Dr. Abby Daunis - Athletes in Motion Podcast Ep 045

Narrator: 0:10

Welcome to the athletes in motion podcast from race to recovery. With your hosts Tom regal and Kenny Bailey

Kenny Bailey<br>: 0:30

Hey, Tom, how are you?

Tom Regal: 0:31

I'm fantastic. Kenny, how are you?

Kenny Bailey<br>: 0:33

I am fantastic. The reason why is we have Dr. Abby Daunis on the phone. I said it right. Yay. All right. T owner and founder of peak tiempo, welcome to the program.

Abby Daunis: 0:44

Thank you. I'm happy to be here.

Kenny Bailey<br>: 0:46

So Abby, you were telling us right before we went on that you specialize in running triathlon, sort of sports injuries and kind of stuff like that. You want to give us a little background on what what that means?

Abby Daunis: 0:56

Yeah, I enjoy and specialize in treating runners and triathletes, mostly because I've been a distance runner and a triathlete for the past 15 years now. And so I love the sports. I know a lot about them. And I have patients that I love to treat I love to talk shop when we're, you know, in a treatment session. I right now have a mobile PT business. So I go to people's homes or offices or gyms to meet them. In the Nashville or Brentwood or Franklin area.

Kenny Bailey<br>: 1:29

Cool. Do you have a race that you're currently getting ready for this year for yourself? Or is it just you live vicariously to everybody else?

Abby Daunis: 1:38

I just did the Nashville women's trial. Oh,

Kenny Bailey<br>: 1:41

how'd you do? I did. Great.

Abby Daunis: 1:44

Thank you. I got fourth of my age group. So now what did you add? Yeah. And that was my first postpartum race. I have a seven month old. So that was exciting. And then I have I'm going to do music city

Kenny Bailey<br>: 1:59

in two weeks. Nice. Yeah, sprint or Olympic distance, sprint for now. Okay, cool. Well, thank you for showing up. The reason why we have you on the show is we have a series that Tom and I are doing called the triathletes journey. And we're following three athletes that have never done a triathlon before or haven't done the distance that they have. We have Sarah, who actually just did the women's over the weekend, she's going to be also doing the same race you're doing in Nashville. For our sprint distance, we have a half Ironman, and then we have our full Ironman person, Elizabeth, who's getting geared up for Ironman, California. And in October. As we start talking to these folks, we're finding that as volume goes up, there is now we're dealing I think Elizabeth is dealing with a knee issue from overtraining. So we wanted to talk to you a little bit about just across the board, what kind of what is overtraining? How does I know it's kind of obvious in the name, but what does that really mean? And what should people look out for those kinds of things? So why don't we start at the beginning and just when you hear overuse training injuries, what do you what, from your perspective? What does that really mean?

Abby Daunis: 3:09

Yeah, so an overuse injury is like you said, it's, it's pretty much defined in the name, it's an injury to a muscle or tendon or bone that's caused by a repetitive stress syndrome. So you know, repetitive swimming, cycling, or running, especially if you're new to the sports or if you're ramping up your mileage, or, or time spent doing those things, you're going to be prone to have an overuse injury. As opposed to, you know, like a traumatic injury would be say you have a bike crash and you break your collarbone. So that would be a traumatic injury, overuse injury more occurs over time from a repetitive stress. So yeah, I mean, you know, with triathletes, and runners, we have all kinds of different kinds. So you let me know which kind of

Tom Regal: 4:02

what would you what would you see? So if someone how would someone know if they were getting an overuse injury, as opposed to something else, right? They didn't, they didn't crack their knee on something. But all of a sudden, they're getting some little pains or little, what types of pains would show up if you were to have like a leg or a knee? Or? Well, let's look at let's step back one second, what are the types of overuse injuries that triathletes are most are most common for triathletes or runners? Let's say that we're cyclists.

Abby Daunis: 4:33

So let's start with swimming when let's just go and race.

Kenny Bailey<br>: 4:39

Perfect overuse injury in swimming. Yeah, people swim that much.

Abby Daunis: 4:47

Sure, I see an Iron Man, you know, bib and you're in the background.

Kenny Bailey<br>: 4:52

That was a river swim. I just floated the whole way. a tin can put a finish that

Abby Daunis: 4:58

I'm the most common overuse injury with swimming is shoulder pain, I would say. Or I would say that's the most common complaint that I hear shoulder and neck pain. Shoulder pain is usually caused by impingement syndrome or bursitis. Some people call that swimmers shoulder impingement syndrome, Amber's such bursitis of the shoulder kind of go together, you usually get them at the same time. So in In brief, if you are swimming too flat is usually the problem and you're not rotating enough, your part of your acromion your shoulder blade zone will jam up the muscles and tendons that are part of your rotator cuff, and it'll give you shoulder pain. I'm trying to not get too technical here. Like strange words, you can, you know, be like, Oh, that's perfect.

Tom Regal: 5:54

If we glaze over then then you know, like, you'd be like, yeah, yeah. And that's exactly why we try to get athletes to roll their hips, and called dip the hips. And then you get the high arm throw, which is better rotation, it's more proper rotation for what your shoulders supposed to do, as opposed to trying to fight it by pulling it forward on a flat plane, as you were saying,

Abby Daunis: 6:16

exactly, yeah. And that's, it's, I mean, I can talk to people over the phone, like if I'm doing a telehealth visit. And I'll almost know immediately that they're swimming probably too flat. So it's an easy fix. Now, of course, if your shoulders really inflamed and you're like way down the path of injury, then there's some PT exercises we can do and some other interventions like dry needling, and taping and some manual therapy that will help you overcome that.

Tom Regal: 6:45

Yeah, I think it's, I think it's crucial for people to understand that these injuries don't happen overnight. Even if the pain starts happening today. It It didn't start happening really till like a couple of weeks ago, right. So it's not going to go away instantaneously. So you have to actually make some adjustments for it. So when you do start to feel something, you need to address it right away. And I've got where it's a little twinge, I'll be okay. And six weeks later, it's a big twinge. And all of a sudden, you're taking time off. So

Kenny Bailey<br>: 7:17

I don't like this episode so far. I mean, you can just power through the pain. You can you can anyone up like me, we can spend two weeks not running because you thought you can power through the pain.

