The Physical Performance Show

In episode 387 of The Physical Performance Show, host Tim Studley picks up part two of his conversation with fellow Pogo Physio physiotherapist Lewis Craig, continuing last week's deep dive into surf life saving and Ironman racing. This episode shifts focus from injury patterns to managing niggles, optimising performance, and the habits that separate top-tier surf ironman athletes from the rest.
Tim and Lewis discuss the collaborative decision-making involved in managing a recurring niggle, the key training and screening recommendations every surf life saving athlete should have in place, the lessons Lewis has learned working with elite athletes in the sport, and his top tips for improving performance — from sand-specific training to fuelling properly for a demanding training load.
SHOW SPONSORS:
💯 Today's episode is brought to you by Pillar Performance and Pogo Physio's telehealth consultations. If you are an endurance runner battling with bone, tendon, joint related concerns, our online Telehealth consultations are an ideal platform to help get you back to your physical best - book online at https://pogophysio.com.au.
💯 PILLAR Performance is leading a new frontier in sports nutrition through micronutrition innovation. Their new Collagen Repair formula, developed in collaboration with Gelita Laboratories, is designed to support tendon and ligament health while promoting collagen synthesis to help athletes stay healthy and perform at their best.
For 15% off your first order, visit https://pillarperformance.shop (or https://thefeed.com for North American listeners) and use the discount code PHYSICALPERFORMANCE (one word, capitals) at checkout.
 
IN THIS EPISODE YOU'LL HEAR:
A recap: this episode picks up where Part 1 (episode 386) left off, continuing the discussion on surf life saving and Ironman racing
Managing recurring niggles: why the decision to rest or continue training should be a collaborative one between physio, athlete and coach
How timing within the season affects the risk-benefit of resting versus maintaining training load
Why a first-time niggle warrants a more cautious, rest-forward approach compared to a chronic, familiar issue
Practical ways to modify training around a niggle — for example, adjusting swim technique (removing paddles, adding kick, more dry-land warm-up) rather than stopping entirely
The physiotherapist's role in performance: keeping athletes pain-free and injury-free so coaches can focus on skill and aerobic development
Baseline recommendations for surf life saving athletes: two gym sessions per week, individual screening, consistent dry-land warm-ups, and tracking training load
How swimmers can track training intensity despite the difficulty of measuring heart rate in the pool, including simple session RPE-based load tracking
Why tracking training load matters most when returning from injury or time out of the sport
The performance and injury-reduction upside of athlete and team awareness around REDs and energy availability
The value of a collaborative support team: coach, physio, dietician, sports psychologist and massage therapist working together
Lessons learned from working with elite surf life saving athletes, including individual variation in pain tolerance, treatment preferences and communication style
Common themes among top athletes: professionalism, a genuine quest for knowledge about their bodies and training, and long-term training consistency
Lewis's top three tips for improving performance: sand-specific training with a focus on calf and lower-limb capacity, prioritising shoulder health from a young age, and taking fuelling seriously
The best piece of performance advice Lewis has been given: you can only benefit from the training you can recover from
Closing thoughts on the sport deserving more attention, and interest in having surf life saving athletes themselves on the show in future
QUOTES / TAKEAWAYS:
"It should always probably be a collaborative decision between the physio treating the athlete, the athlete themselves, and the coach."
"Can I take one or two, three days now to maybe potentially avoid a bigger block or weeks of interrupted niggling soreness?"
"You can only benefit from the training you can recover from."
"Eat more than you think you need."
"There's a professionalism, there's a quest for knowledge, and then there's a consistency thing."
"It's trying not to confuse doing more with being best."
 
TIME STAMPS:
00:17 – Episode introduction and breakthrough experience
00:23 – Episode 387 introduction: Part 2 with Lewis Craig on surf life saving
02:22 – Managing a recurring niggle: how to approach the decision to rest or train through
03:20 – Timing within the season and its effect on rest decisions
04:20 – Why a first-time niggle warrants a more cautious approach
04:50 – Modifying training instead of stopping: examples from swimming
05:47 – The physio's role in performance: keeping athletes pain-free so coaches can coach
06:46 – Baseline recommendations: two gym sessions per week
07:41 – Screening to identify individual injury risk factors
08:06 – The value of consistent dry-land warm-ups
09:06 – Tracking training load and intensity in swimming
10:35 – Session RPE and simple load-tracking methods
11:06 – Why tracking load matters most when returning from injury
11:36 – Awareness of REDs and low energy availability
12:05 – Recap: gym, screening, warm-ups, training load, energy awareness, support team
12:32 – Lessons learned from working with elite surf life saving athletes
13:30 – Individual variation in athlete preferences and pain tolerance
13:59 – Common themes among top athletes: professionalism and consistency
15:24 – Lewis's top three tips for improving performance
16:22 – Recap: sand-specific training, shoulder health, fuelling
16:52 – The importance of eating enough to support training load
17:17 – The best performance advice: recovering from training, not just doing more
18:15 – Closing thoughts and interest in future athlete guests
18:45 – Episode close and thanks to Lewis Craig
19:17 – Recap of the two-part surf life saving discussion
19:36 – Pogo Physio Telehealth Consultations and closing details
 
 
Join the The Physical Performance Show LEARNINGS membership through weekly podcasts here: https://www.patreon.com/TPPShow
Our goal is to get you back to your Physical Best. Find out more about Telehealth Consultations and book online.
 
