We tend to find swimmers do pick up a lot of lower limb injuries. So I’m talking sort of below the knee. So foot, ankle, shins, calves, you know, things like that. Welcome to the Effortless Swimming Podcast to show that help swimmers and triathletes love the water, become a better swimmer and live a better life. Here’s your host, Brenton Ford. Welcome to the Effortless Swimming Podcast. My guest today is Ryan Twist from Basewater Ankle and Foot Clinic. Ryan, welcome to the podcast. Thanks for having me, mate. It’s been too long since we’ve caught up. Yeah, so we’ve done a bit of work together in terms of swimming coaching and your background in sport is triathlon and in particular Ironman, as you can see with a lot of stuff behind you as well with all of those races. And we, you’re a podiatrist and I thought it’d be great to get you on the podcast today because with all the lockdowns and all of that and I’m a prime example of it

is you’ve seen a lot of foot or foot, ankle, leg injuries as a result of it. So if anyone is listening who wants to get into running or they’ve been running and they have found themselves injured like I have, this podcast is for you. So what have you seen the last couple of months since pools are closed and all that sort of thing? Well, it’s been a really interesting trend and something that has definitely started to come through is people starting to pick up more walking and running because if we think about it, all the pools are shut. Well, for most people around the place, pools are shut. There’s no organized sport. There’s no gyms and there’s no other real way of exercising. A lot of places have a radius limit like in Melbourne, we can’t go more than five k’s from our home. So that rules out cycling and a lot of other things as well. So people are taking out walking and running and generally people who are fit and active

and got a pretty good level of fitness and competitiveness are going in at all guns blazing and getting injured as a result of that. Guilty as charged. The first lockdown in the first week I went for a run and I was going to do, it was gonna be 15 seconds sprint, 15 seconds walk and I was gonna do it for 10 minutes and I thought I’m feeling pretty good. I might just do that for 30 minutes and what do you know? In two days I couldn’t run anymore and that took me out for six weeks and then the second one I was just because I couldn’t swim and I couldn’t travel down to the bay. I did 97 and a half k’s in a week so nearly 100 k week which is more than what I did when I was training for Ironman. Just because I was bored and I needed something to do and then I was out for two weeks because my ankle fled up again and I wasn’t surprised, I knew it was gonna happen but it was one of those things where I had to just exercise.

So what sort of injuries are you seeing in what’s most common at the moment for people? Well right now the two most common things either soft tissue tendon injury so Achilles tendinopathy, a couple of other tendons in the foot which commonly get injured or like the classic plantar fascia which is sort of bottom of the heel pain and then the other sort of injury we’re seeing at the moment is a lot of bone stress injuries where bones are getting stressed too much too soon and they develop some swelling and inflammation within the actual bones and that can be a real problem and we’re seeing a lot of that at the moment. Swimmers are especially guilty of this and in non-pandemic world we certainly see this a lot as well in swimmers as a subset. So it’s interesting now. So generally swimmers, swimmers if they’re looking to transition to triathlon or they wanna pick up some running, train for an Ironman or a marathon or they wanna change or introduce more cross training

to their training or whatever, we tend to find swimmers do pick up a lot of lower limb injuries so I’m talking sort of below the knee so foot, ankle, shins, calves, you know, things like that and the reason why I think it is is because first of all, as we touched on swimmers are very competitive. They’re generally sort of quite high achieving in an endurance sport. They’re fit, they’re strong and they’ve got good aerobic base because we know how good swimming is at building that aerobic base. So they could, you know, aerobically and psychologically they can sort of run, they can run for many k’s but the years of that non-weight bearing conditioning you get from running, so you know, the lack of that through swimming is certainly a problem that we see a lot in swimmers because of all those reasons why, you know, they’re fit and strong and healthy and they go out and run. They’re not conditioned to run so they develop overuse injuries very, very quickly

and it’s very common to see. And what do you, let’s say someone hasn’t started running yet or they’re just, they’re looking to start. What do you recommend to those people? Obviously don’t do 60 k’s your first week. What sort of thing? What sort of thing help avoid those sort of injuries? Okay, so the best thing that especially I swimmers or anyone can do is get a strength and rehab sort of program started where they’re focusing in on specific areas of the lower limb and foot to improve the strength of the muscles of the joints of the collagen of the ligaments, you know, soft tissue, everything. At the same time, start running very, very, you know, lightly, we wanna start at a very small base and progressively build. And so generally what we recommend for swimmers to start running would be a few weeks of a walk, run training program where they go out for a run where it’s say 30 minutes, but you’re walking for three minutes, jogging for two minutes,

