Prehab for Mountaineering Training

00:01.87
Steve
Welcome to the Uphill Athlete podcast where our mission is to elevate and inspire all mountain athletes through education and celebration. My name is Steve House and I will be your host today along with Alyssa Clark. We are continuing our mountaineering series with a special guest from our staff who specializes in helping athletes stay healthy and injury-free. We’re pleased to welcome Pete Dickinson onto the podcast. Pete is a licensed physical therapist and has a board certified specialization in sport. He has served as a physical therapist for the US ski team and is an avid athlete himself. He is here today to discuss prehab for training and to make sure you are ready to begin your mountaineering training. Thanks for joining us today, Pete.

00:46.93
Peter Dickinson
Thanks Steve and Alyssa, it’s great to be here. Mountain athletes have been a big part of my practice since the very beginning and I really enjoy working with clients that have high demands placed on them and then have big goals. Of course it doesn’t have to be, you know, an elite gold medalist that has high demands on them and big goals. It can be just us common participants out there that are trying to get out in the mountains but need some help.

01:24.44
Alyssa Clark
Agreed and I think actually our athletes create a unique situation because a lot of them actually have very high work demands and so it’s figuring out how to balance that training with the work demands that they have as well as the travel. I know a lot of my clients are very busy people but we are really excited to have you today Pete and excited to hear about the role of physical therapy in training because I think that we tend to think of it as more of a reactive part of our training. So I’d like to hear how perhaps we can change that mindset into thinking of it as more active. First though I’d love to hear a little bit more about your background and how you became involved in physical therapy and also working directly with the US Ski team.

02:16.79
Peter Dickinson
Well, it’s a journey like many of us. I actually came out of college with a degree in psychology. But then I quickly moved West and worked for some outdoor education programs for people with disabilities and so it’s kind of adaptive outdoor ed so we had both summer and winter programming and through that I became interested in physical therapy was riding the chair lift with a buddy and asked him what he did he said pre physical therapy and that sounded like a good fit for me. Prior to that I’d been with NOLS teaching with them for a little bit so I just love the outdoors and it’s been a great fit for me. Then for the team stuff I started working in Park City had a practice there and that was where the US ski team is headquartered and started treating their athletes in the clinic then was asked to start traveling with the team. So my first team in the 90s was with the men’s downhill team. I subsequently moved to Winthrop Washington which has a big cross country focus and started traveling with the US cross country team. It’s kind of like the difference between Nascar and formula one. You know the downhillers are getting banged up all the time, big surgeries, high demands. But then the endurance crowd with cross country it’s more like tuning a Ferrari as Matt Whicomb used to characterize it. It’s more subtle work more focused on recovery and that’s really helped me broaden my background in treating the high demand individual.

04:09.54
Steve
Well, that’s how we first met Pete. I remember walking into your clinic in Winthrop Washington probably back in 1997 or 98 or 99 somewhere in there when you probably weren’t even open yet. And I was a 20 something year old climber with a pretty serious injury that had resulted from a crevasse fall where I had basically torn most of my hamstring off of one of its attachment points in the back and you helped to nurse me through that I was quite some time ago. So it’s nice to still be working together. Albeit it let’s say in more positive ways.

04:50.98
Peter Dickinson
Yeah, no you were a little bit of a train wreck back then that was that was for sure, not subtle subtle therapy back then.

04:58.81
Steve
Yeah, that was not subtle therapy. So let’s go back to you know, sort of the focus of this episode is we want to talk about Prehab specifically. So what does that mean to a physical therapist and how does an athlete know if they’re ready to begin a structured training program whether that’s in a training group or with a coach or from a training plan. How does one know?

05:31.29
Peter Dickinson
Yeah I mean that’s a hard thing because we all come to these things with our previous injuries or our activity background and where does that place us on the continuum of being ready to take on a structured plan and how do we know that? When I look at Prehab getting ready for an activity I think about having a great strength background because strength is really essential for all these activities and maybe we’ll talk about durability a little bit later. Having a good enough strength basis in which we can tolerate all of our aerobic activity without developing all the tendonitises and tweaks so that’s a good starting point. Can I perform without getting injured or can my current condition with my injury history? Whatever I have right now will allow for further training. But it’s all about this continuum and everyone’s individual about that and that’s what I love. Having a coach helps determine that and then I know Uphill Athlete has a team of people to come in and provide additional insight with the nutritionist, physical therapy and the teams that I work with. We have a staff attending to these athletes when we’re out there. We don’t have that anymore and so that’s why I like having a setup where you can get coaching, you can get physical therapy, nutrition. All these other services.