Tom Regal: 7:30

So neck issue, the neck issue would be from what bad posture when all of these come from bad posture, right. And whatever form it is,

Abby Daunis: 7:39

pretty much yeah, like, it's usually coming down to a breakdown in form. So if you know the neck pain is usually you're you have some muscle imbalance, you'll be tight, maybe on one upper trap and not the other. Or if you're a unilateral breather, those people tend to have some neck pain. And I you know, in the past, I've tried to coach people to learn how to bilateral breathe, especially if you're going to do open water swimming, it's always better to know how to be a bilateral breather. But yeah, and again, you know, you some people are do they do okay with their swim form in the beginning of the workout, but if you're going to swim 4000 yards or 4000 meters, you're gonna have probably a breakdown in your form by the end of that workout. So you really got to stop and check your form a lot. Just to make sure like, am I breathing properly? Am I turning my head as much as I should? Or again, you're swimming too flat, and then you try to really just turn your head that can give you some neck pain.

Tom Regal: 8:40

So yeah, yeah. Now we get onto the bike. Then it gets crazy.

Abby Daunis: 8:48

I know. Yeah. So you know, that's those are the two biggest for swimming for cycling. I mean, man, you can have pain anywhere.

Tom Regal: 8:57

So let's let's do a shout out and say you need to get a bike fit and be properly fit on your bike would help tremendously. Once again, it's form right? We're looking back at form.

Abby Daunis: 9:08

Yeah, so Okay, common complaints for cyclists. A big one is numbness and tingling in my hands and wrist pain. Okay, that's always you know, especially for new cyclists too. If you're, you know, obviously, if you're a triathlete and your seats up too high and you're in a really aggressive position, and you've got a lot of pressure on your hands and your wrist and you're not used to that you're probably going to get some numbness and tingling in those hands. You know, this is why strength is so important. And of course bike fit so if your bikes not fitting properly, you know you might have too much downward pressure. We might need to lower that bike seat Tommy you know so much about this of course always lower. Pressure after hands. Yeah, I mean, sometimes triathletes don't run into this too much if they're riding an arrow position, because you know, you can kind of just rest on your forearms. But also, core strength will help, okay? Because, you know, a pro cyclist has a really strong core, like they could basically ride with fingertips, right to control their bag, they're not really holding on too tight unless they're going to aggressively attack and climb up the hill. But yeah, of course, strength is super important there. But of course, bike fit, and a lot of these things that I'm gonna talk about can be fixed with bike fit. And then, of course, proper training. So

Kenny Bailey<br>: 10:40

yeah, put it in perspective here. I was just doing some math. I mean, if you're doing your standard, like 90 RPM rotation on a bike in one hour, you've already rotated 5400 times. Wow. So if you talk about an overuse injury, and you're not in a quite you fit your knees kind of popping out a little or your your cleats aren't on, right, you're basically repeating yourself 5400 times in that hour, to just exacerbate I mean, that's just, you know, you're just literally grinding that. I'm assuming these are the other things or is it hip flexors? Is it that kind of just anywhere the connection point is,

Abby Daunis: 11:16

yeah, knee pain is a big one. Back pain, I even I made a list of all the things, I mean, cycling, I could just go through the whole body honestly. But knee pain, back pain, neck pain, hip flexors, this happens to a lot of new triathletes that get a try bike, or they get into aero position they use tell me their hips are really jammed up is because now your folded you know, your body's folded down even further. So especially for men, I find that they have a hard time adjusting to that position because they're a little less flexible in the hips. So you'll see sometimes if now you guys when you go ride, if you look at cyclists in front of you and their knees are flaring out. They're probably taking some mobility work to get those hips you know, working to get their knees in. Okay. tight hips.

Kenny Bailey<br>: 12:11

Go ahead. Yeah, I have to ask you because I, I used to. I was on a racing team with my PT back in California, and I hated it when he rode behind me, do you because of your profession? If you go on a group ride? Is it just like your brain just internally freak out? When you see people? Like they got a knee out? Or, you know, their bike placements wrong? I mean, Tom, you asked the same question. It's like, Oh, my God, how are you actually functioning? Does that does that go through your head? And does it take everything in you not to like, Hey, you may want to consider because you want to be that person. My

Tom Regal: 12:41

card. You're gonna win me. Do you see that?

Abby Daunis: 12:45

Oh, yeah. I mean, it's inevitable. i i. So you know, I watch people walk all the time. And I'll just watch them walk down the street, and I'll try to figure out what's wrong with them. Like, it's either their hip or their knee. Yeah. I mean, I, it's, it's kind of fun, you know, in my head, like, Oh, I wonder if they have tight hips, or if they're having knee pain or pain. So it's, yeah, I do that for everything. I can't help it. But especially with runners. I mean, I'm really watching them. And I'm like, oh, boy, I have to try to try hard to keep my mouth shut.

Kenny Bailey<br>: 13:21

Well, it seems like swimming, for example, swimming is, you know, it's a it's technically one of the most difficult ones. But it's, it's on a plane when cycling, you're kind of in one area running, for some reason is so such a wide open field, right? Because you've got foot placement, you got, you know, what you've done as a child, any previous injuries, those kinds of things. It seems like you're you're locked onto pedals. Right? So you're gonna be doing this. So it's relatively, but running. You know, it's a whole world, right? Is that? Is that what you kind of see when you see runners like that?

Abby Daunis: 13:51

Oh, yeah, I mean, running. So all three of these disciplines are so complex, right? Like, we've got a lot of things that have to happen, like in unison for them to really work and to, for us to not have pain when we do them. Yeah, but running, you know, is so dynamic, and everyone's going to run a little bit differently. So it's not always like, Oh, we have to get someone to like this perfect ideal form that I have in my head. I have to kind of see where they're at. And exactly like you said, Kenny, like what is their background? You know, running background, how long have they been running? Were they a sprinter in high school? Or is this their first time ever running? You know? Yeah, but yeah, you can be all over the place. Running, just like cycling, you can have lots of overuse injuries, and yeah.