walk for three minutes, jog for two minutes. So it’s a walk, run cycle. And if you do that consistently a few times a week for a few weeks, at the same time, you’re doing a lot of strength and conditioning to build up that strength in your lower legs. That’s the best way rather than going in and diving in head first, pardon the pun, to just running. That’s gonna help protect against these bone stress injuries and this plan of heel pain and tendinopathy so that we see a lot of, yeah. What are some of the most common strengthening exercises that you’ll give that sort of cover most of your bases? Look, I am a huge fan of developing calf strength. We know through lots of studies and anecdotal evidence that when runners have strong calf muscles, the chance of an overuse injury significantly decreases. And so the calf muscle is made up of four muscles and if we focus on strengthening the soleus, which is the biggest one in that calf muscle complex,

that can go a long way to helping to protect against a lot of overuse injuries. So strengthening the calves is super important. And then I’m also a big fan of strengthening a couple of muscles located within the arch of our feet. They help to control a lot of motion as your foot strikes are ground and responsible for a lot of propulsion. So a muscle like tibialis posterior and another complex muscle located within the actual foot, that they’re really good things to try and focus on. Yeah, right. A friend of mine, he had an issue with his calf for like three years or something and he just couldn’t run for a very long time. He went into see like one of the top three experts in Australia and you basically have to have been injured for at least three years or something to be able to go and see this lady. And I remember him telling me that he went in and it was her and like her trainee apprentice person as well. And they turned him around and they had looked at his calves

and they basically paid his calves out for a few minutes at least picking it up. And then she gave him this really heavy your sort of calf strengthening program. And he’s good to go like he’s ready to run now. But yeah, essentially it came down to calf strength and obviously just easy back into it.

Yeah, apart from being the bruised ego, I’m sure he’s super grateful now. Oh yeah, yeah, yeah, yeah. It’s the reason why is because the calf muscles, they absorb so much load as we strike the ground and they are responsible for a lot of propulsion forwards. Early in my career, I was very fortunate enough to work alongside a podiatrist that was involved at the Australian Institute of Sport. And at the AIS, they’ve got a lot of benchmarks that athletes have to meet, you know, certain strength in certain muscle groups and certain range of motion and certain joints for the calves, it was all weight-bearing athletes had to clear 25 single leg calf raises on each side with the right technique. That’s the gold standard. It might have changed, this was 10 years ago now, but it might have changed since then, but that’s sort of a good benchmark to aim for. If you can achieve 25 single leg calf raises on each side, again, with the right technique,

it makes a massive difference. What do you see? Because listening to that, you think, oh, it doesn’t sound that hard, but I guess I think I’ve sort of done a little bit of it before and 12, 13, 14 reps in, start to feel it. And I’m guessing the form probably breaks down then. Big time, yeah. And then you start compensating. A lot of people will start to say bend their knee, which engages the hamstrings and the glutes, which can assist in it. And then the pelvis anteriorly rotates. And so you’re sort of rotating outwards through your hips. And so you’re engaging all these different muscles and joints rather than actually using the calf muscles to engage the movement. So very few, even high level and even elite level athletes struggled to do 25 single leg calf raises each side. So it’s a good thing to aim towards. And if you’re commencing running, it’s even more important. What about shoes? What kind of impact do they have

having the right kind of shoes? Yeah, everything. As a podiatrist, I’ve been practicing nearly 13 years. I would say the number one risk factor for injury. There are lots. The number one risk factor for injury is footwear. And the wrong shoes can cause injuries so quickly. And so it’s really important to get the right kind of shoe. And it’s probably the number one question we get asked is what shoe do you recommend? And my answer is there isn’t one. It depends on your foot type. It depends on your level of ability. It depends on your injury history. It depends on what surface you’re running on most of the time. There’s so many factors at play. The best advice I can give, there’s two bits of advice. One is that you have multiple pairs of shoes. Studies have shown that if you have more than one pair of shoe, it will decrease your chance of an overuse injury. And then the second thing is that you invest in some time

and some money and going to a proper footwear shop where they do a full fitting service where they’ll take a look at everything, take it all into consideration and then find the right type of shoe for you. So, yeah, they’re the two best bits of advice I can give for going footwear. A couple of questions there. The first one is a couple of different pairs of shoes, like of the same kind, or if you’re running on, say, the road or trails, like what do you mean by a few different pairs? Oh yeah, sorry, yeah. So that’s a mix of that. So it’s good to have, say, a pair of trail shoes. Then let’s say the Sunday long run built up more sort of cushion shoe. And then maybe a faster, flatter pair for your track sessions or speed sessions. And then maybe another shoe for your 20 minute easy run. Having all those kinds of different types of shoes for the different type of running you’re doing is the best way to go about that, yeah.