07:22.81
Alyssa Clark
That’s great. So I think that’s kind of the basis of all of this is that every athlete is an individual and so that’s part of the challenge of making these podcasts and also part of the challenge of more group training.

07:40.23
Alyssa Clark
But if we were to say separate athletes into two categories. We’ll say category one is coming off of a more prolonged break, say three plus months. I know some people we get haven’t really been consistent for 5 years. I’ve worked at a desktop versus an athlete who took a bit of downtime in between seasons but still has a strong base. So say an athlete who maybe took two or three weeks off just as a rest season. How do you treat them differently and what are you looking for in these athletes as say you are assessing them for readiness to get back into things.

08:25.31
Peter Dickinson
Well, the easy one is just coming off a short season or an off season getting ready to get back to your focused goal oriented activity or project that you have coming on that you’ve taken on. So with that typically you’re pretty good with your aerobic activity. You’ve been active but you haven’t maybe been as focused about your strength activity. So that’d be returning to lifting heavy things and getting your strength basis elevated. So that as you then start increasing the volume of your aerobic activity and the intensity and then adding terrain that you can do that gradually now for all groups we have this rule pretty much 10% rule and the 10% rule is that our bodies are amazing.

09:15.90
Peter Dickinson
We have this 10% ability to overreach to increase our volume intensity load by 10 percent and we can adapt. In fact, it’s a stimulus for adaptation. But if we double it or triple what we are normally used to doing then that increases our ability to or the chance of reacting and getting injured so tying into what your increases are is really important wherever you are on that continuum so you don’t suffer from OES which is our overenthusiasm syndrome which we are all guilty of doing. That’s how we get into trouble because we get so excited. It is so fun to be outdoors hiking up that hill.

10:12.34
Peter Dickinson
Put a hill in front of me. I just love that. But that makes it easy to overreach and cause a problem. For someone that is coming newer into an activity or with a long layoff then a lot more care and attention into how we do increase minutes of activity and we try and narrow down these other extraneous factors with terrain. We try to get easier with terrain and just increase minutes of activity. Then layer the volume first and then you’ll start sprinkling in some intensity. Maybe adding terrain because we want to get folks uphill and then just build the strength makes everything good.

11:04.63
Steve
So one of the things that I’m hearing so far, a theme I’m picking up on in both of your responses so far is that the athlete kind of knows themselves right? Whether it’s somebody returning from an injury or whether somebody’s trying to assess themselves for prehab, they kind of have a sense of themselves already. They know what injuries they have sustained over their career right? You don’t just necessarily know that I’m meeting you for the first time but I know and I’m going to come in if I want to. You’re my PT, so I’m going to tell you about someone that I’m going to give you my history and so this kind of leads me into my next question. How can an athlete assess on their own whether or not they’re ready to start training in a healthy way? I mean, Alyssa talked about these two kinds of cases like a really long layoff or a planned layoff but is there some sort of like the yardstick I mean I know my body, I know what injuries, you say I need to be strong in strength. How did you say that strength takes care of everything? But how do I know I’m strong enough and what about alignment? I mean these are the things like am I overstrong in one area? Am I underdeveloped in another? How do I figure that out? How do I approach that problem?

12:29.20
Peter Dickinson
Yeah, that’s a great question. Ah, of course the most important thing is to know yourself. And knowing yourself means to be able to interpret the stories we have in our head that are pushing us to do things maybe we shouldn’t do. And so taking care of that side of the coin because that can really get in your own way a lot if you’re not listening to how your body is responding because your soul is goal oriented. You’re just gonna push ahead regardless so you have to be careful of that quality and that characteristic. We love that goal orientation and that push is required at times. But in the preparation training process it can often get in the way of things that we look at on readiness function and how you’re able to do things. How are you able to hike uphill to go downhill and handle varying terrain? Then how you adapt to that amount of volume or that activity. How much fatigue does that cause? Are you able to do that on repeat days? So some of these self-assessments are important for your readiness to take on activities and then again knowing what you’re doing now. Extrapolating out a little bit more okay, can I get started doing this on that 10% rule? That can come in handy with that. So knowing what you’re doing currently and just like any marathon training, we’ve got this goal out there but we’re here. So if we had to draw a line to get up there. And we’re adaptive so you can just start chipping away at it from wherever you’re at you can achieve as you know Steve any goal that you set as long as you are cognizant of how much time that’s going to take and the support that you need for that. It may take a body transfer.

