuff that you guys probably want to hear more about that isn't necessarily important to lay public quite as much. So let's get into it.

Sarah. Sounds good. So we talked, Dr. Sebastian and I talked a lot about how runners seem to come in with a lot of the same questions and kind of not necessarily illusions about what caused their injury or what can help recover, what they can do to help recover from it. There's a lot of these kind of common threads that come with running injuries and a lot of common questions that runners come in with constantly. And he noticed it, I noticed it, I hear it daily. So I thought that as a pretty intense runner myself and doctor who sees a lot of them, I might get into talking about that. So a lot of this is from my personal experience as well as my clinical experience. And I can, you know, back up some of it with cases or research as needed, but I think I'll get into the first myth, which before you, before you start, I know that every podcast kind of starts with this. Cause everyone's like, who the hell is this Sarah?

Oh yeah. You've been on before, but since we all know that with runners, there's such thing as speed goggles. So let us provide you a little bit of Sarah speed goggles real quickly. Just tell us about your, tell us really quickly about what you've done from a running standpoint so they can understand where you've been. Okay. Um, I am, I would say I'm a middle distance runner, which means that my primary events are 800 meters to the mile. Um, I run post collegiately for a track club locally, shout out to Cal coast. Um, and I ran in college for Cal Poly San Luis Obispo. I also do run some cross country and some longer road races. Uh, last weekend I hopped in a college cross country invitational and ran a 6,000 meters. It was fun. Um, in terms of what I've been up to recently on the running side of things. Um, since 2020 hit, I have, um, I ran at USA indoors, which was one of the last, um, national championships they had before COVID shut everything down. I ran the 800 meters.

Please don't look at my results. I did not run very well. Um, but I made it there and it was my first race at altitude and you know, I died, but it was okay. It was a good experience. Is that the one you were saying where you ran against a couple of the really fast girls and yeah, um, actually oddly enough. Um, so a few women that were on our U S Olympic team this year were competing there. I actually got to cool down with, uh, one of our, actually two of our, um, 1500 meter Olympians this year. And I raced against, uh, two, or I was in the heats against two of the, um, 800 meter women this year, uh, that made the Olympic team oddly enough. And I, I'm not saying this to make myself sound cool because neither she nor I had a particularly good race that day, but, um, our, uh, reigning Olympic gold medalist now a thing, Mo, um, she and I both ran pretty poorly at USA indoors last year. Um, I don't think she'll ever hear this, but if she does for some reason, girl, I feel you, I'm not trying to say you ran bad, but, um, uh, she and I both were like kind of in the back of the pack and she finished time-wise behind me. So even, you know, professional, she wasn't a professional athlete yet, but even a future Olympic gold medalists and American record holders have bad days. Um, and we just both happen to have bad days on the same time. So anyways, um, I did that, um, didn't do a ton after that in 2020, I paced a couple of professional meets. Um, and then this year I did, I did manage to get to pay some of those, uh, women who qualified for the Olympics this year.

Well, I think we talked about this is that you got paid to pace, which you got paid to run, which means you're a professional. Yeah. I mean the definition of professional runner kind of runs the gamut. Um, my coach always says that you're a professional runner. If you have a sponsorship contract or if you make more than $2,000 in a year from running, which I've kind of come close to in a few years recently, but, um, I don't actually normally count that kind of thing. So we'll see. The year's not over. I still have a few more races I can make some money in. Well, so the reason I wanted to have you share all that stuff is because it is really common for people to say they're running doctors when all they really do is half marathons. Like, and there's a very different, um, uh, training and experience associated with that. So you really are doing like you're in drenched in it. So, uh, and you see a lot of people with the same experiences too. So you can resonate pretty well. So I thought this would be, hopefully y'all trust her now. Okay. Yeah. I mean, I think that's important too, because I have to say from my experience when I was, um, before I became a doctor and when I was running and I had all those college injuries that kind of led me into this career, I really had a hard time trusting some of the doctors when they would give me advice about my running because of the fact that a lot of times the advice would look like, Oh, well you just need to take weeks off of running. And I'm like, well, you don't understand. Like I've put in eight months of work for this season. And if I take off three weeks, it's pretty much like throwing almost all those eight months in the trash, not completely, but, um, a lot of the standby for non running doctors is, um, to tell people to take time off when you know what, sometimes time off is necessary and sometimes it's really not. So, um, my goal is to not tell people to take time off unless it is, uh, necessary. But I do think that people tend to trust me a little bit more because of the fact that I have been at that level of intensity I've done, you know, not a hundred mile weeks, but I've done 60 or 70 mile weeks before, um, 60 pretty consistently in college. I've done the high intensity speed stuff. And I also spend most of my time around people who run, um, at pretty decently elite levels, whether it's on the track, the roads in the marathon, or I have a couple of friends who are like, um, elite ultra marathoners. So that's kind of like my life anyways.

Well, so you did mention the things that would be meriting not running maybe for a couple of weeks. I know that I'm going to ping some people's attention. What are some things that just come off the top of your head that might be like, okay, you need to take some time off and maybe what are some things that typically aren't? Well, okay. So I think one of the guidelines that I will usually start with is what is the pain severity and how does it relate to running? So for instance, if you're somebody who has, um, five out of 10 pain with running or above. So if you're a three or four out of 10 and you're in pain and you're running and it stays at that three to four level, I usually think, okay, you know what? You might be able to run through this one, but it also depends on goals. So if said runner comes in, they're like, you know what? My foot hurts. And it's a three to four out of 10, but it stays that way for eight miles. And it's been that way for a few weeks. And I have a marathon coming up and I think I can make it through with three to four and it not getting worse.

Um, then I'll say, okay, like, let's try to run through this if we can and like minimize your time off. Similarly though, it really depends on like kind of performance specific goals for that example that I just gave. If the person's able to get through like, you know, a 16 mile run and their pains a three out of 10 and it doesn't get worse, but their marathons in two weeks, it's like, well, if you taper right now, it's probably not going to kill your marathon depending on how much you taper. So we might be able to just kind of back the running off a little bit, maybe support it with a little bit of cross training, but we're probably not going to take them out at this point. Um, but let's say they start the same person starts running, um, and their pain starts at a one. And then all of a sudden they're three miles in and every single time it gets up to like a six or seven, that person's going to be taking some time to run a little bit less or we'll discuss if there's certain types of running that makes them feel better.