YOUR HOSTS:
🏃‍♂️‍➡️ Timothy Studley - Physiotherapist: Instagram @timothy_physio
💪 Lewis Craig - Physiotherapist and Clinical Lead, Pogo Physio: Instagram @_lewiscraig_
The Physical Performance Show can be found at: Facebook: facebook.com/thephysicalperformanceshowpodcast X: @tppshow1 Instagram: @physicalperformanceshow
Please direct any questions, comments, and feedback to the above social media handles.

In episode 386 of The Physical Performance Show, host Tim Studley sits down with fellow Pogo Physio physiotherapist Lewis Craig to explore the world of surf life saving and Ironman racing — a sport many listeners may be unfamiliar with, but one that shares a huge amount in common with traditional triathlon and endurance sport.
Tim and Lewis unpack what a typical training week looks like for a semi-professional surf ironman/ironwoman athlete, the most common injuries seen across swimming, ski paddling, board paddling and soft sand running, the disproportionate impact running-based injuries can have on an athlete's ability to race, and why energy availability, sleep and recovery are just as critical in this sport as they are in any other high-volume endurance discipline.
SHOW SPONSORS:
💯 Today's episode is brought to you by Pillar Performance and Pogo Physio's telehealth consultations. If you are an endurance runner battling with bone, tendon, joint related concerns, our online Telehealth consultations are an ideal platform to help get you back to your physical best - book online at https://pogophysio.com.au.
💯 PILLAR Performance is leading a new frontier in sports nutrition through micronutrition innovation. Their new Collagen Repair formula, developed in collaboration with Gelita Laboratories, is designed to support tendon and ligament health while promoting collagen synthesis to help athletes stay healthy and perform at their best.
For 15% off your first order, visit https://pillarperformance.shop (or https://thefeed.com for North American listeners) and use the discount code PHYSICALPERFORMANCE (one word, capitals) at checkout.
In this episode, you'll hear:
An introduction to surf life saving and Ironman racing: swimming, ski paddling, board paddling and soft sand running combined into one demanding sport
The semi-professional nature of the sport, and how prize money from series like the Shaw and Partners Ironman Series and World Ocean Series has helped athletes
A snapshot of a typical training day and week: double training sessions, four swim sessions, two to three ski paddling and board sessions, two gym sessions, two standalone runs, and Irons sessions combining all disciplines
Typical weekly training hours for competitive athletes — estimated in the range of 15 to 20+ hours per week
Similarities to other endurance sports: shared challenges around shoulder health, running-related injuries, and managing training load, intensity and recovery
Whether discipline-dominant athletes (runners, swimmers, paddlers) experience different injury patterns, and the possible link between strong runners and higher bone stress injury risk via REDs
What first drew Lewis to working with surf life saving and Ironman athletes, including his early experience working alongside elite athletes at Pogo Physio
Common injuries in the sport: shoulder tendinopathies (supraspinatus, subscapularis), low back pain, Achilles tendinopathy, calf strains, ankle sprains, toe injuries, knee pain, bone stress injuries, and trauma-related injuries from craft or contact
Why shoulder health is a season-long priority, while injuries that prevent running (calf strains, ankle sprains, bone stress injuries) carry the biggest time cost due to their impact on race ability
Estimated prevalence of athletes competing while managing a shoulder or low back niggle, and how this may fluctuate across the competitive calendar
An overview of the surf life saving racing calendar: trials, the Coolangatta Gold, and a condensed back-to-back race season with minimal true off-season
Why the Coolangatta Gold's extra soft sand running volume increases physical demand and potential injury risk
Common misconceptions about the physical demands of the sport, including underestimation of the aerobic and neuromuscular demands of soft sand running
The energy cost and muscle activation differences of soft sand running compared to running on grass or road (roughly 1.4–1.6x energy cost, near-double EMG activity in key running muscles)
Why maintaining some running — and ideally some soft sand running — year-round may help reduce injury risk when returning to high-intensity training
Physical qualities to develop for soft sand running: calf capacity, forefoot strength, neuromuscular control, balance and proprioception, and specific gym-based calf training strategies
Why strong road runners can't assume they have the capacity needed for soft sand running
Common training and recovery mistakes: under-fuelling relative to high training demands, and the potential role of low energy availability and REDs in this population
Warning signs of under-fuelling to watch for, including low iron, frequent illness, low libido in males, and menstrual cycle changes in females
The key pillars of recovery for these athletes: sleep, nutrition, well-structured and individualised training programming, and secondary recovery tools like massage, compression and cryotherapy
Quotes / takeaways:
"These athletes are really, really impressive... it really is akin to the traditional triathlete."
"It's a real juggling act, but also then makes it really meaningful to try and help these athletes."
"If we can't sand run, then often that's no racing."
"Go for a run on the sand and see how hard it is."
"I have a hypothesis that if these athletes all did more running, we'd see a heap of bone stress injuries."
"It gets tricky to do it well and do it right consistently."
Time Stamps:
00:00 – Episode introduction: surf life saving and Ironman racing with Lewis Craig
00:31 – What is surf life saving and Ironman racing?
01:30 – Semi-professional status and recent growth in prize money
02:27 – A typical training day and week for a competitive athlete
04:23 – Typical weekly training hours
05:23 – Comparisons to other endurance sports like triathlon
06:23 – Do discipline-dominant athletes get different injury types?
08:05 – What sparked Lewis's interest in the sport
11:28 – Most common injuries: shoulder, low back, running-related
13:26 – Which injuries carry the biggest performance and time cost
14:21 – Prevalence of athletes competing through shoulder or back niggles
16:34 – The surf life saving racing calendar and trials
18:24 – Biggest misconceptions about the physical demands of the sport
18:54 – The energy cost and muscle demands of soft sand running
20:24 – Bone stress injury risk around high-intensity competition periods
20:52 – Underestimating the aerobic demands of soft sand running
23:17 – Why maintaining year-round running and sand running may help
24:16 – Physical capacities to develop for soft sand running: calf, foot strength, balance
26:14 – Why road running fitness doesn't guarantee sand running capacity
26:43 – Common training mistakes: under-fuelling and REDs risk
29:35 – Warning signs of low energy availability to watch for
30:05 – Recovery pillars: sleep, nutrition, training structure
31:34 – Individualised recovery tools: massage, compression, cryotherapy
32:32 – Recap of key recovery pillars and closing thoughts
THE TEAM:
Join the The Physical Performance Show LEARNINGS membership through weekly podcasts here: https://www.patreon.com/TPPShow
Our goal is to get you back to your Physical Best. Find out more about Telehealth Consultations and book online.
Your Hosts:
🏃‍♂️‍➡️ Timothy Studley - Physiotherapist at Pogo Physio: Instagram @timothy_physio
💪 Lewis Craig - Physiotherapist and Clinical Lead, Pogo Physio: Instagram @_lewiscraig_
The Physical Performance Show can be found at: Facebook: facebook.com/thephysicalperformanceshowpodcast X: @tppshow1 Instagram: @physicalperformanceshow
Please direct any questions, comments, and feedback to the above social media handles.