Kenny Bailey<br>: 14:40

So one of the things like in the knee is particularly funky for me when it comes to sort of to give you an example. I was cycling a time I thought for sure I was tearing my knee up ended up being my IT band. Or if you have runner's knee, it almost may present itself as a torn meniscus and then you know I had a little pop on my knee and it being a torn meniscus when I didn't think it was anything, right. So how let's just talk about the need, for example, like runner's knee or let's let's focus on runner's knee, as, how does it present itself? And at what point, you know, what do you do sort of in the interim to kind of rest it and all that sort of stuff? And then what at what point should you start seeking a professional?

Abby Daunis: 15:22

Good question. So this will be a little bit different for everyone. But if you so if you feel pain when you're running, let's say you're, you know, running out running five miles, and you start to have pain in the middle of your run. So you have to kind of decide like, How bad is it? Do I need to stop is a debilitating or can I keep going? Okay, so I usually tell people, you know, if it's less than a three out of 10, you can probably keep going, okay? The pain scale. 10 is take me to the ER zero is no pain. Okay? And then if your knees still bothering you, after your run, you probably need to address it. Okay, that's your body saying I did something funky, you know. So start putting ice on it and stretching and rolling your legs, all the things that you know that you should do after most runs anyway,

Kenny Bailey<br>: 16:09

everybody does. Yeah.

Abby Daunis: 16:12

Right. Exactly. Yeah, don't don't hide away. It's a roller. Don't make me go walk downstairs and get my butt. Yeah. So when you you know. So I usually tell people, okay, kind of assess it after your run? Is it is the pain sticking around now to other activities going up and downstairs walking around? If so, take a few days off of running. Okay, maybe take two days off, and then try again. All right, and then if that pain is coming back, you know, usually the worst the overuse injury, the sooner in your workout, it will appear. Okay? Like, if you've got really bad plantar fasciitis and you go to run, it's going to start talking to you first few steps and then just get worse and worse and worse. All right, that's, you really need to shut it down, and either cross train or call a PT and say, Hey, I need some help from you look at this, and then we can kind of guide you in the next best steps. So

Kenny Bailey<br>: 17:13

when you want them to see you, I guess, is it at the pain threshold? Like you said, is it you know, it's a four, it's a five or it prevented me from running? arrested, it doesn't seem to be going away. That's when they call you is that is that when you want to see him?

Tom Regal: 17:29

Before it gets to a point of acute pain, you want to address it, right? So if you get you're getting a little, some little spots that pop up in your run or something like that, you need to start addressing it at that point. If it starts certainly if it's shooting pain, you need to jump on it right away. I think plantar fasciitis if you step out of bed and you can't walk then you you're probably way past when you should have dealt with it. And you should you shouldn't get to that point. So I think that's I think that's the key takeaway for everybody has that pay attention to what your body's kind of telling you. But then you have to avoid the overreaction side of it is like, Oh my God, that hurts. Yeah, what does that oh my god. You know, like we're and I know some people that will do that, where it's just kind of like, well, that doesn't feel right. It wasn't like, well, there was a little twinge that popped up because whatever, you shifted your weight a little bit, but it's no big deal. So you keep running and yeah, it's fine. It's nothing that's happening. But if you do get some twinges, some things that start to happen up mid run, and I think that's what your cue to say, hey, maybe, maybe call you or maybe calls a professional to say, Hey, I'm starting to have some issues. What can I do to to address that?

Abby Daunis: 18:39

Yes, absolutely. Yeah. i So yes, the the shorter answer is the sooner the better. I mean, if you start to feel it, so you know, as you increase mileage, let's say like, today, I'm going for my first ever 10 mile run, you might feel some changes in Mile nine and 10 and be like, oh, gosh, you know, my knee got a little twitchy. You can wait a day and see if that got better. But if you go on your next run and your knees hurting, then kind of call me so for someone to say like hey, what's going on? Can you check this out? Do I need you know, Tom, Can you guide me in what to do?

Tom Regal: 19:14

I think if you're over 50 You're at a three out of 10 Everyday constantly. Yes. Just being awake.

Kenny Bailey<br>: 19:20

Are you feeling three

Tom Regal: 19:21

out of three? Yeah, if it gets to a five and I start to wake up it's like you know if you're in California if it's a you know, five 5.0 earthquake then you start to take notice every single of that yeah, whatever it's just yeah, that's every day they call that Tuesday

Kenny Bailey<br>: 19:37

just so there's a Advil good or not, I mean, do you do recommend like trying to do and you know, kind of reduce the swelling and kind of stuff do people over rely on that kind of thing? Do they over medicate? It does the like, icy hot work to those kinds of things are those effective?

Abby Daunis: 19:55

So, if he if you have to pop like a leave For Advil before you go run, then you need to get medical attention to your PT to try to figure out what you're writing this down. I, when people have an overuse injury or if they have acute pain, yeah, I always tell them so step one is pain control, okay? When they come to me, I'm like, let's get the pain under control. So, take the NSAIDs, they actually leave the over the counter stuff, if you can, okay, if it doesn't interact with any other medication you're on. I, yeah, the top of like an anti inflammatories Icy Hot or Tiger Balm or any of that stuff that boltaron cream, I tell them to do all that because again, step one, control pain and inflammation. Then step two, you know, we'll start doing some exercises to see what how can we strengthen what needs to be strengthened? How can we stretch what needs to be stretched and things like that? But yeah, you don't want to like start your run or ride on.

Kenny Bailey<br>: 21:00

Okay, so if I pop three Advil spray to, you know, icyhot on my leg and then go River Run, that's probably hiding the pain is what you're trying to say. Exactly. So cortisone shots, probably another question too.

Abby Daunis: 21:15

If you if you get there and you need it, you need it, but we'll try some conservative PTT treatment.