So for instance, you and I have talked a lot about, um, low back pain with runners and sometimes people will do, um, a lot of high intensity speed work and their pain will get, their back pain will get worse or it'll be debilitating as soon as they finish that speed work. That's kind of a sign that the speed work is a problem, but if they don't have any problems with easy running, we might just back their pace up a little bit. So they're doing a little bit more threshold type speed work instead of just, you know, maybe it's 200 intervals that hurt. We'll back them up to like, let's do a 20 minute threshold run and see how you respond to drops and pace to a certain level. If your back pain's fine, then we'll keep it. Um, am I getting too in depth here?

No, actually, um, I was, I was actually thinking just a, maybe a, a prodding tool that some of the listeners might use if their patients, if they're wondering if their doctor is, or their doctor, their trainer, or somebody is actually in tune with, or in familiar with running programming, maybe they ask them what an interval means. Like the patient would ask the doctor that. Right. Because even like, like, I mean, although we work like, I mean, I guess we work in the same office. Um, I don't know what the hell it means, you know? And so what, when I say workout, I mean, workout with weights, when you say workout, you mean track, right?

When I say workout, and this is not for every single runner, but usually runners of a specific level. Um, or I can't kind of like a breed within running, I guess, cause not everybody would say this, but a lot of people say workout and they mean hard day. So when I say a workout, it doesn't necessarily have to be on the track, but it's a day where I'm going to be doing higher intensity stuff. My speed is going to be turned up and it's not going to just be easy miles out there. Okay. Well, I just bring that up because I just want to make sure everyone does find the help that they need. Um, and you want to have someone who's familiar with what you're, what you're doing.

Um, no, not doing depth at all. Yeah. The, uh, so, uh, let's go on the myths then. Okay. Cause we can, I can see we can go down this rabbit hole probably quite a bit. I know. I just looked at you and I was thinking the same thing. So let's do, what is myth number one? The most common myth that, uh, runners might, uh, have read about when regarding the musculoskeletal injuries. Oh man. So I would say right now, the, the thing that's been coming up in my practice a lot more often has been, well, you know, I need to just change my gait pattern or my injury is a result of my gait pattern. Um, maybe, but probably not. That's a big myth. Um, a lot of the times because people want to just tear down their gait patterning and try to build it back up again. But it's so funny because you hear contradictory things from people that come in with their, like what they read about gait. Um, I had one patient that hurt themselves after switching from a four foot strike to a mid foot strike because they didn't ever see anybody fast who ran with a four foot strike and had read that it was bad for you. Then I'm sure you've had a million people come out, come in and tell you, oh my gosh, I heal strike too much. I need to switch to a four foot strike. Um, or people talk about pronation or whatever. Um, the, the foot striking thing was, was a pretty popular thing at least, you know, like eight years or so. That was like a big thing that kind of became a, a thing that people wanted to look at an attack. And I mean, like I said, I've had people switch, try to switch their gait because they didn't think it was good. And then they wind up injured. So, yeah, I've, I've seen people like this recreational runners on the sides of the street and it looks like it's some like, you know, you look, you look at somebody, you're like, why are they running that way? It almost looks like unnatural the way they're doing it. Some people like, you can see, they're just trying to land on, on their forefoot. And it almost seems awkward. Uh, I don't know. I'm personally of the thought that, uh, for most people don't worry about it. Like if there's another reason probably why you're having pain, it's not because of your gait. Your gait is just happens to be a, uh, incidental finding.

I agree with that. I mean, sometimes there's certain little tweaks that you can make. Like if somebody says, you know what, I keep having this pain on uphills and you realize that it's related to them, uh, not really like they're like leaning into the hill too much, you can tell them to, Hey, you know, like maybe drive your hips a little bit more instead of bending back, bending through the back. Sometimes that's something that can be useful. Um, but usually you don't need to sit there and change your gait mechanics. Like how you're swinging your arms is probably not going to change your world in terms of injury. Um, I agree with that. And I mean, here's my, here's my thoughts on why that happened like scientifically on that. Um, you have been building your motor patterns since you started to crawl and your body has a better knowledge of what your mechanics and, um, anatomy and efficiency is. Um, then, you know, some clinician or yourself probably does. There are some cases where maybe a little bit of gait retraining is warranted, but the vast majority of the people that I see really don't need it. Um, and it's probably not the problem. If you've been running on, if you've been running with the same form for the last 10 years, why would it suddenly become a problem now?

Well, you know, um, what comes to mind is I agree too, by the way, like, I don't think you need a perfect quote unquote, perfect gait to really run pain-free. Yeah. You can still get injured with a perfect gait. I've seen it. Yeah. You know, um, you already know I'm pigeon toed. Yes. I have no, like, like I actually, I'm surprised you guys even see it. People walk behind me and they're like, Oh, you're pigeon toed. I had no idea. I don't have any foot, knee problems, hip problems. I have it back problems before, but they're from other things too. I don't have any problems when I run. Um, and I'm faster than pretty much any guy on my baseball team.

And also you have really strong toes. I think it's cause you're pigeon toed. I have strong toes too. I don't know if I told you, but back when I was, I think I was probably like under 10 years old. So one of my friends, we were at recess. I barely remember this, but he said, how do you run so fast? And so I taught him to run pigeon toed. Oh my gosh. Or I thought, or I thought I did. And I, and so, um, I don't think it matters that much, but when, when people are learning to retrain gait, what I've, what I've noticed that they start to do is people start telling them how to, okay, you need to, you need to go heel to toe or toe to heel. Like it becomes these little baby steps of running or walking, which I think is just fricking annoying. Like, I don't, I don't think even if you were to retrain gait, I don't think that's the right way.

No, I mean, seriously, like your body and years of genetics and evolution have kind of put you into this point where you've, uh, kind of developed all these efficient gait patterns and your brain and central nervous system have done so much to figure out, okay, well, this person's bones are this long and like the joints look like this on this person. So we're going to have them run this way. And yeah, we probably should move on to the next myths, but, um, one, one note on that then is what then rather than address gait, what can we do instead of that? Well, I mean, besides the fact that, you know, sometimes there's a few cues here and there that you can use to help with maybe things that could have to do with like gait, like I said, with the hills, you know, leaning into the hill or leaning away from the hill, whatever, driving through the hips. Um, instead of that, I would work on, um, I would really work on strength or drills, you know, sometimes, you know, the person need, the person does need to work a little bit on hip extension.