In episode 385 of The Physical Performance Show, host Brad Beer sits down with fellow physiotherapist Lewis Craig for a lateral ankle sprain masterclass. Drawing on material the pair recently presented at a Gold Coast orthopedic evening, Brad and Lewis cover the burden and prevalence of lateral ankle sprains, the three-part clinical assessment process, key differential diagnoses, rehabilitation phases, and preventative strategies including bracing and taping.
The episode explores why lateral ankle sprains — despite their reputation as a minor injury — carry a significant risk of chronic ankle instability, and why a thorough, structured assessment is essential to a smooth recovery. Brad and Lewis unpack the different ligament and tendon structures that can be involved, the red flags practitioners need to rule out, the impairment categories drawn from Jay Hertel's model of chronic ankle instability, and how rehabilitation should progress from protection through to return to sport and long-term prevention.
Show Sponsor:
Pogo Physio also offers online Telehealth Consultations for endurance athletes managing bone, tendon, or joint issues — book online at https://www.pogophysio.com.au.
And...
PILLAR Performance is leading a new frontier in the sports nutrition industry through micronutrition innovation. Their Performance Health range is designed to support the crucial hours outside of training and racing, helping athletes return to the start line in peak condition.
One of their newest releases is Collagen Repair, developed in collaboration with Gelita Laboratories and featuring the clinically trialled collagen peptide TENDOFORT. For 15% off your first purchase, head to pillarperformance.shop or, for North American listeners, thefeed.com and use the code PHYSICALPERFORMANCE at checkout.
Pillar Performance continues to lead the way in sports nutrition through micro-nutrition innovation, now expanding into the Performance Health range. One of their newest releases, Collagen Repair, was developed with Gelita Laboratories (Germany) using a clinically trialled collagen peptide (Tendofort) to support tendon and ligament health in conditions like hamstring tendinopathy, Achilles tendonitis, shin splints, and patellofemoral pain.
Head to Pogo Physio also offers online Telehealth Consultations for endurance athletes managing bone, tendon, or joint issues — book online at https://www.pillarperformance.shop (or https://www.thefeed.com for North American listeners) and use code PHYSICALPERFORMANCE for 15% off your first purchase.
 