14:36.52
Steve
Yeah, and the size of the steps that you take along the way right? Like not taking too big of a chunk, so I’m hearing.

14:42.74
Peter Dickinson
Right? The mistakes made when you got this big goal but you have a really limited time frame and you’re at a low level of preparation and you don’t have a time to allow your body to adapt then you’re really gonna overreach and get into issues. Our body is an adaptive organism. It’s a biological process though and that takes time. Time is your friend.

15:08.37
Steve
Time is your friend. Strength is your friend. These are themes that are coming to the surface already.

15:15.93
Peter Dickinson
You got a lot of friends out there, coaches, support and staff. Your community is huge in this because there’s a lot of knowledge out there. You haven’t trust me, you haven’t made all the mistakes you may have made most of the mistakes. But there are other mistakes out there that you haven’t made.

15:22.79
Steve
Yeah, yeah.

15:33.66
Peter Dickinson
You can learn those lessons from other people and then just offer support. We don’t want this to be an individual process. My team members will all report that being in Elite Sport is an isolating selfish activity at times. They’re not selfish people but their activity kind of forces them to pigeonhole themselves into who they can meet and what they can do with their social life.

16:06.29
Steve
Yeah I know that well I lived that for years.

16:13.18
Peter Dickinson
So tapping in the community can be hugely supportive and beneficial.

16:21.71
Alyssa Clark
I think that’s actually the sign of someone who is trending toward success or has found success at a high level is that they have a team around them. Granted Steve is a much you know higher athlete than I am at this point. But one of the things that I’ve noticed in my own athletic pursuits is that as I’ve built a team, the better that I do because I know who to go to when I’m having trouble. The other point that I think has come up a few times and Steve brought this up in the last episode is the narrative that you tell yourself. I think that one of the things that we struggle with is knowing if that narrative is accurate to where you are. And I think sometimes it’s very easy to tell a story that might not be completely true because either you really want it to be that way or you’re protecting yourself from the vulnerability of what that story could reveal. So I think it’s really helpful to have a team that helps you to question that narrative to make sure you’re on the right track. Or to know maybe I’m not ready for this yet. So it’s funny that that kind of internal narrative has come up with the story that we tell ourselves about ourselves.

17:42.80
Steve
Yeah, well you know I’ve spoken to thousands of athletes in the last seven years of Uphill Athlete’s existence and those who have come to us for coaching or training groups or so or whatnot and the ones that have the most unrealistic plans are often the ones that were the most isolated. They’d never in many cases done the sport like I want to climb Everest without supplemental oxygen three months from now and well how much mountaineering have you done? Well I’ve never been a mountaineer. It’s like oh okay, well we got to start at the beginning here. And sometimes you can course correct with those people. Sometimes it’s a conversation, sometimes it takes years and sometimes it takes some time to get the buy-in but I think that this community connects back to physical therapy and prehab and knowing I’m ready because that’s probably often a great reference point as to whether or not, you are going to be able to start an endeavor with a structured training plan and remain injury free and continue to adapt. As we should be given the right time frame. You know our community and that’s one of the things I think is so important with the athlete is creating a community or a bunch of little mini communities all over the world where people start to connect over this over training. Correctly, adapting to improve not only their sports but for their lives and start to have these people to have these discussions with and you know some of that starts right here. But I think this is really really key.

19:29.36
Peter Dickinson
Yeah I mean I often see people come with maybe expectations that aren’t in line with reality a little bit but you’ll also see people that they’ve tried on their own and they keep on getting spit out because there’s some training errors being made so that’s why I love when you can have a training plan or a coach and then a support team. You can really reduce your training errors and when you reduce training errors, you reduce injuries. You reduce all the achilles tendonitis, foot issues that I hear so much about, usually most injuries are training errors in that regard.

20:24.20
Peter Dickinson
And then that’s balanced by you get someone with big hours of training then that’s a different issue because then odd things happen when the body’s under that much stress for so long. A period of time then you can see some odd things that it really helps them to have an experienced eye looking at that.