So why not work on more hip extension running drills or, um, working on strengthening the hip extensors or, you know, work on hip stability or core stability or whatever it is that's not allowing them to get to that extension because their body doesn't feel safe. So, so what I'm hearing is work on the gait during the drill, not the running. Yeah, totally. Okay. Um, let's go to myth two. And I think, uh, I'm going to, at some point try to open this door because it's hot in here, but I hear people talking out there. Okay. So in case I do get up, that's what I'm going to do. You keep going. Okay. Sounds good. Okay. Myth number two. So I think myth number two is going to be my shoes cause my injuries. Um, I mean, running shoes are at the forefront of a lot of running debates going on right now. Um, with the inventions of the carbon plated shoe technology and all that stuff, running shoes have almost never been more popular to talk about among runners. Um, I personally do not run any carbon shoes. I'm just going to put that out there. Um, but I, um, hear so much about people talking about, well, you know, I think I just need to change my shoes kind of similarly to the gate thing. This is going to be able to, this is a question that you can kind of solve by common sense as a provider. Usually if you feel like you need to change shoes, I'm going to say, well, why don't you just try that and see if it helps you? And then if it doesn't, then you can come back in and tell me, because I know that if someone comes into my office and they're very convinced that it's the shoes, then they're probably not going to listen to anything else I'm going to say. So we need to at least get the shoe thing off the, off the wagon.

And you know what? Sometimes people have just changed shoes and they're like, you know what? My foot hurts now. Usually it's like, well, let's just go back to the other ones. And that usually solves 90% of the cases that I have with that. Yeah. I was going to say like, and maybe the easiest thing is, okay, just get rid of the shoe you just wore. And then like people usually keep their own old shoes for a little bit, right? Yeah, exactly. Just as like backup. I always keep an old pair of shoes in my car. I saw a guy before that he used to date his shoes. He used to write it on the white part. I've seen that. I know people who write their mileage on their shoes too.

Oh yeah. Okay. So, um, don't buy fancy shoes unless you need to. Yeah. And also don't blame your shoes for everything. I mean, odds are, um, it's nice because it feels like you have control over things when you can blame shoes, but sometimes you got to dig a little deeper than shoes and look at what other things you could be doing. Um, whether it's a training change or it's, um, you know, just needing to work on those, uh, strength things that we talked about or, you know, whatnot. Um, remember that most shoes are there to support you. And, um, also humans were able to run for years and years without having shoes. So, so I'll provide a couple, uh, short talking points. Uh, well, maybe I should just go barefoot then or wear those little strappy shoes that they used to wear. And Oh, good. Um, you got to work into those. That's a great idea, but you can't just go from like your hokas to, uh, barefoot shoes. That's a huge jump. Um, not saying plus or minus to either of them, because I know people who run injury free with both options, but if you're in a transition to more of a barefoot or a like lower drop or lower cushion shoe, then you have to allow yourself some time to get used to such things. Um, in small increments and also prepare your feet. Like you got to do a lot of like feet, hip, et cetera, strengthening to be able to handle that kind of a thing. So, um, yeah, you can't just jump into barefoot shoes. That would be terrible.

Well, so what do you think about the big soft ones then? Like the hoka, the hokas or hokas the only ones you make that? Is that like, um, that's just like the well-known one. Did they lasso the clouds from the sky and put them underneath your feet? Pretty much. Yeah. Yeah. Well, so what's the deal? I feel like I've only met people as they wear them after they run or they wear them because they do a shit ton of miles. They were originally developed as ultra trail shoes. Um, hoka became popular because they were, they developed a lot of, uh, trail specific shoes. Um, and then they kind of branched out from there. I would say, um, it's very up for debate because it kind of depends on who you're talking to. I'm very much like on the side of the debate of like, you need to strengthen your feet. You can't expect your shoes to do everything for you. But if you're somebody who expects yourself to like run through like rocky trails, I'm sorry, but doing that like in a barefoot or minimalist shoe, like, I mean, it takes a long time to build up to that. So, uh, if you're not really willing to be patient to do those things, or if you're not really willing to like run the risk of hurting, like, you know, actually hurting yourself from like the rocks or something like that, then, um, I don't think that those are a bad call.

Um, I own a pair of hokas at this point. I wear them and a sock and you can borrow, which is a pretty light shoe. Um, my hokas, I generally tend to use for longer days just because my canvarras are pretty light and I like to have just a little bit more, um, cushion on my, uh, longer days. And also cause I feel like I tend to not sprint as much in them. Um, I need to go a little easier sometimes, but I've, I, um, I don't think that they change my gait at all. I tend to be a pretty, um, I tend to have a decent amount of, uh, back kick when I run. So like my leg kicks pretty far backwards and I use a lot of posterior chain, which is the, which is the legs in the back of the muscle or the back muscles in your legs. So like glutes, hamstrings, whatever. I tend to be more dominant in those areas anyways. So, uh, a pair of shoes is not going to change that for me. Um, there are some people who like, I would probably say maybe you shouldn't put on a pair of hokas. There are some people who probably could benefit a lot from them. I've known some people who, whose tissues just needed time to adapt to the load and the shoes were able to help with that. So sometimes when you're dealing with somebody who just needs a little bit of extra support, that can be helpful, but also you're going to still wanting, want to be working with this person on strength of feet and hips and stuff to support them so that they don't really need the cushion as well. Um, so it goes both sides.

