Foreign.

Hello and welcome to the April 18, 2025 edition of the Tridock Podcast.

I'm your host, Jeff Sankoff, the tridoc, an emergency physician, triathlete, triathlon coach, and multiple Ironman finisher coming to you as always.

Well, actually, this time I'm not coming to you from beautiful sunny Denver, Colorado.

This time I am somewhere in the air making my way back to Denver, Colorado.

I have been for the last two weeks in beautiful Indonesia on a scuba diving vacation with my wife Sandra.

And so I am not going to be publishing one of my usual tridog podcast episodes.

Instead, I have a special treat for you all.

As you may or may not know, I have been doing a fair bit of collaborating with my friends over at Fast Talk Labs in Boulder, Colorado.

They are a group of cycling coaches who do a podcast called Fast Talk and have a website that is dedicated to coaches and cyclists and even triathletes, teaching them how to leverage nutrition and strength training and of course, bike riding in order to become the best cyclist that they can.

Well, a couple of months ago, Fasthawk had an episode with a USA Cycling coach and a doctor of physical therapy, Dr.

Stacy Brixon, and she came onto the show to talk about the four fitness foundations of mobility, flexibility, stability and strength.

And so I wanted to share it with you now that I am going to be away on vacation, give you something really interesting and entertaining to listen to.

I think you will all find it to be incredibly educational and if you enjoy it, and I know you will, I hope that you will go on and have a listen to the other episodes that Fast Talk has published.

I am actually featured on a few of them and I think that you will find it to be a very enjoyable addition to your podcast library.

That's what I have for you.

I will be back with Coach Juliet for another episode of the TriDoc podcast in a couple of weeks.

But for now I hope that you enjoy Trevor Connor and this episode of the FastTalk podcast that was originally published in early January of this year.

Hello and welcome to Fast Talk, your source for the science of endurance performance.

I'm your host, Trevor Connor, here with Coach Grant Holicke.

This It's New Year's and if there's one thing that marks this day besides perhaps regrets about how much you drank on New Year's Eve, it's the number of people everywhere who make the resolution to get back into the gym as endurance athletes.

We may not love the gym.

Voiding is why some of us chose to run our bike in the first place.

But the truth is that we need it just as much, if not more, than everyone else.

We've talked about the value of strength and flexibility work in the show, but that's actually part of the picture.

To keep our bodies functional and performing at their best, we need to think about four key.

Mobility, flexibility, stability and strength.

All four work together, and if we are lacking in one, we can see our performance drop.

And worse, it can lead to injuries, particularly for those of us reaching a certain age.

Here to talk with us about each of these four foundations and why they are so important to us is exercise physiology professor, bike fitter, physical therapist, and founder of draft responsibility coaching, Dr.

Stacy Brixham.

She has spent decades working with endurance athletes, keeping them functional and injury free.

We'll talk with her about crossover syndrome and why it's such a concern to cyclists.

When the issue is big enough to see an expert, then we'll dive into each of the four foundations, starting with mobility and how it is the base of this pyramid and what we're ultimately trying to accomplish.

Then we'll talk about flexibility, how it contributes to sarcomeregenesis, and why there's no hard rules about static and active stretching and yoga.

Next, we'll dive into stability and why having a good core is so critical to avoid injury.

Finally, we'll address strength work and why we need both high weight, low rep work and low weight, high rep work.

Dr.

Brixton has been very kind to us and put together three great workout routines that you can find in the show notes for this episode on our website.

They are routines you can do at home with minimal equipment that are going to work all four of those foundations.

So take off the bike kit, throw in your gym clothes, and let's make you fast.

Well, Dr.

Brixham, pleasure to have you on the show.

Thanks for joining us.

Thank you for having me.

I'm excited to be here.

So this is actually an episode I'm really excited to do because we have talked on the show multiple times about work outside of the primary endurance sport.

So I think we're going to probably focus on cyclists today, but we'll also talk to runners and swimmers.

But we've said again and again and again it is really important to get off the bike, to take the running shoes off, get into the gym and do this sort of work.

But, you know, we've probably talked about a little bit about flexibility here, a little bit about strength there, but what we're really going to do today, and I'm going to give you full Credit on this.

You sent this fantastic outline of kind of these four aspects of this off the bike gym type work.

And I think this is the first episode where we've really gonna pull it all together and give suggestions to athletes of here's the sort of things you should be doing in the evenings, in the mornings, when you're not on the bike, when you're not out running, that's going to keep you healthy, keep you stronger.

So I'm really excited about that.

You sent a great outline.

But I think where I'd like to start, because this really is your expertise, is to throw the question to you.

Why is it so important for endurance athletes to do this stuff?

That's a great question.

As a cyclists myself and speaking to your audience, a lot of whom I know are cyclists, we do what we love.

So cycling makes us a proficient cyclist.

But if we only stay on the bike, especially in the off season, it doesn't make us a very plastic, resilient or durable athlete.

And I think that those three things, plasticity, resiliency and durability, is really what gives us the health span.

So the ability to be physically active throughout our entire lives, not just on the bike, but off the bike.

And so I think it's important to convey that to your athlete, to incentivize them, to give them a reason to get off of their beloved machine in the off season or at least add a few other components to their beloved machine in the off season.

I think that's a great point.

I think the thing that I love about this is we've talked about it a little bit with nutrition.

Right.

Trevor?

This idea of what we do on the bike isn't necessarily the best thing for us in the big picture of our health and our lifespan.