Kenny Bailey<br>: 21:21

So let's talk about some sort of preventive stuff. So this is, you know, we kind of you know, we did the so you got the proper bike fit, you feel like your run form is kind of on point, but you are ramping into Tom's point. You know, people like us, we're in our 50s. So, you know, things just tighten up. What do you recommend for folks to try to help sort of reduce that I know, we talked a little bit about sort of probably rolling and exercise and stuff, but specifically, what what would you what would you tell people, like if you're doing a seminar and say, Hey, to prevent overuse injuries? You know, here's the top three things you should be doing?

Abby Daunis: 21:53

Totally. Um, well, there's plenty of things you can do. And I just want to add real quick. Or maybe we can go back to this but for running, the most common overuse injuries I see are going to be leg things, okay, leg injury, so Achilles tendinitis, plantar fasciitis, calf strains, okay, and sometimes shin splints. I haven't seen shin splints in a while, which is interesting, but those are really the most

Tom Regal: 22:18

common causes shin splints what's cuz that that used to be like an everyday occurrence for a lot of people.

Abby Daunis: 22:25

Yeah, um, old shoes, and really like heel striking, pretty hard, too much impact too fast. Okay. And because ground ground reaction forces go straight up the heel and right through the tibia, that bone you can feel like on your, on the front of your lower leg, your shin. Shin splints are really medial tibial stress syndrome. So you'll have little, like micro tears in the muscle and the tendon and the bone on the inside of that tibia. Okay, usually, almost always old shoes and poor running form, or just, you know, too much heel striking.

Tom Regal: 23:01

So do you find it with the surface, the running surface as well? Because we've always talked about sidewalks and cement being much harder. I've always felt that that was more hard on my legs than running on just asphalt. Which seems like there's probably not much of a difference, but for some reason, it seems like I have less leg fatigue on asphalt surfaces as opposed to concrete sidewalks. And then I just would prefer to jump on to trails because so much softer.

Abby Daunis: 23:34

No, that's all in your head top. No. Problem, probably. No. Yeah, I mean, totally. So I as a PT that treats really active adults, I try to always keep you active. Okay, so if you have pain, running on sidewalk and really hard concrete, I'm gonna say you can try some running in the grass. All right, because we're gonna keep your cardio up. We're probably trying to get to race day here. So what can we do to keep you moving forward without keep without, like, furthering this injury? Okay, so yes, I have to let people try running on grass that can present its own problems. So that'd be careful with what we do there. Usually, I'll kind of tell people hop on the elliptical and do a running motion. That's the closest we can get to running or Aqua jog, you know, running Yeah, without impact. So but yeah, I mean, it's, you know, if you feel better on asphalt, or and, or like, grass, do it, you know, and you're not getting any other tweaks or changes or weird knee pain or hip pain. That's great. Yeah, that's what I tell people to do. So. Yeah.

Kenny Bailey<br>: 24:41

So that's part of the prevention is, you know, look at the surface you're looking at because I think yeah, concrete just beats the crap out of everybody. I mean, it's the hardest surface out there. So absolutely. Yeah, it's it's it's not like Ironman Arizona is entirely like concrete or anything, but it's entirely on concrete.

Tom Regal: 24:58

98% It is all sidewalk. It's ridiculously

Kenny Bailey<br>: 25:02

stupid.

Tom Regal: 25:02

It hurts.

Kenny Bailey<br>: 25:05

So, rolling, stretching before you get running those kinds of things.

Abby Daunis: 25:10

Yes. Okay. Well go back to prevention. Yes. I just had to fit in No, no,

Kenny Bailey<br>: 25:14

that's fine. My tells us about your personnel your OCD, like we didn't finish that third one.

Abby Daunis: 25:19

I like that on my list right here.

Kenny Bailey<br>: 25:22

Well, you got to list I mean, I did.

Abby Daunis: 25:25

And we can always do if you have more questions, we can come back. So prevention. With, we'll we'll do this in three parts again. So swimming, check your form, have someone watch your form, okay. Have a coach like video, your swim technique, and then you get to go back and watch it and you guys talk about it and say, Okay, how can I improve my freestyle form? Okay. Or I don't know, if you want to breaststroke, you know, your Ironman. How can I improve my rescue?

Kenny Bailey<br>: 25:53

I want to see that. Absolutely.

Abby Daunis: 25:55

Yeah, that's true. That's true. Oh, yeah, you take a break, rollover, and then go back for it. With cycling, have a really good professional bike fit that will help with to prevent a lot of aches and pains. Before you buy a bike, make sure the frame is going to fit you. That's huge. I mean, I think a lot of newbies make that mistake, they're like, Oh, I like this bike, I'm just gonna get it. And then all of a sudden, they spent all this money and the frame isn't right. You know, of course, there's some parts that you can change and adjust, but not the top tube, unfortunately, yeah. And with running, make sure you have good shoes, and I tell my runners to replace their shoes every six months, or at least every year, depending on their mileage. And, you know, also for all of these things to cover all three, you should do some strength training to really prep for any endurance race. So there's research that shows even two days a week of lifting weights has benefit. So if you can fit that in just a little bit, you know, and I can I guide people on this all the time, a huge part of my job is like okay triathlete, you know how to swim, bike and run, here's some exercises I'm going to give you to do, that are going to, you know, improve your strength and obviously, like, they're going to give them therapeutic exercise to help address their injury and their weakness. So, strength training is huge bike fit, form, running form, have someone you know, I love to film people running and help them adjust their form that can help prevent injury to usually, I'm doing that after people are having pain. So we kind of have to go back and then learn how to run in a better way. Like you said, Kenny stretching and foam rolling after you exercise always really helpful that can help prevent injury. And there was another one that was in the forefront of my mind that just disappeared, but not on the