So it almost sounds like the Hoka or a soft shoe, uh, could be almost like a, like a blood pressure medication. It's like you're on it for a period of time and then the goal is to get off of it. Yes and no. Um, I don't necessarily think that you would ever tell somebody to get out of a pair of shoes that they're comfortable in and that they do well in. Um, unless it's seen, unless it really does seem like the injury is a shoe mediated, but if it's been working for you and you've, uh, done well in it for a while and stayed injury free, like I'm not going to be someone that takes shoes away from people. Now I do read a lot of the, um, a lot of the more like anti-shoe barefoot stuff, as well as the other side of the story. And I think both have valid points. So this is annoyingly one of those cases where it'd be like, Oh, it kind of depends on the person in the case and like what you've noticed about them. Uh, but the main real takeaway from this is that shoes probably did not cause your injury. And if they did just change your shoes and it should change your problems. And if it hasn't, then the shoe is not the problem. Yeah. Pretty easy answer to that one. Just change your shoes. And if it doesn't fix it, then it's not a shoe problem. Yeah. But if you didn't spend 10 minutes talking about it, I wouldn't believe that one line. I don't know. Uh, okay. Let's go to myth number three, which, what do you want that to be? Um, let's see. I was going to go with, do you want to talk about it band right now? Uh, we could do that. I know we talked about, is there a speed one? I think, uh, there was a, Oh yeah. Uh, there was quicker pace.

Yeah. Was there a fifth one? I know that we, there was five, we can run long on any of these. So I was going to say, um, Oh yeah. So I think the third one was, um, speed is always bad for me when I'm hurt. Um, not necessarily the case when I was talking about an earlier example in our first myth, I was going to go over a case where somebody who has back pain actually feels better with intervals, um, or high speed stuff. And then worse with that slower, longer distance. Um, there are lots of patients who actually, and different kinds of injuries that actually do feel better with speed. For instance, um, sometimes some of those like hip impingement presentations will actually feel better with running and with, uh, faster stuff. And then as they walk around or, you know, kind of do lower intensity exercise, they'll actually feel worse. And the thought behind that is that you're engaging a lot less of your supportive hip musculature when you're doing those things versus when you're running fast. So I'm, I'm a fan of when I reintroduce people back into running, obviously heart condition, um, specific, if they don't have really any heart conditions, like stadium steps, which the stairs will make it. So like long stadium steps will make it. So they have to elongate their stride a little bit and drive their arms. Um, also most of the time, like I know this one guy asked, so should I, should I run, should I, my, should my swing phase be more with toes up or toes down? And I said, just if you're toes down, you're going to trip. So, you know, if there's stairs there, then you won't necessarily do that. And it'll guess quote unquote, train your gate on automatically. Um, but also running, uh, or sprinting some form of sprinting, submaximal sprinting up a, up a hill. Um, uh, I heard a, I heard a good saying today of, um, they said basically go into your fast switch fibers are gone. And someone asked, how would you know?

And he said, you'd slow down. And so true. And so just go into your fast switch fibers are gone and then just walk back. Um, but I think it supplies a lot more, uh, success, especially when people are hurt at running slower speeds, you just change, you're changing the trigger a little bit versus just, um, telling them they can't run. Yeah. And that can help a lot with keeping fitness. Um, I mean, you get most of your gains from the harder stuff anyways. I mean, depending on what you're training for, of course, um, obviously if you're training for an ultra marathon, doing sprints can only do so much for you. We'll help with your hills though. Um, I would say speed training can be very useful in injury recovery, depending on how it's applied and what your injury is. So don't always assume that speed is the bad guy. And, um, also with that guy with the swing phase thing, good luck trying to point your toes down while you're in swing phase. That just doesn't naturally happen. You know, so it's funny, like when we were talking a little bit, uh, like, so I usually like to ask people like, so what do you think you're doing? Like, cause he's like, I think I, should I be doing this? So I said, what do you think you're doing? And he's like, I think my toes are down. And I'm like, okay. You know, I didn't want to argue with him about it, but I was like, I'm pretty sure you can't like most people when like, if you just guys, if everyone just kind of sat there and forcefully tried to raise their hip up, even if you're seated, your toes are probably up. Like you can probably see your toenails. Like it'd be very, it's kind of uncoordinated to point your toe down and lift your hip up at the same time. Uh, kudos to dancers and ballerinas to be able to do it. Cause it seems very kind of unnatural, at least to me. It's more something that has to be trained. Yeah. Yeah. You're breaking up, uh, uh, what do they call them? Um, uh, not complimentary movements. You know, Hey, when you grab something and pull it towards you, your elbow automatically flexes and your shoulder, you know, so they're a coupled movement. So it's basically the word.

Yeah. When you look down, like automatically your, your head goes down, but also your, your mid back flexes too. Like it's really hard to, to keep upright and look down too. It's just unnatural. So there anyways, yeah. Coupled movement for those of the people who are not in the room with us. We're currently trying to do these while we're talking. So it's hard. It's like, uh, patting your hand on top and rubbing your belly. Yeah, absolutely. So, I mean, I agree with, I totally agree with you on that one. Um, and yeah, so the, the big takeaway with that one is that speed is not always your enemy. And sometimes when you're injured, it can be your best friend. Um, let's see.

Myth number four was going to be just, if I just stretched more, all of my injuries would go away or, or the, I need to be more flexible. Um, that was a good one. I liked this one. My goodness. So flexibility is kind of a myth in a lot of ways, but I'm not going to get into that whole, uh, sand sandbox there. Uh, well, actually, why don't we start and start with one thing. Static stretching is the only thing I think that's been shown over and over again throughout research to be, uh, detrimental to, to sprinting performance and a lot of things. And it does have its time in place, but for some reason, um, uh, static stretching still keeps on. It's like, you see runners, like, like crows on a wire. They all have their heels or toes up on a, on a, on a curb stretching statically before they go. So, um, it, it does a lot of things that are not really super productive, but, um, without going too deep into the well, let's move on from that.

Yeah. I'm going to go on record by saying that I do not have a stretching routine anymore. I don't do it. I did it for years, uh, high school, college, post-college for a while. And I mean, I, I knew all that research. I learned about it when I was, you know, kinese major at Cal Poly and, um, further in my exercise science knowledge. But as I've come to learn, a lot of the stretches that we do are actually like the stretching feeling that you feel isn't what you think it is. Um, and not to get in the weeds of neural tension, but there's a lot of stretches out there that actually the stretch feeling that you feel is not the muscle. It's a nerve underneath the muscle that's stretching.