20:42.41
Steve
Right.

20:43.79
Peter Dickinson
Because they’re not usual. They’re going to be missed and my elite athletes are the ones that teach me the important lesson of listening to your patient because they’ll tell you if you pay attention.

20:57.98
Steve
Yeah, but those are the people that need an in-person physical therapist.

21:03.37
Peter Dickinson
Yeah, you’ll see all sorts of autoimmune stuff or are just strange presenting conditions.

21:14.35
Steve
So how should we think about physical therapy? I mean I originally thought of PT as reactive work but should we be thinking of it as everyday active work and injury prevention. What does that look like and what can we do to help our athletes to take on this more active preventative point of view of physical therapy?

21:34.64
Peter Dickinson
Are.

21:41.52
Peter Dickinson
Right? Well yeah, it’s prehab and it isn’t just under physical therapy. It’s strength and conditioning, coaching, we all have our finger in that pot of getting someone ready. For the imposed demands that are coming and when you need physical therapy is when you have a loss of function or loss of range of motion. You have acute injury or you have a chronic injury you haven’t been able to overcome. Those are good conditions for a physical therapist to put their eyes on you and to give some insight and some directions. You should be going that would be maybe counter to the stock. Like I just don’t want to do deadlifts when I do overhead presses, pull-ups, things like that because we’re all individuals and we all will benefit from individualized approach.

22:48.56
Peter Dickinson
So the other part of that though is I like being involved on the prehab throughout the whole process because we like little tweaks and little injuries not to become big things and that’s kind of the team concept. Why you have someone kind of involved is that you don’t want to let things develop because you’re just ignoring it so you want to treat little injuries so they don’t become big injuries and then you don’t lose training time and that’s you know that preparation period of time where we’re trying to continue to increase volume or intensity. And prepare for that big event. We don’t want our big thing that gets in the way if we lose time due to injury. We don’t want to sacrifice that.

23:42.73
Alyssa Clark
And I think that goes back to truly the secret of athletic performance and training is consistency and so if you lose that time you are losing that consistency. So on a more positive note. I would be curious I feel like sometimes with physical therapy I’m sure you feel this at times it can be like you’re the doctor if you’re seeing people when they’re perhaps not at their best they’re coming in injured or tired you know things just haven’t been going well but to flip that script a little bit. What commonalities do you see with athletes who have built and I love this word, durability. Athletes that are doing things right? That are able to keep that consistency and stay healthy.

24:36.34
Peter Dickinson
Um, so durability that really speaks to someone that has greater training hours. They’re active consistently throughout their week, throughout their month and throughout their years and they have years of background being very active, being exposed to a lot of load typically so either self-imposed through strength training or through their work conditions. They have good learning behaviors. They learn from their mistakes so they can keep in the game. You don’t accumulate hours over many years if you get spit out. So usually you have to have good learning behaviors. Keeping your injuries manageable early treatment is important. They also know how to manage fatigue. They’re comfortable with fatigue. Their durability usually speaks to someone that’s very motivated so they don’t mind accumulating fatigue. But then they recover. Fatigue is an important part of athletic preparation. You have to expose yourself to that so that you can adapt to it and so those are some of the characteristics of someone that’s durable. They’ve been in the game a long time. They’ve handled load for a long time but they have pretty good behaviors.

26:07.52
Steve
Yeah I’ve often thought about this with climbers that I’ve known where there are some that are as you say durable and there’s others that just seem to be constantly injured. I think there’s sometimes just a certain genetic component.

26:24.98
Peter Dickinson
Sure.

26:27.70
Steve
Sometimes my conclusion. Some people have shoulders that are just never going to stay stable, but one of the things that I’ve noticed is with the people you know and I’ve learned just the hard way multiple times is. Taking those injuries and learning from them. You know one example for myself is with shoulder issues that I developed when I was ice climbing a lot and then learning through research and physical therapy and talking to my community that I was weak in a certain way and then ever since then there’s been a therapy band hanging on a doorknob somewhere in every house I’ve lived in. I don’t count reps or stats or any of that. But I do my certain little exercises and it’s just kind of second nature. It doesn’t really take any time. It doesn’t take any energy but it does keep my shoulders healthy and I haven’t had shoulder issues in over a decade because of adapting that behavior and I think that’s the kind of thing that is a small thing but it can be really really helpful.