Partners / links mentioned:
Ortho Tools (Cumberland Ankle Instability Tool / CAIT): mentioned in-episode as the online questionnaire resource
Contact: Lewis Craig — l.craig@pogophysio.com.au
In this episode, you'll hear:
Episode context: Lewis Craig's return to the show after being last on around episode 109, and his progress toward finishing his Sports Masters through the University of Queensland
The burden of lateral ankle sprains: why they're the most common musculoskeletal injury in sport across field and court sports, contact and non-contact alike
Recurrence risk: why roughly 40% of people who sprain their ankle go on to develop chronic instability, and why the one-year mark is a key risk-reduction milestone
Early predictors of chronic ankle instability: the Doherty 2016 study on single-leg landing and drop-jump testing at two weeks post-injury
The three priorities of assessment: ruling out red flags and fractures, forming an accurate diagnosis, and identifying impairments
Screening for fractures: mechanism of injury, the Ottawa ankle rules, weight-bearing ability, and key bony landmarks to palpate
Differential diagnosis: ATFL and CFL sprains (70–80% of ankle sprains), peroneal tendon injuries, bifurcate ligament sprains, deltoid ligament tears, syndesmosis injuries, and talar dome injuries
Why getting a clear mechanism of injury from the athlete is critical to an accurate diagnosis
Identifying impairments: the ROAST consensus and Jay Hertel's updated model of chronic ankle instability — pathomechanical, sensory-perceptual and motor-behavioural impairments
Clinical and objective testing: balance progressions, calf raise endurance and strength benchmarks, and power tests including triple hop, crossover hop and timed lateral hop
The role of patient-reported outcome tools: the Cumberland Ankle Instability Tool (CAIT) and FAAM, and why they're useful for tracking progress and motivation
Rehabilitation framework: protection and appropriate early loading, followed by strength, stability and mobility phases
Managing specific injury types: use of moon boots, orthotics, low-dye taping and ASO ankle braces depending on the structures involved
Addressing dorsiflexion loss: why regaining ankle range of motion is often one of the hardest parts of rehab, and the Torillin infographic on identifying the source of restriction
Late-stage rehab and return-to-sport: hopping, change of direction, and integrating exercises into an athlete's normal training week for ongoing prevention
Bracing and taping as secondary/tertiary prevention strategies to reduce recurrence
Long-term consequences of poorly managed ankle sprains, including links to post-traumatic osteoarthritis and eventual ankle surgery
The biggest mistake athletes make: assuming rehab is "done" once they can run, despite still having deficits in power, change of direction and stability
Lewis's top tip: get every ankle sprain properly assessed, no matter how minor
Quotes / takeaways:
"It's just a simple lateral ankle sprain... and then someone who goes missing for months at a time."
"Four out of ten people who have an ankle sprain go on to develop a chronic instability."
"The better quality of the assessment, the more likely there's an accurate diagnosis."
"It's really hard to sprain your ankle when it's really well strapped or with an appropriate brace."
"Once someone gets running... you can run in a straight line really well and have really considerable deficits still."
"Get it assessed. Understand what you've done and understand what impairments you might have."
Time Stamps:
00:17 – Episode introduction and breakthrough experience
00:23 – Episode 385 introduction: lateral ankle sprain masterclass with Lewis Craig
00:50 – Sponsor: PILLAR Performance and Performance Health
01:15 – Collagen Repair: formulation, TENDOFORT and collagen health
01:44 – 15% PILLAR Performance discount with code PHYSICALPERFORMANCE
02:19 – Welcoming Lewis Craig back to the show
02:48 – Lewis's tenure at Pogo Physio and progress on his Sports Masters at UQ
03:45 – Introducing today's topic: lateral ankle sprains
04:37 – How common and burdensome are lateral ankle sprains?
05:36 – The "she'll be right" attitude and why it's changing
07:02 – Lewis's personal history with recurrent ankle sprains
08:02 – Impact on Lewis's own running and trail running
08:28 – The one-year mark and recurrence risk statistics
09:26 – Predictors of chronic ankle instability: single-leg landing and drop jump
09:53 – The Doherty 2016 study explained
10:51 – The three priorities of assessment
11:21 – Ruling out red flags and fractures
12:45 – Why assessment quality drives rehab outcomes
13:14 – Screening for fractures: mechanism, Ottawa ankle rules, bony landmarks
14:39 – Deciding on imaging: x-ray or MRI
15:06 – Differential diagnosis: the many subcategories of ankle sprain
15:35 – ATFL and CFL: the most common ligament sprains
16:35 – Peroneal tendon injuries
17:04 – Bifurcate ligament sprains
18:04 – Deltoid ligament tears with lateral ankle sprains
18:33 – Syndesmosis injuries and mechanism differences
19:31 – Clinical tests for syndesmosis
20:01 – Talar dome injuries and other easily missed diagnoses
20:30 – Why getting a clear mechanism from the athlete matters
21:29 – Identifying impairments: what it means and why it's important
22:51 – Jay Hertel's model of chronic ankle instability
23:48 – Balancing patient education without causing fear
24:17 – Motor outcomes: strength, power and kinetic chain
24:43 – Assessment time and thoroughness at Pogo Physio
25:08 – Objective testing: dynamometers, balance and calf tests
25:38 – Balance test progressions as return-to-sport criteria
26:37 – Strength testing: inversion, eversion and calf raise endurance
27:07 – Power testing: triple hop, crossover hop and lateral hop tests
27:33 – Using objective markers to guide return-to-sport decisions
28:01 – Patient questionnaires: Cumberland Ankle Instability Tool (CAIT) and FAAM
28:57 – Coping vs non-coping athletes and objective scoring
29:25 – Moving into rehabilitation: individualised management
29:54 – Protection and appropriate early loading
30:20 – Moon boots and protecting specific structures
31:16 – ASO ankle braces for lower-grade sprains
31:45 – The strength, stability, mobility rehab framework
32:14 – Early loading phase: range of motion, balance and strength
32:43 – Addressing dorsiflexion loss
33:13 – The Torillin infographic on restriction sources
33:40 – Progressing balance and strength exercises
34:10 – Preventative efforts and integrating rehab into training
34:40 – Late-stage rehab and return-to-play criteria
35:39 – Bracing and taping to prevent recurrence
36:08 – Long-term consequences: osteoarthritis and ankle surgery risk
37:34 – Lewis's own experience with taping and bracing
38:02 – The biggest mistake athletes make in managing ankle sprains
39:29 – Lewis's top tip: get every ankle sprain assessed
40:27 – Where to reach Lewis Craig for questions
40:52 – Episode close and sponsor reminder
41:20 – Pogo Physio Telehealth Consultations and closing details
THE TEAM:
Join the The Physical Performance Show LEARNINGS membership through weekly podcasts here: https://www.patreon.com/TPPShow
Our goal is to get you back to your Physical Best. Find out more about Telehealth Consultations and book online.
Your Hosts:
🏃 Brad Beer - Instagram & X @Bradbeer and YouTube on @PogophysioAu
💪 Lewis Craig - Physiotherapist and Clinical Lead, Pogo Physio Instagram: @_lewiscraig_
The Physical Performance Show can be found at: Facebook: facebook.com/thephysicalperformanceshowpodcast X: @tppshow1 Instagram: @physicalperformanceshow
Please direct any questions, comments, and feedback to the above social media handles.