And, but it doesn't feel like a nerve. Oh, well, if we're probably the everyday conversation, no, of course I don't try to go get into that with people. Cause I don't want to have that argument, but trust me, it is. If you bend down and try to stretch your hamstrings and touch your toes by doing it, um, and you bend your knee, a lot of that feeling goes away, but you can still stretch a hamstring with a bent knee because the hamstring does, um, Well, an easy, an easy way to tell it too, is like, if you have, if you're seated and you put your leg up on like a chair or an ottoman in front of you and just wiggle your toes up and down, you'll notice that all of a sudden your hamstring gets tighter as your toes go up and the hamstring doesn't go that far. So there's, there's a lot of different ways we can, uh, affect mobility and flexibility without really stretching the muscle itself. And I don't think sarcomeres, those little muscle increments, they don't even really elongate, do they? I'm pretty sure they don't. So you can't really elongate a muscle. I mean, besides like, you know, the actin and myosin and like the, Oh yeah, it's, it's normal parameters, right? But you're not going to like, you're not going to suddenly just majorly improve the ability of the muscle to be longer.

Yeah. No. Right. But that doesn't mean you can't get more mobility. Yeah, of course. I mean, when, what mobility really probably is, I mean, it's something that's still kind of up for debate, but what it really is, is your nervous system is okay going into certain ranges of motion. Um, and it's letting you do that. And it's let, and it's more your joints ability to kind of go into certain ranges of motion, either passively or actively, which is a little bit more of a central nervous system construct. So, um, sometimes that means that your nervous system needs to feel comfortable with certain movements, um, either because it doesn't do certain ones very often, or because it's not strong or stable going in a certain direction. When the, uh, I don't want to leave the muscles and tenants out of the equation. They're, they're part of it, but they're, they're kind of reactional. Like they, they help out to, um, they're kind of told what to do.

Yeah, exactly. They're pawns in the game of chess. So, um, anyways, so stretching, you don't do it before you go anymore. Is that what you're saying? I don't stretch really anymore. I'll sometimes do like little baby stretches with friends after a run, just cause we're like hanging around talking about things. I'm not really sure what to do with my body. Um, and you know, sometimes it's fun when, if I do hop into a gym workout to like do some of those stretches that people do, but I also try to avoid doing a lot of them just cause a lot of them are pretty unproductive or unproductive, but really because stretching and flexibility does not really prevent or help injuries. Like I bet you most people listening right now, if you tried, if you thought about any injury you've ever had and thought about like, Oh, what you tried to fix it, you probably tried stretching and it probably didn't help you. One of the things that I think is funny is when people think that they have a muscle injury and they're like, Oh, but I keep stretching. And I'm like, if you had a muscle injury, you wouldn't want to keep stretching it anyways. If you have something that's like torn, why would you stretch a torn area? That wouldn't help. Um, similarly to there's other things going on. Well, some people might have just the listeners that are like, there's obviously everyone's in a different situation. And so some of you might be like, well, no, I've stretched it and it's gone away. Some people do have that experience and that's not wrong, but there are a lot of people that we end up seeing that they try to stretch it for months to years and it doesn't go away. And, um, you're right. If you had a muscle tear or a strain, why would you stretch it? It's a, it'd be an actual, um, like injury of the muscle tendon complex. So once you give it a chance, don't try to stretch it. Like that's how it got that way.

Right. Yeah. Centric elongated. It was an overstretch movement. Same thing with, if you had like a ligament injury, ligament injuries are basically overstretching of the ligament fibers. So there's a lot of types of injuries that you actually don't want to stretch, but you're right. There are some times that people are like, Oh, I stretched it and it felt better, but they usually don't end up in our office. So yeah, you can't discount those possibilities. Cause it does happen. Um, I just, I, if I had to guess, I'd say probably over half the time, stretching does work enough for people where it's not like an immediate thing. They need to go see anybody. And then after that there's, they might notice it comes back or they might notice that, you know, it never did go away.

Yeah. I mean, it totally works in short term. There's a lot of people out there that are like, wow, I stretched my back and it felt so good for like an hour. And then it comes back. So I got a buddy that he, um, uh, he strained his hamstring about three weeks ago. Um, and so he took the liberty to take their man to the day off and stretch it. And then, um, the next week, uh, we, we talked and he's like, I feel great. I've been fine all week. I just rested it. Um, within the first 10 minutes of activity, it came back again. And then he rested a week again. And then the next week we didn't see him again. So mainly he didn't, he didn't, he didn't play again. And so it took him three weeks, um, to basically do resting and stretching. And this is a, this is basically a situation where it's not working out. Um, but if it did, if it was going to work, it would have worked. Yeah. Pretty quickly too. And I mean, you know, like I said, it's very common for people to have temporary relief with stretching. Um, cause that's a lot of feedback and input that you're putting into the, into the body in that area. But if it isn't something that seems to last, then it's probably not the fix. Well, so then how about we give them an idea of what maybe what a better thing to do is other than just general, like, let's just say you want to elongate your calves or whatever the goal is, instead of being like on that little, uh, like the, oh, my calves feel tight kind of thing. Yeah. How might you warm up to loosen them up versus stretching them on a curb? Great idea. Um, well, real quick, I'm going to answer that one in a second, but I wanted to bring out the whole like flexibility thing. Actually, I'll answer that and then I'll talk about that. So nevermind. So to warm up your calves. So if you're somebody who's like, oh, I have chronically tight calves, knots in my calves all the time, need a foam roll, that kind of thing.

Um, you definitely would probably consider doing a little bit more of an active thing. A lot of times people who have tight calves, um, might have some like shin muscle stuff that needs working on. So like this muscle in the front of your shin called the tibialis anterior, you might want to do some drills to kind of activate that area a little bit more. Um, and some drill, I would, I would basically, I'm suggesting a more active warmup with drills or, um, kind of light movements to warm it up instead of passive stretching. So passive stretching is when you just hold a position, um, ankle circles. Well, there's something, there's some drills where you kind of just like rapidly go into like dorsi and plantar flexion and like some skipping things, like A skip, B skip, things like that, stuff like that. Um, there's some, there's a little bit more specific ones that I'm thinking of, but, uh, toe walks and heel walks can also be kind of good because you're starting to kind of just get more blood flow in that area and you're going to be a little bit more active and they're more similar movements to what you're doing when you're running than just like holding a muscle, like in a stretch position. I would suggest that, um, if you're somebody who feels like you have a calf injury, maybe some like isometric holds might be a good idea too. So using the curb in a different way. Yes. Repurpose the curb. So, uh, what if they have like a hamstring they want to stretch, um, or a hip flexor? I would say that you probably actually just want to warm up that area again, using more active methods. So some of the aforementioned drills might be good, but I would really even think warm the glutes up or, you know, warm that area up, do some like light movements. Um, we have some pretty good band exercises that we like in here. If you feel like your hamstrings are tight, um, and they're working too hard, let's try to get those glutes on to share the load. So glute bridges, um, probably not clamshells. I don't like clamshells very much.