27:44.27
Peter Dickinson
We’re all individuals. We all have our special things and Steve, what you speak to is you identifying that. It’s different for everyone for me, it’s my spine for Alyssa, its nothing because she can do 95 marathons in ninety five days but for the rest of us, we have our achilles heel we have something that we have to keep up on and identifying that knowing yourself really goes a long way towards keeping you in the game and not losing training time.

28:22.50
Steve
Well I want to unpack this for a second because I’m curious, Alyssa can you tell us a little bit just about your 95 marathons and ninety five days. I admit that I don’t know that much about it, when was it, what they were like, what was the whole idea and then I want Pete to figure out why you didn’t get injured doing that.

28:43.84
Alyssa Clark
That’s a fun kind of real life case scenario. Okay I won’t add that part because we’ll have Pete unpack it. But I began them in March of 2020 when we lived over in Italy. Covid lockdown was very bad over there and I had a treadmill available to me, but we were not allowed to go outside. All my races were canceled for the season and so I was trying to keep myself honestly from going insane because I am used to a high load of training and so I found myself just kind of mindlessly running up and downstairs in our house. I was like I have to do something that gives me a goal and focus and so I originally planned to run a marathon every day until restrictions were lifted and we were allowed to go outside. It was supposed to be fourteen days to start and then it quickly became something that just didn’t go away so I continued to run for ninety five days and that included an international move from Italy to Florida, so I ran on a German Air Force base in the middle of the night I ran in 3 different states.

30:12.28
Alyssa Clark
And it was just kind of a wild journey that I never anticipated doing. It just kind of fell in my lap we shall say.

30:18.85
Steve
Wait, so you did 95 marathons on a treadmill.

30:24.90
Alyssa Clark
I probably ran fifty to 60 of them on a treadmill because we were not allowed to go outside.

30:35.66
Steve
That’s still incredible. Wow. Okay.

30:38.68
Peter Dickinson
That yeah and so to be clear, you came with a good training background for this because I know you’re a former skier and biathlete and have also been exposed to soccer and all those activities. That’s a great, wonderful preparation for anything in life. We should all be so lucky to have that. So I’m curious, did you do any maintenance activities during.

30:57.24
Alyssa Clark
Lacrosse but also soccer.

31:12.96
Peter Dickinson
Ah, during your 95 marathons?

31:14.84
Alyssa Clark
So probably the best maintenance was a good diet and sleep. That is truly what sleep was, the magic elixir if I did not sleep, well the marathon the next day was very hard. If I slept well then the marathon was a lot easier and so cumulative fatigue managed that sleep I mean you wake up and you’re like okay I’m ready to go.

31:48.78
Alyssa Clark
I think I stretched just a little bit but honestly it was more about energy conservation than pretty much anything else.

31:57.66
Peter Dickinson
Yeah, doing the big things first you know, sleep and nutrition. And probably also managing your pace and your train was really super consistent. So we have a principle called the said principle, the specific adaptation to the imposed demands and after a while your body has adapted to doing that running and you started off though without it being not much of a reach because you’re probably fit and had a good strength basis to protect your joints. If you’re not strong enough, going into it your joints will see too much load. Your tendons will see too much load because they’re not stiff enough for that activity and you’ll get into trouble. It probably helped you that you had a treadmill for a lot of it. You’re okay between the ears being on a treadmill for 60 marathons.

32:54.45
Alyssa Clark
I think a lot of people would question if I’m okay between the ears but I think that’s what makes me lovable.

33:05.90
Peter Dickinson
I’m not even going to touch that. So the thing we see with activity though is it causes inflammation in your tissues and with training with anything your fibers get a little sticky. They form bonds between each other in the fashion. You don’t slide and glide then that starts skewing off the vectors for all the force loads on your foot and your knee cap and shoulder. So I was curious as to whether you’re a pretty flexible person to begin with.

33:43.49
Alyssa Clark
I am not very flexible. I will say there were about 3 things I was going to say I noticed. I’m drawing a blank on what I was going to say. Oh, okay here we go number one. I probably put on 10 pounds in the first twenty marathons because of inflammation so that was something that makes exact sense to what you were just saying.

34:12.77
Peter Dickinson
Um, ah yeah.

34:20.76
Alyssa Clark
The inflammation added quite a bit of water weight. It did come off my upper body then shrank to basically nothing and my quads were very strong. My legs gained quite a lot of muscle from the other adaptations.