Yeah, interesting. Because the reason I asked about the shoes is I’ve got, so I had a pair of new balance shoes, no idea what they were, but I bought three of the same kind. There was one pair that I wore through, they were great. And then the second lot of that same style, the left shoe, just for whatever reason, the didn’t sit the same. And so I developed a bit of an injury from using those. And so I went on to the third pair, and then the right one had, I sort of had a similar issue with the fit, like they weren’t exactly the same. Just because they’re like the, I think not the sole of the shoe, but the little insert in it felt just a little bit off and that just impacted how I was landing. And it was all down to the shoes. So I’ve got rid of those and got some new pair, some new trial shoes, and they are great for on the trials, but on the road they just, yeah, they’re not that great. So I need to get another pair of shoes

for the road basically. Yeah, and if you stick to the same basic principle of how that trial shoe feels for your trial, if you sort of, you know, because trial shoes and running shoes have got pretty similar technology. If you stick to that basic principle, what works in the trail to the road, it’ll help a lot, yeah. Yeah, yeah, gotcha. And then in terms of seeing someone, so they’ve got, I know they’ve got the athlete’s foot, but you know, they have their sort of basic fit and that kind of thing. And then do you see podiatrists about that stuff as well? Do you guys do that? Or it’s more, you’re going to like a shop like that because I’ve heard reviews on those, just, you know, the foot shop and you probably, yeah, that smile sort of says it all, but that’s something that you guys do. Yeah, definitely. And look, like the athlete’s foot is, you know, it does largely a good job, but you know, the commercial reality is

they’ve got budgets to fit and a lot of the time they’re kids serving them. So there can be holes in that system. So yeah, as podiatrists, we can certainly guide people down the right sort of path, but until someone actually tries that shoe on their foot, they’re not going to know exactly. So yeah, in these days, there are good sort of specialty running shoe shops that are opening up. People recognize gaps in the market. So the running company is a super good footwear shop if you’re in Australia. But there are certainly lots of others popping up around the place and they’re really good. It’s worth the time and money to go to places like that if you’re, you know, pretty serious about your running. Yeah, yeah, definitely. And I think even just in my last six months, I looked at it and let’s say a pair of shoes cost you $200. Well, I think if it’s going to sit me out for six weeks for not because I can’t run, because I’ve injured myself,

it’s like I’d much rather spend $500 on a pair of shoes and still be able to train for six months. 100%. And I’m sure you’d rather spend it on the shoes than coming to see podiatrists. Well, true. Yeah, you’re going to spend it one way or the other. Exactly. Yeah. And if someone is, they’re feeling a few niggles here and there, how do you know when’s the right time to when to stop? Should you just stop completely? Obviously going to see someone about the injury is a great idea. But do you need to stop for a number of weeks or can you continue to train a bit lighter? Now, what’s the sort of standard that you see there? Look, it’s a really, really good question. And it depends on the type of injury that you’ve got. So if we look at a bone stress injury, so bone stress injuries when there’s swelling and inflammation within a bone, and that can be a little, little bit all the way to a stress fracture. So anything along that sort of paradigm,

if it’s a bone stress injury, then ideally no weight bearing, no running at all. Because if you continue to stress the bone, it’s going to get worse and worse and eventually crack. So that’s why swimmers are all right to deal with in that sort of injury because they’ll go and swim. If you tell a pure runner to swim, they can’t swim and they hate it. So that’s all right for swimmers. But for a soft tissue injury, say we’re talking like a tendon or a muscle or a ligament,

they like to have a certain amount of load put through them in order for them to recover and repair. Complete rest for a tendon, for example, is quite bad. But knowing where and how much load to put through that damaged structure is really hard to determine. And that’s where I guess a physio or a podiatrist or an osteo whoever can help guide people on that. Because if you do too much on an injured tendon, then it will flare up and it’ll get worse. If you do too little to an injured tendon, it may not repair and regenerate, it might drag on. So finding where that load level is and then staying around that load is super important. In terms of when to pull back or get advice on and you have a bit of a niggle, it’s a really difficult thing to try and explain to people. But as a general rule, what I like to say is that if your pain level, and this is very subjective, I’ll start by saying this is subjective. So it has a lot of flaws.