In episode 384 of The Physical Performance Show, Brad Beer and fellow physiotherapist Tim Studley tackle a wide-ranging Q&A on tibial bone stress injuries. Following the recent bone stress injury mini-series and two-part tibial bone stress injury masterclass, Brad and Tim answer listener questions covering chronic tibial stress responses, recurring shin pain, rehabilitation, plyometrics, strength training, anti-inflammatory medications, and how to reduce the risk of future bone stress injuries.
The episode explores some of the practical clinical questions that arise when athletes are trying to understand persistent shin pain and return to running. Brad and Tim unpack the difference between tibial bone stress injuries and medial tibial stress syndrome (MTSS), explain how workload and tissue tolerance interact, discuss when to introduce single-leg strength and plyometrics, and highlight why a thorough assessment of both biomechanical and biological risk factors is essential for athletes with recurring bone stress injuries.
Show Sponsor: PILLAR Performance is leading a new frontier in the sports nutrition industry through micronutrition innovation. Their Performance Health range is designed to support the crucial hours outside of training and racing, helping athletes return to the start line in peak condition.
One of their newest releases is Collagen Repair, developed in collaboration with Gelita Laboratories and featuring the clinically trialled collagen peptide TENDOFORT. For 15% off your first purchase, head to pillarperformance.shop or, for North American listeners, thefeed.com and use the code PHYSICALPERFORMANCE at checkout.
Show Sponsor:
Pillar Performance continues to lead the way in sports nutrition through micro-nutrition innovation, now expanding into the Performance Health range. One of their newest releases, Collagen Repair, was developed with Gelita Laboratories (Germany) using a clinically trialled collagen peptide (Tendofort) to support tendon and ligament health in conditions like hamstring tendinopathy, Achilles tendonitis, shin splints, and patellofemoral pain.
Head to pillarperformance.shop (or thefeed.com for North American listeners) and use code PHYSICALPERFORMANCE for 15% off your first purchase.
Pogo Physio also offers online Telehealth Consultations for endurance athletes managing bone, tendon, or joint issues — book online at pogophysio.com.au.
 