34:38.98
Alyssa Clark
I could run 4 marathons in a row within a minute of each other pacing-wise I had an exact pace that was exactly where my body was efficient and I did not have to try at all to hit that pace. It was like a metronome.

34:58.69
Alyssa Clark
And what’s interesting is that my coach was actually going to have me come down from the marathons. I ended up getting sick so wasn’t able to finish them hence 95, not 100 but he was going to actually have me decline the mileage. Not just stop cold turkey because I had created such an adaptation to running the marathons he felt that I would actually cause more damage if I just stopped rather than if I ramped down to say twenty miles, sixteen, ten then rest day.

35:35.67
Peter Dickinson
Yeah, and that’s part of having a coach to give you some guidance during these high demand episodes. It’s a fascinating story. Just love that and we’ve got a lot of athletes out there.

35:46.92
Steve
I still have one question though because I’m sure there are listeners in the car where Pete said well you played soccer and lacrosse so that set you up like.

35:49.98
Peter Dickinson
But there are a lot of different stories like that.

36:01.60
Steve
I mean we all played soccer and lacrosse. I mean I didn’t play lacrosse but you know we all did something like that when we were kids why did you hone in on that like yeah so she skied and I mean yeah, me too. But I could not have run 95 marathons in ninety five days at any point in my life.

36:20.43
Peter Dickinson
Ah, first off, Steve if you grew up in East Central Illinois no you don’t have access to soccer or lacrosse. Back in the day it was only football and basketball.

36:20.66
Steve
What are you getting at with that? What are you trying to say with that exactly?

36:30.30
Steve
In full disclosure I also did not have any access to soccer or lacrosse, I had cross country running or football.

36:36.13
Peter Dickinson
And baseball.

36:42.39
Peter Dickinson
Okay so in response to why some of these other activities are so good for change of direction explosively with soccer and cross training or other sports. Early on especially, we develop ourselves physically and you get really able to tolerate eccentric load and change of direction which I think relates really well to descending and ascending mountains and handling varying terrain. When you expose yourself to that early through your childhood I think that sets you up to expand on that later then when you just have a unilateral movement with no change or high loads.

37:37.52
Peter Dickinson
Early on you have to work a lot harder to develop that later in life. So that’s why we want our kids playing all sports to find out what floats their boat and see if you can sneak in some strength training as well.

37:39.90
Steve
Okay, that makes sense. I didn’t think of that.

37:57.43
Peter Dickinson
So they understand how to pick up heavy things because that’s also a very useful preparation tool for high demand activity.

38:09.17
Steve
There’s a little.

38:09.33
Alyssa Clark
I also grew up running and hiking on technical trails which I’ve kind of been told over the years that small muscle strength and balance capability also coming from nordic ski training does help long term. And so I think that I’ve just been lucky enough to have all of those factors come together and I’m saying this right before I go race a hundred miles this weekend and I’m probably going to get blown up by an injury after this whole conversation.

38:45.76
Peter Dickinson
I think you’ll probably be pretty prepared. I’ll be curious as to whether you returned to your strength activities and regained it because you didn’t have the ability to do that for many months. You were just running.

39:02.77
Peter Dickinson
So did you notice any difficulty transitioning to other activities after your 95 marathon days.

39:11.48
Alyssa Clark
Um, I certainly lost a tremendous amount of upper body strength. If you look at the body’s ability to adapt it adapted to the fact that I did not need upper body strength at all to perform what I was asking it to perform. So that took a while to build back up and I did focus on strength following the marathons more than I usually do.

39:40.83
Peter Dickinson
Right? Yeah, it’s fascinating how our body transforms with different types of training over a period of time as well. So that should be very encouraging to anyone listening that they can make the changes. And we want you to make those changes with as little drama as possible and without making those training errors that we’ve all made due to our overenthusiasm syndrome and knuckle headedness.