Kenny Bailey<br>: 28:06

list. So I have a I have you brought you brought up an interesting question. Just to by the way, it's interesting to me as a person on the other side, right? Because you know, you're a coach, you're you're a PT, I'm just a dude trying to get stuff done. Right. But what's interesting is you think you're self aware of how good or not good you're doing, right? And I know Tom's like, you know, you're crossing over the plane on your swim like, No, I'm not. He's like, No, you are. So no, my hands out. And then he shows me the point like, oh, I because I don't it doesn't feel like I'm doing that. Or running. You know, you look at your run form. You're like, oh my god, I look like a bear trying to chase a rabbit. You know, I'm just not that nice, you know, that kind of thing. So I think the self awareness sometimes is having somebody film you is always really good. For some reason, you brought up this weird question that's in my head, because I see a lot of like videos and professionals about having different types of running shoes. Like, oh, if you're gonna be doing track running, you should do these or if it you know, I use these shoes, if I do distance running those kinds of things. I've got an incredibly sensitive calf for some reason, I just overload my calf every year, it's kind of a problem. So you know, it's Hoka or Hoka Hoka. For me. For normal people that don't have gap issues is using like a different running shoe. I hear it's helpful. I hear it's not helpful, that, you know, a lighter shoe for a faster race is kind of cool, but I use a more you know, bigger shoe if I'm doing distance. Is that something that's is that a myth? Or is that is that true? You can can normal humans actually use different use? Is that Is that a thing?

Abby Daunis: 29:33

They can Yeah.

Tom Regal: 29:35

Wow.

Abby Daunis: 29:38

Yeah, so again, there are so many recommendations on out there. I would say sometimes I do recommend that people have different shoes and they kind of change them up during the week. So but again, you know, like you just said, Kenny for you hope guys are the only ones that work so stick with us. Yeah, don't change it if it ain't broke, you know. But I had a friend who she would run her long runs, you know, in Brooks, and then that was on the weekends. And then maybe during the week, the shorter runs, she was running, and we'll say like Mizuno, or ASICs. And that worked for her. So, yeah, I'd say if you can do it, you know, or just even if you have two different pairs of one brand shoe, your shoes will just last longer anymore out, you'll see a lot of recommendations from like specific running coaches, they'll say where this shoe is, shorter runs and your tempo workouts, and this you for your longer ride. So but again, that's on a patient by patient basis, it really, you got to look at the whole picture, how new are they to running? What's their budget, like, you know, can they have multiple pairs of shoes,

Tom Regal: 30:52

I think that's huge, because that's part of the frustration of running is experimenting with shoes to find the ones that work. And then the next year, they come out with new improved the same model that worked for you for the last four years that now all of a sudden feels funky and doesn't work. And you're dropping 150 Plus bucks per per set of shoes. It just it's super frustrating. And I have I'm one that goes through multiple shoes, I have three or four different shoe types, for different runs that I like to mix from from soccer Hoca, and then altroz. And then my trail shoes are a different animal altogether, but I ended up dropping, you know, six $700 When I buy my shoes, and then yeah, they last longer, but I'm still dropping, you know, several $100 all at once, just to have shoes. And once the mileage kicks up, then I'm having to get another set. Because you know, you can blow through you can blow through the mileage on some of the issues so quickly. It's just not even it's it's not even fun. I mean, it's just terrible. So I think you have to look at that you have to look at what's your budget? And how much experimentation Are you willing to do? And hit miss? Like, there's a couple pairs of shoes I got. And I was like these are not going to work at all. I can't return them. I can't do anything to him. So yeah, maybe I were him to do the lawn or yard work or something. But that's, you know, $150 I mean, that's crazy.

Abby Daunis: 32:23

Yeah. stores, like I know, fleet feet will let you you know, by I'm pretty sure. Gosh, don't

Kenny Bailey<br>: 32:30

think it's like a 30 day thing, right? Yeah. So you

Tom Regal: 32:33

run in them, right in some, some brands where you can return them, but they can't be used. So it's like, basically you can wear them around the house. And if you can't decide then, right, you're completely I know, REI has a very generous return return policy, and then they turn around and try to sell them used later on. But I see some stuff that's pretty worn out. Yeah.

Kenny Bailey<br>: 32:58

Yeah, yeah. I mean, there's and you can replay we will talk about other stories that I've been through that said, you know, a second it goes off at this carpet is yours. Are you kidding me?

Abby Daunis: 33:07

Right. So that's you got to find a good running store where you can go run, and then return them if needed.

Kenny Bailey<br>: 33:14

Yeah, and support your local running store, please.

Tom Regal: 33:18

Think I have some really usually have some really good people in there that can help you figure out the right shoe. And some of the some of the stores have technology that you know, look at your foot, scan your foot, see what it is, and they can at least point you in the right direction to try some shoes. I like the ones that have a run at you know have like a treadmill there that you can actually run on the treadmill. While you're there. I used to pop into one store locally for me and I would go in and I would give them three or four pairs that I want. They pull them out for me I'd just leave me alone. Because I know what I'm doing. I put them on the treadmill go nope. Absolutely. Yeah, no, these are the ones I'll take these. Okay, give me four pair I'll take.

Kenny Bailey<br>: 33:55

So, back to the overuse thing. I'm sorry, I kind of diverged on that. But I was just so jealous of people who buy shoes. As a person that deals with, you know, deal with overuse injury and I hate it that I have to do that the hard part by any Far and Away is Yeah. Okay. So I got to figure out the mechanics of my forms. Not Right, right. Okay, so that's corrective. Yeah, I got arrested because, you know, I screwed up the toughest part and probably the biggest art form is trying to figure out what that timeline is between. Okay, I've given it enough rest and now I can go back. That to me has been probably the biggest frustration because like it like my calf is I got the tendinitis in my calf. You know, I'm trying to I'm trying to rest it. It feels fine today. It feels great. I've been doing strength exercises, you know, I've been trying to keep it stretched and, and limber. Now, you know, it's that okay, it back to Tom's point, you know, is it a three because I'm starting to exacerbate it again, or is it a three because you know, it's been a while since I've been on it. That to me has by far been the most frustrating thing because it feels like a Three, and then you don't want to get so far out on your run, it turns into a seven and then you're limping back to the car. So that to me is the struggle. How do you how do you get people to start? What's that process for you? Or how do you recommend that people to kind of go? There's no hard number, right? It's not two weeks, and you're good. It's this weird sort of, you know, feathering, how do you? How does that look? I'm sorry, you can sell frustration to my voice too. But does it? How does? How does that work? Yeah.

