Dre Dillon and Tori Orlowski (both PT, DPT) recently opened Shift Physical Therapy & Performance, located in the heart of the Eastern Sierra, Bishop, CA. 

Both Dre and Tori are athletes, and each have been patients. They are certified specialists in running mechanics, gait analysis, rehab and training. Their approach is centered on individual goals and whole body systems whether it is to come back stronger from injury, move between the track, roads and trails, or win an ultramarathon. Through individualized exercise and hands on bodywork, they want to help you shift toward lasting gains. They’ll get you back on your feet, and help keep you there. 

Q: Hi Dre and tori, I’m curious to know more about what types of injuries you commonly see in distance trail runners and some techniques on prevention and recovery. –ethansphotons

A: Hi Ethan. We’ll speak to overuse injuries, as these result from various running form patterns, which over time create imbalances through reinforcement and can make one more susceptible to specific types of injury. Of course, acute injuries can happen, and can sometimes be predictable based on one’s training, strengths vs weakness and type of running. Most often, though, acute injury is about fatigue and circumstance. As far as overuse injuries go, there are a variety of lenses to look through; tissue type (i.e. tendinopathy vs joint inflammation), kinetic chain (i.e. anterior/front of the body vs posterior/back of the body), global view (i.e. how does one’s cadence, preferred distance, resistance to fatigue, etc. contribute to break down?) and general body structures (i.e. hyper vs hypomobile joints, quality of soft tissue, neurological resistance to stress/fatigue, motor control and placement of center of gravity on varied terrain.)

We commonly see runner’s make the mistake of “slow, easy” running when an overuse injury begins, which can contribute to forces through joints and soft tissue, worsening the injury and then the person is caught in a cycle of poor healing, poor form and pain with running. A general tip is to adjust running for quality (good cadence, good form, energetic, engaged) versus slow, “slogging” time on your feet if you are beginning to have an issue. Another general tip to avoid common overuse injury, is to make sure you are taking care of your tissues.

Every runner should know their weaknesses and have a routine to address them throughout their season. Running is hard on our bodies and it’s important to build tissues back up with running specific exercises, mobilization of key joints, drills and adequate recovery. For example, there are “air runners” and “ground runners”, generally. Each have their own running gait patterns and propensity for specific overuse injuries. “Air runners” for example tend to be on their toes, heavily recruiting the back of the lower legs and putting them at risk of achilles tendon issues. It’s important they take care of their ankle mobility and foot/ankle dynamic stability to stay healthy. “Ground runners” tend to have a lot of bending in their knees and hips, putting them at risk of knee pathology. It is important they have strong hip external rotators and extensors and that they know how to keep their quads healthy. To prevent injury, the best thing you can do is know what your individual imbalances are, understand some key statistics about your gait and work on your running technique.

Running is a sport that is wonderful; a pair of shoes can get you started, but like all sports, there are techniques to improve form, efficiency and decrease forces through your body, making you less likely to become injured. There is a lot of great information out there, but it takes a baseline understanding to know where you are and what will be best for you in the long run (puns, anyone?). We have spent a lot of time learning about running and how to help runners. If you’re stuck, it’s worth finding someone who specializes in running mechanics to assess your individual weaknesses; ideally before injury.

Q: So excited for you guys! I have some personal questions regarding patella tracking issues. I was just told I need bilateral knee surgery, tibial tuberosity osteotomy, to prevent further damage and bilateral knee replacements, and am looking for some expert advice on whether or not surgery is the right move. How normal is it to see cystic bone changes, cartilage wear/depletion, and osteopathies in a 30-something year old female? Can you train yourself out of it? –jlawberry

A: Oh @jlawberry so sorry you are facing all of this, and please feel free to reach out directly for more information! First, the simple answer is, no. What you’re dealing with is not “normal”, so having a comprehensive evaluation of history, imaging, mechanics, tissue quality and goals will provide the best course of action. Second, get lots of opinions from a variety of disciplines before making a permanent (surgical) decision. While targeted training and working with mechanics can help to support your individual body mechanics and decrease the forces through your knees, it won’t reverse osteopathies, cartilage depletion or degenerative bone changes.