40:11.50
Steve
Yeah, and this is also something that I would say we’re going a little bit off topic. But it’s a little bit fun too with people who do a lot of different sports as an adult where they want to do it all. They’re often frustrated because they are plateaued and the reason they’re plateaued is because their body doesn’t quite know what adaptations to keep and which to get rid of. I know that when I was only high altitude mountaineering my body looked a certain way. And when I was in a period where I was doing more tactical rock and ice climbing, my body was very different but during those periods I was focused on those activities and when I was high altitude mountaineering my legs and lungs. When I was tactical climbing there was a lot of upper body and a lot of arm strength and finger strength. You know fingers to elbows and your body looks a different way but you do adapt and I was focusing on those things and not trying to do it both at the same time. It’s very difficult to try to do multiple sports with different demands. At the same time, I often tell people if you want to improve as an athlete, pick one thing. You can do 3 different sports but you’re only gonna maintain those 3 sports if you want to improve as a runner. Let’s pick running and build you up and improve your running for a period of time and then you can go back to doing those 3 sports and you can probably keep that running at a higher level for a long period of time and may perhaps work on something else, but you can’t elevate multiple capacities at the same time. It’s too much.

41:57.84
Peter Dickinson
Yeah, we have a saying you get good at what you do. So that’s where you want to have the focus you want in sport training. We talk about general preparation phases and then specific training which really sharpens you up for that activity and you have to be going from general to more specific. I know on our US cross country team there’s a lot of very specific cross country skiing and then strength twice a week. So it’s kind of even in a hyper focused endurance sport. They also don’t like to lose the strength support for all those specific activities and I think that’s mimicked in many mini events.

42:39.60
Steve
Um, yeah makes sense.

42:43.56
Alyssa Clark
Make sense.

42:50.40
Alyssa Clark
And that’s what we do with our training plans. What we do with our athletes is that base period of more generalized fitness in aerobic and straight training and then as you’re getting close to the event. It gets more specialized for sure. I’m glad to hear we’re kind of tracking on all levels. But if there were 2 to 3 exercises and maybe this is an unfair question. But if you could have an athlete do 2 to 3 exercises every day that would potentially reduce the risk of injury. What would they be?

43:28.58
Peter Dickinson
Ah, I love this question. This is great. Okay number one for strength and mobility to do, one exercise, one to rule them all would be a floor to stand and get up. A Turkish Getup. For those that don’t know this, what you do is you lie down on your back, press up a heavy KettleBell and then you go from straight on to your back. There’s some dance moves basically to go up onto your elbow then go up onto your knees and then to stand up with that weight overhead and then to reverse it now. The interesting thing about that activity is it requires immense core strength and stability. It also helps with a lot of mobility especially through your thoracic spine which many of us lack. So it’s good for the back and good for the upper back and the thoracic spine. It’s a big strength movement both for your shoulders and your legs. There’s one activity to incorporate on a regular basis. It would be a Turkish getup number. Number 2, well you did ask for the easy ones right? So it was just 1 pick.

44:40.65
Steve
I I absolutely love to hate the Turkish get up.

44:55.30
Peter Dickinson
Hard one that would be really helpful actually with your durability to go from floor to standing and picking up a heavyweight that really stiffens you up and the strength game is a tension game so we like learning how to be stiff and control heavy load. The second one may be going in a different direction with all of our other activities. We create these localized inflammation from micro trauma or for just working hard in our tissues and so to release those bonds those bonds are temperature dependent. So if you just create some friction they release and they start sliding and gliding better and you reduce all some of the negatives of chronic training and that’s just going on a foam roll and rolling out your legs and your hips and your back and your arms it can be just with a simple three foot foam roll. So we really like that for loosening up your whole fascial system to take away some of the negatives of chronic and heavy training. Number 3 also speaks to recovery and with a lot of training and a lot of activity where our sympathetic nervous system is stimulated and if that keeps going all the time you don’t recover from the training.

46:23.31
Peter Dickinson
And so you’re not getting the benefit from that so we like to doing things that activate our parasympathetic nervous system and that’s the vagus nerve. One of the 2 things that really help is foam rolling that stimulates the baroreceptors deep in your tissues which activate your parasympathetic nervous system. So foam rolling is nice and then the other thing is deep slow nasal breathing so doing like a 2 or 3 second inhale and a 6 second exhale through your nose and we think now that there are some theories that with all of our meditative yoga. All these other restorative activities. One thing they have in common is deep and slow nasal breathing and so encouraging to incorporate something that helps with stress helps with a lot of things so those were the 3 things. Pick up something heavy and go overhead, roll out your tissues and deep slow nasal breathing.