I don't like clamshells. I think mini bands might be, mini band sumo walks might be a good thing to do. Yeah, that would be a good one too. Um, I'm drawing a blank on the one that's a mini band where you're going like leg forward and it's kind of like a stride. Oh, um, I don't recall. Yeah. But a couple mini band ones are good. I just can't remember the name of that one. Well, just, just some food for thought on what you kind of mentioned. So everyone can get a little creative if they want to, to, to develop their own little warmup. But, um, you know, one of the best ways to stretch hip flexor is to do hip extension, which is that bridge you talked about. Yep. One of the best ways to stretch the adductor is just to squat deeply. And so you might consider how the muscle elongates through the actual action of the movement that you're doing. Yeah. And that's how you can make it a little bit more of an active warmup. Yeah. I actually air squats are a great idea too. Um, maybe practicing some movements that you may, that, you know, you may not be as good at if you know enough about your kind of movement abilities. If you're somebody who needs to work a little bit more on hinge patterning, maybe do some hinge, hinge stuff with a band, um, or a weight or something like that. Um, I really like that though.

You're right about the best way to kind of elongate a hip flexor is to go into hip extension anyways. So might as well get that working out. Um, and they can get a little creative if they want to, but totally just, does, does Sarah, does Dr. Sarah have any videos of warmups she likes? Um, I have a couple actually. I, one of my, uh, colleagues who practices in Texas asked me to put up like some drills. Um, and I put up some pretty basic drills, a YouTube video. Um, I think it was a YouTube video of some pretty basic drills that we could do there. Um, I give my patients some specific things to do based on their condition for warmups before running, which won't necessarily help anybody listening, but there's a few easy things that I have on my YouTube that are like, Oh, try this to like, you know, work on tight hip flexors or whatever. Um, those might be helpful for some people. So is that Sara Van Dyke with Sarah with no H on YouTube? Uh, it's dash chiropractic actually. So dash chiropractic on YouTube. Okay. I'm not a behemoth like Sebastian, but yeah, well I've been on there longer. Let's do the last myth and okay. Then we'll clean it up a little bit. Sounds good. I'm going to finish one last point on that last one about, um, people and their feelings about their flexibility. Okay. So one last thing, there's been a lot of studies that have shown that, uh, very more of our very efficient runners. So the people who have a lot of running economy and are like naturally better at events, like the marathon tend to have really low, like quote unquote flexibility, like those flexibility tests that you probably did in elementary school.

Um, those people usually don't do very well at those. And it's usually, and it's thought to be because they're more, um, efficient and economical. And so their joints don't really go into any aberrant or like unneeded ranges of motion and that their joint is pretty, just pretty much just like economic through like a certain range. So they're not using energy going into places that they don't need to. Um, so a lot of times those type of people will be the ones that are like, you know, I just really need to work on my flexibility. I need to stretch more, but actually sometimes that's your gift is not being very flexible because that allows you to be more economical and efficient. My stride is not efficient. I'm more speed-based. I literally kick my butt when I do sprints sometimes.

Um, and I have a lot of range of motion in certain areas and it's not always a blessing. So sometimes you don't want to be more flexible. Kind of depends on what you're trying to do. So I wouldn't take your lack of flexibility as like, you know, the biggest problem that you have. Yeah. Are you trying to be a ballerina? Are you trying to be a marathoner? Exactly. That's what I'm saying. So don't necessarily assume it's a bad thing. Let's move on to myth number five then. Okay. Well, I think before we should go, I, we should mention that I did beat you in a foot race before. Oh yeah. I thought you were trying to prop up my cred.

No, I'm, I want to, I want, I want to prop up my cred a little bit too. Uh, the debatable results on this one. We're outside the office one day and Sarah was wearing slacks. She said she didn't warm up in her stretching way. And, uh, and I was mostly just that I was wearing slacks. I slipped on the, at the, uh, I slipped at the, uh, starting line and then we had a debate of where the finish line was. And yeah, I like stopped and then he like passed me right as I stopped and it was like a 25 meter race and, um, he was declared winner, but there was a lot of things going on there. So I guess next time we have, we have to have more clear parameters.

Well, we're trying to figure out what a good fair distance is. Cause Sarah would do very well, probably at 200 to 400, but I think I would maybe hit a hundred on her. So we're trying to figure out where would a fair, uh, distance be. But it's funny because the last time we did race, I mean, you said you slipped. I don't know. Cause I was too busy running, but she was too busy. I got out faster than he did. And I, I assumed that he was going to get out so much faster than I did because he's, he's an explosive athlete. So, so it's funny. And so in baseball, there's a trick that's happened sometimes. And that happened this last weekend is so I was running through and going to home. And so we use it as a throw home and there was a throw I thought coming. And so you see the catcher. I seen pointing at second base, directing traffic, but then at the last second, the ball comes in. And so you almost, you're tricking the person into slowing down. Uh, luckily I didn't, I actually thought about slowing down, but maybe I was just tricking you.

Possible. Uh, let's go to myth number five then. So this is your favorite, the IT band stuff. So what did we actually call? Oh, sorry. I need to get closer to the mic. What did we actually title this myth? Was it stretching the IT band? IT band pain? I think let's, let's maybe like organize it, uh, really quickly to where if you have thigh pain, not just knee pain, but thigh pain too. And you think that your TFL or your glute med or your, you know, your actual band, not where it inserts into the knee is your IT band problem. It's probably not. So I don't know where you do that title, but it's probably not your IT band. Myth number five.

Pretty much. Um, but yeah, you want to start with this then? Um, yes. When I was in college, there were many, many girls on my team who ended up having to take time off for IT band syndrome. And, um, I don't know, there's lots of different prescriptions that we all gave them like, Oh, you just need to strengthen your quads, go do more squats or whatever. Um, but it, um, the IT band, a lot of people think, like, Oh, my IT band is just really tight. Like the IT band tightness is seen as just like a huge, huge problem in the running world. And I'm here to tell you that your IT band as a band, maybe it can get a little stiffer, but you're not going to stretch it.