When facing a major surgical change, it’s important to weigh the risks and benefits, of course, but we usually recommend patients look at this in terms of limitations. For example, are you able to do 100% of what you want to do, but with some pain, or are you operating at about 50%? If it’s the latter, would an 80% improvement be acceptable? What if there is a complication and you get a 20% (or no) improvement? Have you tried “everything” prior to surgery? Meaning, are you very confident that you are out of options and there is no other way to improve at this point? This last question is important because recovering from surgery or injury is hard physically AND mentally. If you are very sure of your reasons going in, it seems to make the ups and downs of the recovery process much easier to handle. Our recommendation is to find people you trust and create a team; a surgeon, primary care provider, PT, etc. Lean on these people, do your own research, ask lots of questions and ultimately follow your gut. 

Q: Congratulations on your new practice. Wondering if you have any advice to deal with what feels like lingering Proximal Hamstring Tendinopathy, or something very near that, up by the insertion. It started after a run. But, almost any sitting bothers it hugely. Yet, my hamstrings are very strong, when I do tests I find online. Could it have been caused by something other than weak hammies? Could somewhat poor form –over-recruitment of the hamstrings and not enough glutes — be a contributor? Am now going on 6 months dealing with it, and it’s still around, though lessened. Baffling and frustrating…. –chrisasolomon

A: Nicely done. You nailed it! Most commonly in high hamstring tendinopathy or proximal hamstring tendinopathy, we find weak or inhibited glutes, overstriding, fascial/neural restriction through the posterior chain (back of the leg), restriction in the anterior hip, and limited muscle length so that as you swing forward you hitting the limit of your hamstring’s elasticity and then stressing the tendinous insertion at your pelvis. If you’re strong with muscle testing, I’d look into your hamstring length, both passively and dynamically. The hamstring is a great example of needing to train the muscle in a way that is specific to the demands of running; passive stretching and heavy loading (i.e. deadlifts) don’t accomplish this, but are commonly used in treatment. The hamstring needs to be strong and fast with high elasticity to “catch” the swing of your leg on the forward stride, assist with propulsion and rapidly lengthen again. There are a variety of other factors but checking hamstring length as compared to your non-painful side is a solid place to start.

Dynamic releases before and after running, along with general hip mobility and core control to make sure your pelvis isn’t “stuck” in a position causing increased tension is also important for healthy hamstrings. If you have not had a running assessment yet, let us help you figure out all the factors involved in your individual case!

Q: Tori and Dre—the Eastside community is so lucky to have you two and Shift as a resource! I’m curious to know, as a runner, what is the best way to improve running economy and decrease injury potential while building weekly mileage? –acsturgi

A: Thank you! We are so happy to be getting such a warm welcome in our Bishop community! Great question. Decreasing running injury potential and improving running economy are really like 2 sides of the same coin. Both result from optimizing mechanics for maximal efficiency, resistance to fatigue and greatest transfer of energy for forward propulsion with lowest forces lost to gravity, the ground and aberrant movement. For example, running with a slow cadence can result in increased torsional forces through the leg and pelvis and deeper bending into the joints, which then requires more energy to move your center of gravity forward AND puts your joints and soft tissues at higher risk of injury from twisting stress. We often also see an up and down motion as opposed to forward momentum with this example.

As far as building weekly mileage, the key is to be strategic and remember that mileage is only one variable. We see injuries pop up when runners are increasing in elevation, intensity and/or mileage at the same time. This is common with seasonal change or an initiation of a new running program, like following a coach, introducing speedwork or adding hills. It’s great to get psyched and ramp up, just keep the big picture in mind and listen to your body as you ramp up. If something comes up, adjust your plan for that week as taking one day off is much better than missing the rest of your season if that little “off feeling” becomes a full blown injury. 