But if your pain level is about a seven out of 10 or less, generally it’s okay. When it gets to about an eight out of 10 or more, then generally you need to see someone. So if we go out and train and we’re going for a run,

yeah, we’ve got a little bit of a niggle, that little bit of a niggle, for you and me might be a bit different. It’s hard to know exactly, but if you think of that number seven out of 10 or less, then it’s generally gonna be okay. But a bit more than that, you need to see someone. Yeah. Yeah. But again, I understand, I appreciate how subjective that is and everyone’s seven is gonna be different. So it’s really, really difficult. But the best advice is if you’re unsure, it’s best to be seen earlier than later. And what about in terms of volume of running or how many times a week? I mean, I’ve seen, I’m just thinking of one friend in particular who was, hates running.

Don’t we all? Yeah. I’d say in the last, probably 10 years since I’ve known him, he would just always refused. Like he would never run. He’d always sort of talk about how much he hated running because he’s a swimmer and now he’s been running three times a week between three and five Ks really. So pretty light. He’s not injured or anything. What sort of volume would you look for people to sort of limit it to if they’re coming purely from a swimming background and they’ve started running in the last six months. And I know everyone’s different obviously, but what sort of things are you seeing causing those injuries? Like what sort of volume are those people doing? Yeah, the injury, if someone gets injured, generally they’ve done too much too soon. So they’ve made too much of a jump and too much of a short period of time. In terms of the type of volume, it depends on the base that that athlete or that person’s got. And some people can deal with a huge jump in their training

and generally they’ll be okay. But as a general rule, like many years ago, we heard this 10% rule where you should increase your volume by 10% each week. For someone who’s pretty fit and pretty strong and towards sort of a pretty good level of ability, you can generally increase by about 20%. Again, that will decrease if your volume’s massive. So say you’re running 120K a week, it’s not a good idea to increase that by 20%. But for those pretty good level athletes, if you stay somewhere between 10 and 20% increase each week or each month, that’s a pretty safe sort of window. If you’re coming back from an injury or you’re starting from the bottom, if you’re a swimmer who wants to just get into running, then it’s best to keep it under 10% increased per week or month. So I hope that makes sense. Yeah, that was kind of gonna be the next question. How much each week should you generally increase by? And one of the things that I found quite helpful

as I’ve been running the last few months is

I’ve been doing lots of sort of slow, easy case. I’ve sort of been out in the forest and near the mountain that sort of near my house and just exploring around there. And so it’s some really steep grating. So I’ve just been walking the uphill and just kind of cruising for the most part. And I haven’t done many efforts. And I’ve found that that’s made a big difference with just being able to do a bit more distance than I would normally do is like, I’m running some pretty slow case there compared to what I’d normally do. Like a slow case would be like, if I’m running just easy, it might be to say five minute case or five 15. But some of these have been much slower and I’ve been able to hold keep pretty good distance throughout since then. And what do you, do you ever sort of talk about pace and speed and that kind of thing? Cause the first time that we went to lockdown it was cause I was doing too, I did too much sprinting off the bat

and that’s that caused me to get injured. So now I’ve just gone too far in the other direction. I think just all easy case. Yeah, I’m a huge advocate of this from an aerobic benefit scheme, but also if we look at injury prevention scheme as well. So what we do know is that if you’re running easy and running slow like what you just mentioned there, generally your heart rate’s gonna be a bit lower than you’ll be in that sort of zone one, zone two area. And we know that when you’re training in that zone, your body’s producing certain hormones and certain enzymes and chemicals which aid in aerobic fitness, but also decrease the overall toll on the body so you recover a little bit quicker. Once we get into those zone four and five heart rates, we’re producing different hormones, different enzymes, different chemicals. It’s a bigger toll on the body. It takes longer to recover and it’s much more demanding on the system as a whole.

And so if we’re constantly in that zone four and five heart rate, our body’s gonna fatigue much more easily and it’s gonna more likely develop an injury as a result of that. Whereas most of our training is done in that zone one, zone two area with that top up in that zone four and five area, then that’s the best way to first of all get fitter, but second of all, prevent injuries from the caring because those hormones and enzymes and chemicals that are being produced in those lower zones, I’m talking the physiological reactions but also a cellular reaction in the muscles and the tendons and the bones. They’re getting much fitter and stronger, much quicker in those zones and recovering much quicker as well. Yeah, so I’m a huge advocate of running slow to run fast. Yeah, it really makes a big difference. And I speak a lot with my athletes, my patients who come in who, I’ll often look at their training program and I’ll never write a training program for them

because generally they’ll have a coach but I’ll have a word to their coach and make slight adjustments and tweaks and recommendations based around that sort of theory because it’s so important that it makes a massive difference. Yeah, and as you were saying before, I mean, well, swimmers are a competitive bunch, triathletes are a competitive bunch and I know personally, like most of the time I just want to get in there and go for it and it’s hard to hold yourself back. Definitely, definitely. As a male, a young male as well, that can also be a thing I’m guilty of that myself but swimmers especially, especially if they’re a good swimmer, they’re used to being in that fast lane and they’re leading out their hundreds and they’re smashing out those sets and they swim faster than most others and they swim better than most others and swim more often than most others. So when they start running, they’re right at the bottom.