It's, uh, too strong. They've done some studies with, uh, cadaver IT bands where they basically like attached weights to it to see if it would stretch. And they put like more than the average human's body weight on there and it still wouldn't stretch at all. So in most likelihoods, you're probably not going to stretch that thing and you're probably not going to loosen it. Um, most methods of doing that don't really seem to pan out and what some of these articles examining it have shown. Um, I could be wrong. And there's, there's such thing as like, sometimes that area will feel looser because it's more of a nervous system problem. Um, and there's areas around it that are like tightening or it feels tight because your body's trying to block you from moving in that direction because it doesn't feel safe. But, um, a lot of times the pain or like sensation of stiffness that you're having there, which is like a dull, achy pain, um, it's really coming from other structures. It's, it's pretty hard to actually injure or tear an IT band. Have you ever seen one? A torn one? An actually torn IT band. No, never. I've never, never seen one either. And I mean, the syndrome is really just like a description of like, Oh, this feels really tight here and it inhibits me. And I feel like I can't run and it gets really achy or dull or sharp or shooting pain down the AT band when I try to run. I mean, a lot of people get very attached to this diagnosis. Even people who I've talked to that have like weakness in their leg, can't push off from the calf and have all these other associated symptoms will still get mad at me when I tell them it's not your IT band. You have all these other things going on.

So, so I think, I think that's, that's actually a good direction to probably take on this. Um, that, uh, if you, I know a lot of people will self-diagnose with IT band, they'll read up some junk in a forum or whatever, and they'll decide on that, or they've been told it. But if you believe you have it, I think probably number one, if you have any numbness or tingling, you don't have IT band. No, cause numbness or tingling is only going to be a vascular neurological issue. And if you have back pain, you don't have IT band. Totally. And I mean, I understand that I've had an extremely tight feeling IT band before that was like a solid year plus in college, but I can tell you that the things that didn't help it were stretching, rolling and like soft tissue work as well as ice and heat.

Well, it's interesting too, with like, it does feel temporarily better with those things though. I know it does. The, uh, it's interesting that when you examine someone with an IT band, problem on say the right side and you compare the left, typically the right side or the problem side is more flexible or has more passive range of motion. Um, meaning their hip is more mobile. The IT band is more mobile. Um, but they still feel tight. And so, cause they spend a lot of time stretching it, which there is, you know, adaptation at some point, but the feeling of tight is different than actually being tight. So the feeling of tight can be from something else.

Totally. And I mean, for him and I, usually what we find is that's going on with that. And we've talked about this a few times. Um, usually you're dealing with something that's coming from another area. So whether it's just that you are offloading a lot of your stress onto that side of the hip, because you don't have a lot of stability in the opposite hip or somewhere else. Um, or it's just that you have something coming from this is, I mean, for people who don't see this all the time, they're going to be like, what the heck is she talking about? But, um, it can, can come from the spine. It can come from the nerve that runs under the IT band. Um, that feeling of tightness or that like really uncomfortable, like pulling or stretching sensation that you get there could actually be from pulling or stretching of the nerve. So, um, that's something that we see that's pretty common and it feels so much like an IT band. It really does. I can tell you that from my experiences. It really, really does. Yeah. Yeah. It's, um, I know that when people have, I guess we should, we should probably mention that if, when we already kind of said that like people, it's not your IT band really. Yeah. And so we're alluding to, it could be something else like a referring, referring structure. Maybe we should just really know what it could possibly be. Yeah. And maybe how simple or challenging it is to remedy it. Yeah. I mean, you can go, I feel like I've not alone talking. You can talk about that. You did. I'm just an interviewer. You want me to talk?

Yeah. Okay. So, uh, yeah. So there is the possibility of referred pain. Um, most people are familiar with referred pain when you talk about things like sciatica. If you've had sciatica, you're like, yep, I know it. It felt like it's coming from my back. Other people might be familiar with things like, uh, I have hand pain or you've heard of hand pain or face pain associated with heart attacks. Uh, even things like organs can refer as hearts can, spleens can kidney kidney. Yeah. All that kind of stuff. So everything can refer. Um, typically spine is really common when you're referring to the outer part of the thigh. So usually something like an L five radiculopathy, uh, slang term is pinched nerve is really common to create outer thigh pain in runners and recreational and professional runners. Um, or something else, which is creating pinching onto that nerve, which might be the actual mechanics of the hole right there, which would be like stenosis and older, uh, or foraminal stenosis would be in older runners possibly into their seventies or so. Um, and, or in younger runners, it might just be simply that they have a small disc herniation or something simple to resolve. Uh, typically these are not very challenging to resolve. They actually can be fairly rapid without They sound scarier than they are. Yeah. They sound really scary. And, and, uh, I guess to be clear too, you don't need an MRI x-ray or any of that stuff to diagnose it. You just have to have a good thorough examination. Um, and someone like Sarah can figure it out for you probably within what, 30 minutes.

Yeah. I mean, I mean, you know, the imaging stuff can help, but yeah, totally. I mean, I had somebody that came in and my first few months in practice and I mean, it was definitely not an IT band person was very attached to being an IT band. Three months of rest didn't help it. All the other things didn't help it. They'd seen a lot of soft tissue, no help, but they also had, um, to use this example again, like progressive neurological weakness. Um, they had so much neural tension, meaning like they were so stiff when I tried to lift their leg up that like, I couldn't actually get it off the ground, which is pretty unusual to be that bad. Um, and they got better with a few, uh, low back exercises, but because of the fact that it was so, um, because of the fact that it seemed so much like an IT band, uh, they ended up sadly deciding that they didn't want to do the rehab that we prescribed to them and took, decided to just take more time off for it to heal. The time off didn't help because that doesn't actually really help a low back usually. And, um, ended up going to see a orthopedic specialist who got an MRI for them months later. And lo and behold, it was a low back disc and I was really, they, uh, reached back out to me to tell me that I was really like kind of sad and upset.