Tom Regal: 35:29

Yeah. How

Kenny Bailey<br>: 35:29

do I get back?

Abby Daunis: 35:31

All right. I know, I know. It's hard. So I'll never forget as a PhD student, my professor, she said, PT is not black and white. It's very gray. And we all hated that. We're like, well, that's the worst answer. You know, none of us wanted to hear that a bunch of people in PT school. So in it really is it's very great. Number one, depends on your injury. Okay. So for your calf, for example, you know, I was started asking, When do you feel it you only feel it when you run? Do you feel it when you walk, you know, and then I put you through a bunch of heel raises, like, can you do double legs leg? And things like that? Can you do them with a bent knee with a straight knee? And kind of tease out what the problem is? But it's, it's hard. It's always a trial and error of when can my athlete go back to running? So usually what I'll do is, you know, get you to a certain point where once my hands are on that tissue, and I'm like, okay, Kenny, your calf feels pretty good under my fingers. You know, let's try some heel raises. Okay, those feel good, good. Let's try some jumping. Can you handle that? Great. Okay, now go run five minutes. And then you might come back and say it didn't like that. And they'll say, Okay, we gotta shut it down again, you know, but it is hard. And that is probably like one of the hardest parts of treating runners. Oh, absolutely. So yeah. And again, it just depends on your injury in the in the person. You know, I have a lot of people who, again, I try to keep everyone moving, right. So if you're like, my calf hurts when I run, then I'm going to say go Aqua jog, or get on the elliptical for however amount of time you're supposed to be running, you're gonna do that now. Okay, sometimes is what I say depends on how close we are to race day, because I'm trying to keep their cardio up in a non painful way. Okay. And that's the closest thing that I can mimic running to without having them pound outside. But again, it's helpful to have someone watch you run and maybe I can say, Kenny is your hip that's making you hurt, you know, now, when you have a calf injury, or let's say Achilles tendonitis, or something like that, usually that spot is weak. Okay, so this is the also the fine little line we have to walk is we have to start strengthening that tissue that is hurting. Yeah, that is very hard. Okay. Yeah. And it's, it's frustrating. And, you know, because, again, we have to say, all right, calf, are you ready for strength? Let's try it and then slowly ramp it up. Okay, until we can get it strong. And that tissue can say, I'm good. I can handle all of this running for 26.2 miles. Let's go. Okay, good.

Kenny Bailey<br>: 38:22

Yeah, because I think and I talked to this on a previous one, it I don't say this, like Ironman is heartless, but Ironman doesn't care. Right? It's the day is the date. Right? October is gonna come right. My race is in July. They're not going to move it for me, because I'm not feeling good. Right. And so as you get closer to that window, there, dare I say, there's a desperation to get back. Right? How do you manage expectations with with with your patients, because that's a that's a like it. This isn't like, oh, I want to go run a marathon someday. It's like I have a date. I have to you know, I have to do these three disciplines. Whether I'm limping or not limping. Either way, I'm going to finish it. It's whether I finish ugly or I finished strong. How do you manage that sort of, I guess, frustration or expectations to want to hurry up? It's like, Hey, I got a ramp. I got it. You know, I've got a half I got to do. I mean, if I'm only doing four miles, how do you talk to your patients about sort of trying to be realistic, but at the same time trying to be helpful?

Abby Daunis: 39:19

Good questions. So thank you.

Kenny Bailey<br>: 39:22

This is really just therapy for me. We all know that. All these podcasts. That's why we do the podcast.

Abby Daunis: 39:29

It's yours podcast, you can do whatever you want. Exactly. Um, so I always look at how many weeks do we have? Okay, let's start with you know, how many weeks till race day? And then I see you know, Kenny, how many how far can you run right now? Like how many miles was pain? Okay. And then I started looking at is this realistic? Or do we have to change to a Walk Run, or are we going to walk The whole thing, but I have to have this conversation with the patient, like, what do you want? Because you're in control. So do you want to defer if if you can't run an eight minute mile for the whole half marathon, or do you want to do it at all? Okay, some of them? Yes. Some of them? No. Okay. So, some people are like, no, absolutely not. And I'm like, Okay, let's look for a different reason. And then we kind of like, set our sights on something further out, or next year, you know, hopefully just months away, not next year. Um, yeah. And then some of them are okay, with wiggling like, No, I just want to walk run, or I'll walk the second half, I don't really care. You know, I'll I'll walk the second half of the half marathon. So it depends on our timeline. The patient's personality, like, what are they going for here? You know, a lot of first timers are like, I just want to finish. So I don't really care. And I'm like, Okay, well, you know, and then I have to be realistic with them to this is probably the hardest part of my job when I have to tell someone like, I do not recommend that you do this, because probably further injure yourself. I hate giving you bad news. It's terrible. You know, but yeah, it's just being really open and honest with them. I always try to push it as much as I can to get them to race day, if that's what they I'm like, if you want to get there. I'm going to do everything I can to get you there. Okay. But I

Kenny Bailey<br>: 41:25

think that's what I like about what you just said that there's stuff you don't like, they're Shades of Gray, right? Which is okay, you may not be doing a PR on your run. But you know, what, if we do, you know, three, two, we're going to run for three, walk for two, because that seems like what you can do. That seems to be your ability. Are you okay with that? Right? You just set those expectations like, okay, because I knew last year, for example, my cap was so bad that, that I whatever the run is going to be I'm probably going to walk half of it, which I did, right. And but the good news is, you know, I'm doing it in a nature preserve, and I'm staring at Deer and it was a beautiful 82 degrees sunny day in Oregon. I mean, that's, it's hard to be mad, you know, when you're looking around, you know, let's just reset expectations, right? So I finished, I believe, but I finished. But I think setting that expectation to your point and making sure you're saying it, look, it's going to be like this. Are you okay with that? The other thing that some athletes do, and I'm not going to name names, like, I don't really care if it's a nine, I'm just going to blow it up and then worry about it after the after the race is over. Like, okay, you know, it's gonna hurt like hell, but I don't get to race until you know, after it's for a while. So I mean, do you run across people like that with that person? I was like, Don't Care gonna blow it up, and then we'll deal with the fallout later.