Partners / links mentioned:
Show sponsor: PILLAR Performance — 15% off your first purchase using code PHYSICALPERFORMANCE at checkout.
PILLAR Performance: pillarperformance.shop
North American listeners: thefeed.com
Pogo Physio Telehealth Consultations: pogophysio.com.au
 
 
In this episode, you'll hear:
Chronic tibial bone stress injuries: whether an experienced ultramarathon runner can adapt to a persistent Grade 2 stress response and continue running without progressing to a stress fracture
Recovery strategies: what sauna, nutrition and strength training may—and may not—contribute to recovery from tibial bone stress injuries
Nutrition and bone health: the importance of adequate calorie and micronutrient availability, and why recurrent bone stress injuries may warrant review with a sports dietitian
Calcium supplementation: what is known about calcium availability and why there isn't a clear tibia-specific dose linked directly to bone stress injury recovery
Recurring shin pain: why an athlete can continue experiencing medial shin pain despite controlled mileage and well-rounded strength training
The three-part clinical framework: biomechanics, workload, and tissue capacity as key areas to investigate when shin pain keeps returning
MTSS versus bone stress injury: why persistent posterior-medial shin pain may represent medial tibial stress syndrome rather than a bone stress injury
Individual differences: why some runners seem more susceptible to shin pain and why comparing your injury history with other runners can be misleading
Plyometrics and single-leg strength: when to introduce spring-based loading, hopping and jumping during tibial bone stress injury rehabilitation
Rehabilitation progression: why single-leg strength work can begin relatively early while plyometrics are generally introduced later
Training the opposite leg: why the unaffected limb should continue to be trained during rehabilitation
Return to running with persistent shin pain: how MRI findings, symptom location and clinical presentation can help distinguish MTSS from tibial bone stress injury
Strength training progression: moving from higher-repetition, lower-load work capacity training towards heavier strength and eventually rate-of-force and plyometric training
Anti-inflammatory medications: what regular use of ibuprofen and diclofenac may mean for bone and skeletal health, and why they are unlikely to be the sole cause of a running-related bone stress injury
Posterior tibial stress reactions: how running workload can exceed bone tolerance and how factors including bone geometry, bone quality, biomechanics and psychology may influence risk
Preventing recurrence: why runners with a previous bone stress injury have a significantly elevated future risk and need to identify and manage their individual risk factors
The role of the gym: why strength and conditioning can help restore muscle capacity, support bone health and prepare the tibia for the demands of running
Hop testing: why a pain-free hop test is useful when assessing tibial bone stress injuries, while recognising that other diagnoses can also produce pain with hopping
The 10 cm palpation rule: why longer areas of shin tenderness are more consistent with medial tibial stress syndrome than focal bone stress injury
Clinical assessment: why practitioners need to consider gait, palpation, loading tests, biomechanics, workload, tissue capacity and differential diagnoses rather than relying on pain intensity alone.
Quotes / takeaways:
"Bone stress is not something that the body adapts to."
"Most people are paying a tax, I always say, to play the game they want to play."
"There's no recipes."
"It's never just one thing."
"You need running workload and that workload exceeds, in simple terms, bone's tolerance."
"Once a runner's had a bone stress injury, they have much heightened risk, six to seven fold for the rest of their running life."
 