Cause I was like, man, like you are an elite runner and you just took like, you know, probably at least they were in pain for at least 10 months at this point and probably took off like four or five months more or off and on of running. And I mean, gosh, it would have been so simple had we just done the, like, you know, prescribed exercises. So it is really simple. And the longer people have it, the more challenging it is because there's other chronic pain association and other things that come along with it. Also the body adapts, um, in the other direction, which it just takes, you just have a bigger hole you have to fill in is all. But, um, it's probably important to note that like, this is, this is something it ban is something that people have a really, it's almost like they have a relationship with it. It's like, it's hard to break them of the idea that it's not their it ban. And so quite honestly, a lot of times we work with people. Um, we don't really try to argue with them about it too much. Cause it's not really worth it, nor is it really productive. And we just have them do things that work. Um, typically, uh, you think a fair timeline, Sarah would probably be about three to four weeks to feel over 50% improved if you do the right thing. Oh yeah. We're even better. Yeah. So, and you probably running within in good, on the good side, you might be running within week two or three. I would think week two for sure. So it was something really severe. Sometimes we do see that.

Well, even, even true it man should have the same recovery. Oh, totally. Yeah. So if you're having a poor success and it's been months and months and once, I'm going to speak logically to you, you're probably doing the wrong thing. So maybe you should just try something different. And that happens to be something like a low back intervention, like Sarah was talking about. Instead of resting. Just give it a chance. Just give it a chance. Whether you believe it's the IT bed or not, just give it a chance. Um, and I bet you'd be pleasantly surprised. There are a few structures that need months of rest that don't require imaging. Meaning like there's the only things that I can think of that you need to take months off for is if you have a true muscle tear, which, you know, you would know if you had that, cause you're not walking around as much like that. Um, or you'd be seeing it on imaging or you'd have a ball of a muscle in your leg or something that's bone related. Um, some, uh, certain types of stress fractures can take that long to come back from, but you again would probably need imaging for that. And it's also not one of those things that you're probably gonna be able to run through for very long. I mean, people do run through stress fractures, but you're going to figure it out at some point. You're not gonna be able to walk.

So, yeah. So, uh, Sarah, did I ever show you the picture of one of my friends' hamstring tears? Oh no. So he was, he was, so this is just to, just to paint the picture of, like you mentioned, like how thick, how quick things can recover, but this was actually pretty substantial. Uh, he had, he felt a pop in his hamstring while playing baseball. And this is what he sent me three days later. And so I'll describe it. It's his leg and it's black and blue. Is that black and blue? Oh yeah. There's a lot of purple there too. Purple. You can see it in the crease of the back of the knee. It goes all the way from his mid thigh down to his knee. And I bet it was even down to the bottom of his foot. This is a pretty substantial tear somewhere. Um, so this happened, uh, uh, I want to say two months ago, maybe he played last week. He, he ran to first base with obviously apprehension, but he wasn't in pain. And so even large muscle tears can repair themselves and you can feel better. But if you're taking 10 months off and nothing's changing, I'm pretty sure you're missing something. Totally. And I mean, if the symptoms tend to move around a lot, then it's probably not your it band. Cause usually if you have, if you have something like a muscle tear, it's going to be torn in a specific place. Like obviously right after you've torn something, just like right after you've sprained an ankle or broken a bone, it's just going to feel like everything is throbbing. But if it's been two months and your pain constantly moves around that something doesn't make sense there.

Yeah. So I think we're, uh, finishing this one up, but basically the last myth is that good luck, um, good luck trying to find a true it band syndrome. And it does happen, but the it band is probably not going to be the cause of the pain. And it's, uh, probably not going to be solved by stretching or foam rolling. I'm going to say if you're playing roulette and you're gambling it, man, you'd probably put your money on that double zero. Like that's probably how often you find it. Maybe the second zero, but most of the other numbers are going to be something else. And if it is really an it band syndrome, it's going to resolve quickly.

Oh yeah. You just, you just load the hip and get the foot to do foot and ankle to do a little bit of handy work. And then you're probably off to the races again. Yeah. Um, I mean, last quick story around that one, I actually have to thank the it band from, uh, for bringing me and my boyfriend together a little bit because, uh, my boyfriend coaches high school. So I see a lot of high school running injuries as well. And one of his excuses to kind of hang out with me in the beginning was like, Oh, I have like, uh, just an epidemic of it band syndrome on my team right now. Um, and it was like summer practice. They were getting ready to head up to mountain, uh, mountain training camp in mammoth for the summer. And he was like, really worried about taking all these young kids with injuries.

And I, he won't, because he, um, wanted to spend time with me and was willing to kind of trust in the thing I said, because obviously at that point he kind of liked me, I guess. Uh, I told him like, Hey, try these things on your kids. None of them were IT band related just cause I wanted to see. And he went back to practice and tried all of them with all of his kids. And it worked for every single one of the kids, except for one, which ended up having a stress fracture and not an it band syndrome. So, um, a femur, a femur stress fracture. He had a pelvic stress fracture. Oh gosh. So yeah, poor guy. Um, a reason to take off running. Definitely. That is a real reason. But the thing is, is I didn't give him any, anything it band specific. I gave him like some spinal stuff to work on and some glute stuff. And between the spine stuff and the glute stuff, all of them got better. And I mean, this was not even something that I stood to gain from because none of these kids saw me as my patients. I just gave Matt some things to try and just improved his conditioning and warmup probably.

Yes. Cool. Well, so how does everyone reach Sara Van Dyke? Then if they want to get in contact with you? Well, let's see. Um, my website is dash chiropractic.com. That's D A S H C H I R O P R A C T I C T.com. Dash chiropractic.com. Um, you're welcome to, uh, go to my Instagram, which is at dash underscore chiro. Um, and you could email me, but that is also on my website as is my phone number. So my email is pretty long, so I'm not going to spell that one out for you guys. Um, just reach out to me either on my website via those contact ways, or you can, you know, just direct message me on Instagram. I do have a lot of people that do that these days, so that's fine too.

Cool. Well, thanks for being on. Uh, and thanks everyone for listening. Thanks for being part of the movement movement. Make sure to subscribe. You'll get episodes that come out once every two weeks at this point. And if you are clinicians, remember the premium versions there, and we'll talk more in detail about probably why gate doesn't matter, or I'm just joking. We'll go over clinical reasoning and so on, but we'll see you guys next time.