Q: Any advice for a runner preparing for a multi day event? Have done ultramarathons up to 100 miles, but doing PTL 300k event at UTMB in August and would welcome any advice and insight. –balancingmatt

A: All the things you probably know. Prepare, prepare, prepare and then show up rested, well nourished and mentally ready. Simulate race circumstances in your training so that the logistics don’t throw you; run at night, run at times of day that you are not used to if you’re always a morning or evening runner, run long runs back to back days, and have a plan if you know where your body tends to fail first. Running multi-day events allow for a lot of variability and will definitely take you to fatigue. Know where your “weakest link is” and have a plan so that it doesn’t shut you down, whether it’s taping, self-release, muscle activation, keeping up glycogen stores, etc. Trust that you put the work in and enjoy the racing process. Take care of your physical game in the months before the race and have a plan for your mental game when doubt sneaks in during the day(s) of your event.

Q: Hello Dre and Tori. Great news!!! I have been running for about 15 year now and I have dealt with injuries over that time. Over the last few months I have been dealing with internal deep tissue pain in the balls of both feet. I have taken a few months off and have only been running on flat trails when I do, but the pain is still present. Thank you. –eledder

A: It is important to make sure that when you take time off any activity for an injury, that you also identify and address the root cause of the injury before getting back into the sport. We see you have had multiple injuries over the past 15yrs, which is not uncommon given that duration of time, but sometimes if we just rest and never got to the root cause of the injury, it can move around in our body and show up in different ways through compensation mechanisms that our bodies just choose to take. Our body will always move in “the path of least resistance”. When a certain muscle group is tight or weak, other muscle groups pick up the slack for the demand of the activity. Our bodies then start to neurologically recruit the muscles that have picked up the slack in the past, and our strong muscles get stronger while the weak ones keep sitting on the couch eating potato chips. If you haven’t had running gait analysis in the past, or have rested but not identified the root cause of the injuries over your running career, make an appointment and let us help you navigate and come back into running with your body ready for the demands of running! 

Q: Hi! I’m curious if you all have any tips for balancing consistent running and other hobbies like climbing or skiing? I just finished my first marathon and the increasing load made it hard for me to keep up with some of my other favorite activities! –abatobio

A: We hear you on increasing load while training for 1 activity or event, and leaving other worlds of your hobbies lacking in time. The best thing to do is take time to think about what your goals are at certain time intervals throughout the year, and work backward to train accordingly. It’s natural that our lives only have so much time allocated for hobbies. If you are training for a marathon race, and there is a date, you want to make that your top priority. But, you don’t have to make it the only priority! You want to make sure your body is trained to handle the load of the marathon, but you don’t want to overly train, either.

You can include days where you do your other hobbies and shift your running training accordingly. For example, you are training for a race, but you love skiing. You can use skiing as your cross training day, or delete some miles of running and use perceived effort (does it feel mellow, or are you pushing hard?) of backcountry skiing in order to replace a “moderate” or “easy” running training day. You can do the same for climbing. Analyze in your week where you may be able to take time away from running and switch it for climbing. Is your climbing day a long approach? Would it cause you to overtrain if you complete all your running AND your climbing day? Then delete some of the running training, and put in the climbing.

You want to optimize your time getting your body stronger than running to handle the load of running your marathon, and often we can delete miles of running and instead add in time skipping rope or doing specific dynamic training which is actually harder on our bodies than running. If you can take out your “recovery running” allocated time and shift it to another activity, you can keep your body ready for the marathon while participating in your other loves, and make sure you’re not piling on too much.

This is a balance that needs attention and analyzing how hard you are working at any one activity. It’s best to use your own perceived effort to judge how hard you are working and where to replace one activity with another. When that marathon is over, replan how you like to spend your hobby time for the next period of the year! Analyzing what all the different activities you love take as far as body capacity can be challenging, if you need help making a plan and judging how to shift your running schedule, book an appointment, and we can help you along the way!