When they’re used to being at that top end of their sport, now all of a sudden in a sport that’s relatively similar, they’re so far down, they try to work extra hard, extra hard to get to that level that they’re used to being. So dealing with swimmers can be tricky because of that. One of the things I’ve really enjoyed is the last, I guess six months ago, for those easy runs, I’ve just been practising nose breathing, nasal breathing, so I only breathe in and out through the nose, close your mouth and if I do get to that point where I’m going too fast where I’ve got to breathe through my mouth, I’ll just back off the pace and I’ve been doing all of my easy runs with that and at the start, the first two weeks, it was really challenging even to go at an easy pace but after that it’s just, it made a difference and when we got back in the pool in that middle section when I was able to swim again, I was pulling out some really good times in the water

because aerobically I was really fit and I think that nasal breathing made a big difference or it helped me at least maintain that when I wasn’t swimming, I was only running. Have you sort of experimented with that much or have you looked into that much at all? Yeah, yeah, I’m a big fan of that breathing pattern, it makes a big difference and especially for swimmers, I find it helps. From a personal perspective, I’ve done the same and I’ve found the same as well when we could swim there for, what was it, a month or so. I felt like when I hopped back in the water, I was actually breathing much more efficiently, much more easier because of exactly what you just said, yeah. Is there anything that we haven’t talked about that you think’s important to bring up for those that are starting to run a bit more? Just be wary that, yeah. If you are a swimmer and you’re a high-level swimmer, just be wary that your bones and your muscles

just aren’t quite conditioned for the running. Yes, aerobically, you’re right up there and you’re probably better than some of the good runners but from a cellular level with what occurs when your foot and leg impacts on the ground, the damage that occurs to those bone cells and those muscle fibres, it’s gonna take a harder toll on your body than that well-conditioned runner. So you just need to be patient. You need to grow into it slowly, do that strength and conditioning at the same time, you’re doing that walk-run program for a few weeks before progressively building and you’ll get there so much quicker than someone who goes in too hard too soon or has no background in swimming or running. You’ll really accelerate if you follow that general advice. I hope that makes sense. Does that sound clear? Yeah, and one other thing that just came to mind there is I haven’t asked about mobility. What sort of importance does that play

for avoiding those injuries as well and what kind of tightness wear and what sort of stretches you’re giving to people? Yeah, look, that’s really, really important.

There’s 26 bones and 31 joints in each foot. So there’s a lot of moving parts, there’s a lot of bones, a lot of joints and so they can seize up and become very tight and if one becomes tight, the rest sort of go out in unison with it. So stretching the calves, and ankle range of motion, even toe range of motion movements and regular massage is really, really important. It can help a lot, but as podiatrist, well, myself trained in mobilization and manipulation of joints of the feet and that can make a massive difference as well. So if anyone’s listening out there and they’ve got really tight calves, a really tight ankle or really tight arch, there’s no necessary injury or pain, but they’re super tight in any of those areas. C. podiatrist is qualified in that mobilization and manipulation and some soft tissue work and it can make a massive difference in your comfort levels, but also preventing an injury. Awesome.

And for those that are listening, you’re obviously based in Melbourne, where can people find out more about where you guys are and how you can help? Sure. So people can look up my personal pages, Facebook and Instagram or on work. Work pages are also Facebook and Instagram, which is a Bayswater foot and ankle clinic. And I love my swimming, I love my water, but Bayswater is not located anywhere near the bay or any water, unfortunately. So I don’t know how I got that name, but yeah, Bayswater foot and ankle clinic. And if anyone wants to shoot me a message or we can even do online appointments to anyone around the world at the moment. So yeah. Awesome. Thanks for jumping on and probably partly selfish of me because I’ve been dealing with some injuries in the last six months. But yeah, no, I appreciate that. Yeah. No, I’m back running. So it’s all good now. Good. And yeah, thanks for jumping on the podcast. Thanks for having me.

It’s been great. Thanks, Mike. Thanks for listening to the Effortless Swimming podcast. If you’d like us to help you become a faster, more efficient swimmer, go to www.effortlesswimming.com.