Time Stamps:
00:00 – Episode introduction and breakthrough experience
00:23 – Episode 384 introduction: Q&A on tibial bone stress injuries
00:53 – Sponsor: PILLAR Performance and Performance Health
01:20 – Collagen Repair: formulation, TENDOFORT and collagen health
01:49 – 15% PILLAR Performance discount with code PHYSICALPERFORMANCE
02:18 – Episode begins: listener Q&A following the bone stress injury series
03:24 – How the listener questions were gathered and why these themes matter
03:53 – Chris' question: chronic Grade 2 tibial bone stress injury in an experienced ultramarathon runner
04:23 – Can the body adapt to bone stress and allow an athlete to run through it?
05:49 – Why symptomatic bone stress requires an appropriate deload
06:16 – Sauna, nutrition and other recovery techniques
07:11 – Micronutrients, calories and optimal skeletal health
08:07 – Strength training and progressive restoration of tibial capacity
08:33 – Calcium intake and the importance of sports dietitian review for recurrent injuries
09:57 – Zane's question: recurring medial shin pain despite controlled mileage and strength training
10:52 – Why some runners continue to struggle despite avoiding obvious training spikes
11:51 – The three key areas: biomechanics, workload and tissue capacity
12:19 – MTSS versus tibial bone stress injury
12:46 – Biomechanical strategies and the example of professional triathlete Josh
13:39 – Strength and conditioning relative to the demands of professional triathlon
14:07 – Why recurring shin pain may require a more individualised assessment
15:03 – Why comparing yourself with runners who appear injury-free can be misleading
15:33 – "Paying a tax" to participate in the sport you love
16:02 – Isaac Fishlock's question: when to introduce plyometrics and single-leg strength
16:28 – Plyometrics as a late-stage rehabilitation tool
16:57 – Why bones need spring loading and high rates of loading
17:26 – Introducing single-leg strength early and training the unaffected leg
17:55 – Why the opposite leg may also be at increased risk after deloading
18:18 – Are there strength or pain benchmarks before introducing plyometrics?
18:45 – Why rehabilitation progression needs to be individualised
19:15 – Rhonda Gainsford's question: persistent medial shin pain with a negative MRI
19:45 – Why persistent symptoms can point towards MTSS rather than bone stress injury
20:13 – What an MRI showing no bone stress response can tell you
20:42 – Focal versus longer-length tenderness along the shin
21:10 – Can the runner return to running?
21:41 – The Coil Crew's question: heavy reps versus endurance work for calf raises
22:10 – Starting with higher-repetition, lower-load work capacity
22:41 – Progressing towards heavier strength work
23:09 – The three-pronged calf framework: endurance, maximum strength and spring
23:39 – Clinical benchmarks for calf endurance and reactive strength
24:09 – Ryan Williams' question: can regular ibuprofen or diclofenac cause a stress response?
24:37 – Anti-inflammatories, collagen synthesis and potential effects on skeletal health
25:03 – Why anti-inflammatories are unlikely to independently cause a running-related bone stress injury
26:01 – How a posterior tibial stress reaction develops
26:31 – Running workload versus bone tolerance
27:00 – Bone geometry, bone quality, adolescent sport and other risk factors
27:29 – Why bone stress injuries are multifactorial
27:57 – Reducing future risk through biological and biomechanical risk stratification
28:26 – The heightened recurrence risk following a previous bone stress injury
28:54 – Does going to the gym reduce the risk of future stress reactions?
29:22 – What the research says about strength training and injury prevention
29:50 – Restoring calf size, strength and muscle characteristics after deloading
30:15 – Building an individualised strength and conditioning program
30:42 – Osteogenic exercise and addressing obvious strength deficits
31:10 – Lenny P's question: symptoms greater than 10 cm and a positive hop test
31:37 – Other causes of pain with hopping, including calf injury and MTSS
32:06 – The 10 cm palpation finding and what it suggests
32:35 – Why pain intensity is not a reliable guide to bone stress injury severity
33:04 – Q&A conclusion and invitation for further questions
33:33 – Future expert episodes on femur, foot, ankle and sacral bone stress injuries
33:58 – Episode close and PILLAR Performance sponsor reminder
34:26 – Pogo Physio Telehealth Consultations and closing details.
 
THE TEAM:
Join the The Physical Performance Show LEARNINGS membership through weekly podcasts here: https://www.patreon.com/TPPShow
Our goal is to get you back to your Physical Best. Find out more about Telehealth Consultations and book online.
Your Hosts:
🏃 Brad Beer - Instagram & X @Bradbeer and YouTube on @PogophysioAu 💪 Tim Studley - Physiotherapist
🏃‍♂️‍➡️ Timothy Studley - Instagram @timothy_physio
The Physical Performance Show can be found at: Facebook: facebook.com/thephysicalperformanceshowpodcast X: @tppshow1 Instagram: @physicalperformanceshow
Please direct any questions, comments, and feedback to the above social media handles.

Physical Performance Show – Episode 383 Show Notes
In episode 383 of The Physical Performance Show, host Brad Beer sits down with Professor Franco Impellizzeri, one of the most influential and outspoken voices in athlete load management research, for a wide-ranging conversation on why "load management" is an old concept dressed up in new data, why the acute to chronic workload ratio (ACWR) never held up to scrutiny, and why context — not more metrics — is what separates good decision-making from noise.
Show Sponsor:
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Head to pillarperformance.shop (or thefeed.com for North American listeners) and use code PHYSICALPERFORMANCE for 15% off your first purchase.
Pogo Physio also offers online Telehealth Consultations for endurance athletes managing bone, tendon, or joint issues — book online at pogophysio.com.au.
 