47:31.69
Steve
Those are three really good ones. So I think that that kind of leads me into thinking about recovery again, particularly mentioning the foam roller. We talk about foam rolling a lot. How should an athlete differentiate between delayed onset muscle soreness from training or a potential injury that’s coming on? How do you talk about that with patients and athletes? What are the cues that they should be looking for, that we should be looking for?

48:18.42
Peter Dickinson
Yeah, and we talk about treating injuries at a low level so they don’t become big so it gets a little bit harder when I tweak that a little bit. Is that really something or not? We look at if you have a loss of function, your ability to do something, being able to pick something up and put that plate in that upper cabinet. If you are doing something you’re used to doing, is that now getting difficult to do or painful or a loss of range of motion? Are you getting stiff or you can’t move in overhead or do a deep squat, things of that nature or you’re getting some gate impairment. You’re starting to have a hitch in your gate when you’re running or hiking uphill or walking. Those things start concerning me more if you’re ticking those boxes. Of course any swelling or deformities. But your training history also will help guide this. If you’ve just done a heavy strength session then getting some muscle soreness some DOMS from that would be expected and I would give you a few days to make sure that should clear within 48 hours and you can move on from that. But if something is lingering and I give it a pretty short leash. 1 to 2 weeks then we want to start addressing it right away and not let things go on for longer than that because then we start losing training time. We usually do it very quickly with some mobility, some kinesis, and some supportive strapping.

50:09.20
Peter Dickinson
Some other techniques we have to mobilize tissues and loosen things up. Look back over training history to make sure we don’t have a training error and to correct that of course coaching is so important with all that and again I’ll just reiterate with a coach or a plan you really reduce your risk of injury because you’re not making training errors. That’s the foundation for all this usually.

50:36.32
Alyssa Clark
So it sounds like a lot of it is knowing yourself to know when things are different than they usually are which takes training history. So a funny way to put it but essentially being able to know your training history to know that’s usually an easy exercise. Something’s different about it here’s a red flag.

51:03.50
Peter Dickinson
Right? But the knowledge base for that athlete rises on a continuum. Yes, some people there have made a lot of mistakes. They have a lot of experience and so they can tap into that then you get those that are just starting off. And they kind of don’t know. Is it bad? Is it good? And so that’s where having at least starting with a training plan and then we adapt from there. It can be really really helpful because built into that training plan are discrete progressions that aren’t too big so that’s what I like about that.

51:40.68
Alyssa Clark
Excellent. Well I think that just about wraps it up for us. This has been fantastic to hear all of your insight Pete and all the great stories. Is there anything else either of you would like to touch on?

51:55.31
Steve
I would just like to quickly ask Pete because I know that he performs online assessments of some of our athletes that come in that have injuries that are often working with the coach and Pete, how does that work? How does that look for people? How do you do that?

52:16.78
Peter Dickinson
Well, if you’ve identified with yourself that you need some help that you’ve struggled before or you have an ongoing injury that maybe you’ve gone through a treatment phase but you’re not quite sure how to get back to that hopping on a plan. And progressing from there. Is my injury going to slow me down? Am I ready at my current status to initiate something? A lot of those can be just a consultation over Zoom or phone if it’s more involved then we can go ahead and transfer into a more structured approach with actual physical therapy activities. So it kind of depends on the needs of the individual. Ah, but I will say that one thing to add is that I think it’s very powerful to have goals in your life. To be striving for something and that pushes us further than we normally would maybe organically evolve so we have strong goals. I call it fear based training because you’ll do the work because you know it’s really going to hurt you if you haven’t done the work once you do your event. I love hearing everyone’s goals and the variety of goals within the uphill athlete system. it’s it’s remarkable

53:47.97
Steve
Yeah, we have a lot of great community members out there doing a lot of amazing stuff.

53:54.29
Alyssa Clark
I think the good test of a goal is if it instills a little bit of fear. Not too much but at least a little bit. It’s probably a good goal to aim for.

54:05.55
Peter Dickinson
Yeah, a little internal motivation is good within reason.

54:13.36
Steve
Absolutely.

54:15.71
Alyssa Clark
Definitely. Well thank you for listening to the Uphill Athlete Podcast. Pete, thank you so much for being here. We ask if you can rate, review, and subscribe on all of the major podcast platforms or pick the one that you use. That’s really helpful for us to reach a bigger audience. We really appreciate you taking the time to do that.

54:42.77
Steve
And it is not just one, but a community together. We are uphill athlete. Thanks for listening.