Tom Regal: 42:35

We'll fix it and fix it and post?

Abby Daunis: 42:38

Absolutely. There's plenty of iron men that are like,

Kenny Bailey<br>: 42:42

how do you how do you handle that? Do you try to get them logic? Or is it just like,

Abby Daunis: 42:47

I mean, yeah, I mean, I just tell them what I know. You know, like, here's what may happen if you go and run this hard. Yeah. You might have to wait months, six months to run it. You know, I don't know until you come back to me after race day. And then it's like, Alright, let's see what happened.

Kenny Bailey<br>: 43:11

And you're near like writing just saying like, well, that'd be four months worth. I've got a client for the next four months, because he's, like, yeah. Guaranteed to go

Abby Daunis: 43:20

further. Yeah. No, but it's,

Kenny Bailey<br>: 43:23

but it's really tough, right? Because as a racer, you're spending a lot of money for these Iron Man's Right, I just, you know, I booked a trip to Oregon. And it's just like, it's ridiculously expensive between getting my bike, they're getting myself their rental cars, all that sort of stuff. And then you know, it doesn't come around until next year. So postponing it feels almost like, a no op, right? So then it becomes

Tom Regal: 43:43

or they cancel the race, decide not to host it there anymore, right? They give up the license and disappear, right? Like anyone who wanted to do Alaska man, and, you know, got excited that they had the first year and then they decided never to do it again. So how many races? Are they doing that with? Right? So it's like, is it going to be around next year? Because that was that I think, you being able to give the athlete concrete advice on here's what's happening, right here, your options, you can make a solid choice and then helping them work through the emotional side of it and that desire to want to do it, right. Just know the consequences. If you do it at this level, this is what's probably going to happen to you and it's going to be devastating, right? If you do it at this level, it's going to be slightly less devastating, but you can get it done or my recommendation would be you know, what, is it really worth it, you have family of friends, you have a job, you have everything else, what's the most important thing for you? I think, trying to get through those decisions and that thought process and a quick amount of time, you know, for them to make that decision. It's just like that's, that's the toughest part. I can imagine. You're giving them you know, the best advice you can the best knowledge to make that decision. Some people can't make good decisions. That's just they just make poor decisions. That's

Kenny Bailey<br>: 44:57

well and you're too close to the sun, right? You're Nickerson Let's look right, because you're in the middle of the whole thing. So we're gonna try to put a nice bow tie on this thing rather than talking about, you know, terrible things like that. So it seems like there's a theme, right? You know, some people are going to experience some level of overuse injury, or there's going to be some tweak going on. Because of that, you can't train for seven, eight months perfectly clean. If you can bless you. It sounds like you know, in to kind of recap it, you know, if you see something that's greater than a three, if you see something that's persistent, you know, stop, you know, stop, take it, take a pause, go go either see if it goes away, if it doesn't go seek some help, either through a PT who can then figure out whether or not you need to look at form issues or strengthen issues or other issues. But if you if you sort of ignore it, it doesn't get better. Is that a sort of safe thing to say?

Abby Daunis: 45:49

Yes, almost always, if you ignore it, it doesn't usually just disappear. And I will add, this was my other thought that came back to me from earlier, people, when they're training for an endurance event, they go too hard, too fast, that will injure you. So if you do not have, you know, a pretty clear cut training plan, and that's going to vary depending on your, you know, athletic ability and how many years you've been doing this, you know, but you need to slowly ramp up your mileage in, in any event, swimming, cycling or running. That is really how you prevent injury, you have to get your muscles, your tendons, your bones, your whole body adapted to what you're asking of it. So slow, ramping up. Yes. But yes, you know, and like we said earlier, this sooner, the better to seek out like medical help, okay. I will always advocate for PT first because I'm a firm believer in physical therapy. So, and in the state of Tennessee, a lot of people don't know this, you don't need a doctor's referral to go to a PT, you can just go first. And then what we have to do is we do have to communicate with your physician and say, here's what we're doing. And then they sign off on it. They say cool, go ahead. So you can have a referral. If you go to your doctor, and then you come see us. Great, that's fine. But you don't have to, and usually we're a little bit faster to get a hold of them to get in to see them. So yeah.

Kenny Bailey<br>: 47:20

So along those lines, you know, we appreciate you coming on the show your fantastic PT is as people are hunting for PT, what are those things that you should be looking for?

Abby Daunis: 47:31

Um, you know, finding a physical therapist is just like finding like a talk therapist or a psychotherapist who has to be a good fit. You know, I, I try to encourage runners and triathletes to call me because I know about their sport and what they're doing. But you have to let's be realistic here. Okay, like, we're all busy humans, so it has to be convenient for you. Is it close to you? Or can like me? Can I come to you, you know, can I do at your house or gym or office? You know, is are they easy to get to? Do they have availability? And do you jive with them? You know, you can. So usually you have to try it once and then if you're like, oh, they just weren't a good fit for me, then you can break up move on. It's okay.

Kenny Bailey<br>: 48:20

But I mean, to your point, you know, try to look for PTS that are working with other athletes similar to what you're doing, you know, if they do geriatric, that's great. I mean, Pts are needed for that, but they may not be the best for you because you're dealing with a unique kind of thing.

Abby Daunis: 48:33

Correct? Yeah.