Professor Franco Impellizzeri's work can be explored here:
https://profiles.uts.edu.au/Franco.Impellizzeri
And...
https://scholar.google.com/citations?user=z35F1WAAAAAJ&hl=en
 
Listen in as we delve into the following:
What "load management" actually means, and why it's a relabelling of concepts coaches have wrestled with since the 1930s–40s
The double-edged sword of the data revolution: from heart rate monitors to today's GPS, wearables, and AI-driven analytics
Commercial and career incentives behind pushing metrics — both from tech companies and researchers
Confirmation bias and why interpreting data without a theoretical framework is "like reading tarot"
The case against the acute to chronic workload ratio (ACWR): its lack of scientific support despite IOC endorsement
A landmark runners' study showing the opposite relationship between ACWR and injury risk — and what that reveals about the field
Why meta-analyses and systematic reviews in load research can be manipulated to "find whatever you like"
The difference between using a metric personally versus promoting it as scientifically validated
Why the most skilled clinicians tend to hold their conclusions with the least certainty
A real-world case study: a soccer training drill "failure" that was actually a video-monitoring blind spot, not a bad drill
The expanding role of data scientists in sport, and why interpretation — not collection — is the real skill gap
Whether AI and machine learning can (or should) replace the sports scientist's judgement
Individualised and personalised training approaches — and why even these are still built on group-level generalisations
Distinguishing signal from noise, and why one "failed" intervention doesn't mean an athlete won't respond next time
Practical advice for coaches and practitioners: accept uncertainty, treat training like a "trial of therapy," and reassess
If he could track only one metric: heart rate (or perceived effort) over power
The push for more honest scientific debate — including a proposed on-air "intellectual sparring" series with dissenting researchers
 
Quotes:
"Understanding the quantity of training for athletes has been a hot topic since training methodology started... managing load is not new." — Professor Franco Impellizzeri
"When you don't have a theoretical framework and an a priori idea strong and supported, it's like reading tarot, to be honest." — Professor Franco Impellizzeri
"There's zero evidence that this metric can either help or can actually reflect some sort of mechanism." — Professor Franco Impellizzeri, on the acute to chronic workload ratio
"Don't take yourself too seriously." — Professor Franco Impellizzeri
 
Timeline:
00:00 – Introduction: host's specialist physio training and the load management "viva" question
01:04 – What is load management? An old concept, relabelled
02:31 – From heart rate monitors to GPS: the rise of training data
06:14 – Commercial interests and the risk of becoming "slaves of data"
08:05 – Why load management matters: the drug-dosing analogy
09:24 – Load management as a decades-old coaching concern
10:23 – Confirmation bias and interpreting data "like reading tarot"
13:17 – Championing methodological rigor in sports science
16:33 – Meta-research, honesty, and acknowledging uncertainty
18:22 – Why the most skilled clinicians express the least certainty
19:18 – Origins of the critique of the acute to chronic workload ratio (ACWR)
20:09 – Takeaways for contemporary practitioners on load management models
21:34 – Why the ACWR lacked scientific and conceptual support
23:02 – Training load, time-at-risk, and reframing injury risk
24:24 – The contradictory runners' study and what it implies
26:43 – Cherry-picking and overfitting in load-injury meta-analyses
28:34 – Taking a stronger public stance on social media
30:34 – Science as a self-correcting process
31:31 – The discipline required to properly read and critique research
33:58 – Why data alone can't tell you what to do
34:24 – Case study: the soccer drill that "failed" — until the video told the real story
36:49 – The role (and limits) of data scientists in sport
38:46 – Could AI replace the sports scientist's job?
40:42 – Advice for coaches and practitioners: accept uncertainty
42:09 – Individualised approaches are still a form of generalisation
44:31 – Separating signal from noise — and why not to give up early
46:56 – If only one metric: heart rate over power
48:21 – One piece of advice: "don't take yourself too seriously"
48:51 – This week's physical challenge: swimming without pain
50:16 – What's next: meta-research projects and replication studies
51:43 – A proposal for public scientific debate, and Ian Shrier's work on consensus
56:32 – Why genuine debate is hard to find in science communication today
57:59 – Episode close
THE TEAM:
Join The Physical Performance Show LEARNINGS membership through weekly podcasts here: https://www.patreon.com/TPPShow
Our goal is to get you back to your Physical Best. Find out more about Telehealth Consultations and book online at pogophysio.com.au.
Your Host:
🏃 Brad Beer - Instagram & X @Bradbeer and YouTube @PogophysioAu
The Physical Performance Show can be found at:
Facebook: facebook.com/thephysicalperformanceshowpodcast
X: @tppshow1
Instagram: @physicalperformanceshow