Kenny Bailey<br>: 48:35

You need somebody who's more empathetic that, you know, these races aren't aren't just like, Oh, it's a race. Who cares? Like no, no. You know, I surround my surround my family around this, I surround my schedule around this, like, everything's surrounded by this. This isn't just a race, it's, you know, it's a lifestyle, right? So I've always

Tom Regal: 48:51

said if you if you walk into a doctor's office, PT or you know, Cairo or whatever, and you tell them you have this issue in a race coming up, and they immediately say we can't do the race, and you walk out and you find somebody else, right. Yeah, your walk the other way, because that That's somebody who a doesn't do the races or doesn't isn't that active isn't, you know, a sports specific. That's what, you know, the speciality is that you can walk in there and they go, okay, and they start asking questions and go, okay. If they look at how we can get you through your event, then you've got somebody that's probably worth sticking around with and working with because they're going to work with you. They understand your mental state of what you're trying to accomplish. And they will maybe the ultimate thing will be no you shouldn't do the race, but at least they're willing to examine and explore and walk through all the all the issues with you. So

Kenny Bailey<br>: 49:46

it sounds like half your job is you know, it's basically therapy, you know, mental therapy, right? It's, it's, and so you want anybody that deals with athletes like me, but you want to your point, you know, there's a lot of fear and uncertainty and doubt Right, there's a flood factor that's going on, I can't I get back to this. And can I do this? And if you go to somebody that you don't feel like is addressing that Fudd factor as well, that idea of yeah, this is an important thing to me. This is, this is not something you know, it hurts when I do this, well don't do that. It's like, no, no, right? I mean, I was lucky enough to get a surgeon on that was working on my meniscus tear. The first thing he said to me walked in, it was like, when's your next race? Not Hi, how you doing? Or whatever else. It's like, winter. Next Ray, that's October is like, our, let's see if we can get you there. Right. That's, that's the kind of thing, you're going to trust that person more if they say, look, I, you may want to push this off. Because if you just have somebody that immediately just rare, you know, and they want to push it off, it's like, what do you know, like, you don't understand that. So trying to find a PTS that have that viewpoint like yours, right? That, that understanding that empathy to make sure that it's more than just can they physically do the right thing. It's also today understand sort of the importance level what you're trying to do and how that may be, you know, vital to you, right? It's, it's kind of what keeps you moving. Right? Absolutely. That's important.

Abby Daunis: 51:06

I mean, I always there's a few good points here. So I, I keep racing a because I love it. Be because it also like, you know, I'm like yes, I'm out here with you, like I want to be I love the triathlon and endurance sport community. And so I'm totally immersed in it. Like, I'm still racing, I'm still helping you guys brace to Yeah. And oh, gosh, where's where's my brain going? I had so many good thoughts from those just said, Oh, also, you know, I've been a PT for 10 years. And what I've learned is you have to listen to your patient. And I just started and say, How can I help you? Like, what do you want? And you know, and then they told me, like, can you might say, I want to finish this race, you know, I gotta get to my Ironman, and I want to run without a calf pain. And I'm like, Alright, let's see, I'm gonna do everything I can to get you there. And then if I don't think it's safe for you, I'm going to tell you that to ultimately, the patient has the power, I only give recommendations. And you guys decide what to do with that information. It's the same as a doctor, believe it or not. I'm married to one physicians are not gods, okay. They,

Kenny Bailey<br>: 52:22

they don't put the toilet seat down. What? I'm just saying.

Abby Daunis: 52:28

Yes. Yeah, I mean, you know, all medical professionals, we just give recommendations, and then you decide what to do with that information. Okay. So, you know,

Tom Regal: 52:41

I think that's important to, for people to remember that, that you are the the customers that we, you know, the customers is number one, right? So and I think a lot of people get what's the what's the word kind of, in awe of a doctor, when you sit in the doctor says to do, blah, blah, blah. And they just Well, the doctor said, so I have to do it. It was just kind of like, No, you you can, you know, question the doctor in a nice way and not tell him tell the doctor stupid, I'm out of here, right, whatever. But you, you have the ability to say, Hey, can you explain that to me, let me make the proper decision. And I need all the information from it. And to have a doctor that's going to work with you, whether it's a surgeon to, you know, to PT to anything in between, it's just like, what, what are the questions you need to ask how do you kind of get through the thing you are in control of your destiny, you can make a decision to continue on with the race and do damage to yourself, you have the ability and the right to do that. Not always recommended, rarely recommended. But just to know that you can question what the doctor is saying, and you probably should, you should probably get to somebody that and if they can't explain it to you again, another, maybe that's a small red flag if they can't explain why you should do this, or what's going to happen. Maybe they don't have a full understanding of your particular issue, which is perfectly fine. Every doctor can't know everything. So it's impossible said, so yeah, there you go.

Abby Daunis: 54:13

I had a patient call me the other day. And they said, my doctor is recommending that I have this back surgery. And I said, Well, let's talk about it. And you know, he sent me the exact name of the surgery, and I went and read about it. And I said, Here's what I know. And here's what I can tell you. And when I've treated patients that have had a similar surgery, here's what it looked like, you know, and so and he but I said it's your choice, like you can decide and we kind of talked about how debilitating is this, you know, like, how much is this impacting my life? But yes, again, to that point, you're always in control. You know, it's good to talk to different people. He talked to me a PT who obviously I don't do surgery, but I told him what the other side of surgery looks like, you know, the rehab, the rehab side. Yeah. So he decided I'm gonna wait a few months and then see how I'm doing great. And I'm like, I'm here to help. Along the way, so yeah, it's it's a complex thing for sure. So there you

Kenny Bailey<br>: 55:06

go. Well, Abby, thank you very much for taking your time today. This is this has been a very enlightening conversation. I think I think it's a needed one too. For that, so yeah,

Tom Regal: 55:16

for sure is everybody's ramping up and getting through every thank you so much. And everybody, thank you for, send us your questions and comments we like we like kind of building our community, you can find us on their YouTube channel. You can find us on Facebook, we have that up now going, we're starting to build up, you know, some awareness of of the Facebook to get some conversation in the community. So send us questions, all of that. And as usual, give us some ratings, five stars, thumbs up, all of that good stuff that helps the algorithms find us and bumps us up a little bit more people get to hear the great content that we're putting out. So we appreciate all of that. Thank you so much. And until the next time, we'll we'll catch it up.

Abby Daunis: 55:55

Yeah, thanks, guys. It was so fun to be here. You know, I love the triathlon world and helping people get to race day and get out of pain. So this was a great time.

Tom Regal: 56:06

We appreciate you