And you know, what we do on the bike, yeah, it's good for us, it makes us healthy, but it probably doesn't make us the most well rounded human.

We weren't evolved to get on a bike.

So I really love where you're taking.

Us and I actually want to share a story of how important this can be.

Even if you're just, you're focused on how well can I perform on the bike.

I mentioned this in a previous episode that I was getting ready for my big race, the Tour of Tobago, and I went in for a bike fit.

And the fitter, Ryan Ignatz, who was on the show not all that long ago, he took a look at me on the bike and just went, your glutes aren't firing at all.

And said, You've got to be losing a ton of power.

And yeah, I'd noticed that it was pretty extreme in the last year, year and a half, you know, my FTP, my threshold power has probably dropped 40, 50 watts.

And I was blaming on other things, but he was like, if your glutes aren't firing, you're not pulling into your best muscle to work the bike.

So that's probably where you're losing a lot of your power.

So that had an impact.

He fit me on the bike.

But then in the off season, I always go out running and this year running, I'm getting all this calf pain, I'm having all these issues with my running, I'm really slow.

So again, I went to see an expert on this and described it and she went, well, that's what happens if your glutes aren't working.

Because, you know, if your glutes aren't doing the primary movement, you tend to rely on your calves and then you're going to get really sore.

So you're just seeing this.

I have lost this particular function that if I had been more prudent about that off the bike work, about getting in the gym, doing this sort of stuff, might have been able to tell a very different story.

And Stacy, I'm sure you see this sort of thing all the time.

Yeah, Trevor, that is a really common occurrence among cyclists.

So as you know, when you're in a posture like cycling chronically, so hours and hours and hours upon the bike, we adapt to that position.

So in a typical cycling position, and I know typical is different for a triathlete than it is a cyclocross, but in general, our cycling posture creates a shortening of tissues in one plane and a lengthening of tissues in the other.

So, for example, there's this phenomena called the crossover syndrome.

So back to your glutes.

You can imagine if you're on a bike and your hip flexors, or I should say your hip joint is in this acute position, it's natural for your hip flexors to shorten, to adapt to that position.

So when you're pedaling and there's an acute angle at your hip, the hip flexors see that and they think, well, we should adapt.

We should be more proficient in this shortened range.

And so they actually lose something called sarcomeres, or the functional unit of muscle.

And so they become really good in the shortened position.

Well, that seems like a great idea.

But what that does then is the opposite muscle of that, the glute go, hey, we're Lengthened, we don't like it here.

The cross bridges, the actin and myosin, the little, not so little, but the important protein that allow contraction.

Now they're lengthened, they're like, well, what the heck?

So they stop firing.

And then from there, what happens is that the pelvis becomes more anteriorly tilted because these hip flexors are shortened, the glutes can't oppose.

And now that sets you up for knee pain, foot and ankle issues, because if you lose that stability from which to move, the sequela is that those forces become abnormal below the chain and above the chain.

Above the chain.

But because we're bipeds, that doesn't become quite an issue unless you're a swimmer.

So that is very common to see the weak glute and then knee pain, ankle pain, tight Achilles for runners, beyond that.

So, yeah, chronic position is going to lead to crossover syndrome, which, again, is just adaptive shortening on one side and stretch weakness on the other side.

Yep.

Which.

So the expert who I'm going to see who's helping with this, she tried stretching my hip flexors and just started laughing.

I was so tight.

So that makes sense.

So, yes, you know, cycling in particular is a very imbalanced sport.

So what are the sort of common issues that you see with people who just ride the bike and don't keep their bodies in balance?

And I just described one that unfortunately, I used to be really good about keeping this in balance.

I haven't been doing as much off the bike work as I should be, so I'm a prime example of what can happen.

But what are other things that cyclists see?

Right.

So we just talked about the first one, this, you know, crossover syndrome of the lower extremity that also happens in the upper extremity.

Cyclists don't complain about it as much on the bike, but off the bike, they notice it.

So we tend to have really tight pecs, upper trap levator, scapulae, so they lead to this sort of kyphotic posture.

So real rounded shoulders and a forward head is what his grant straightens up is what that looks like.

And that's problematic off the bike as well as on the bike.

But, you know, people may have neck pain, they may have some shoulder instability because their scapula or their shoulder blades are now protracted or rounded, and so they're unable to perform their upper extremity motions from that unstable base.

I think the other thing that we don't pay as much attention to as we should are the feet.

So, you know, feet aren't meant to bike.

They just weren't designed to be locked into a shoe that is locked into a pedal.

So normally when we're walking or running, we have this natural movement of the foot, which is called supination to pronation.

Back to supination, right?

This rigid lever to this very accommodating position.

Back to a rigid lever.

On the bicycle, we stay pretty much in a pronated position.

And when we do that, we really lose the strength of our foot.

Intrinsic muscles, we flatten our arch, we compress the neurovascular structures through the foot.

That's what hot feet are, hotspots.

And so I think that over time, the feet become fairly problematic and that we should off the bike, pay more attention to those structures and give them the attention they deserve.

Well, I think one of the things that's really interesting that you brought up shoulder and upper body position is the rest of our lives don't tend to help that very much either.

We're at a desk or on a computer.

We're driving in a car.

All these things that we're doing take us away from that good posture that our bodies are created to have, walking or running.

And so everything starts to cave forward and you bring up shoulder instability.

I mean, you see how many people have we talked to as they get older?

Like, I don't know, I was reaching behind me in my car and I hurt my shoulder.

You know, these little things because that we're just not taking care of ourselves.

And everything we do piles on and exacerbates the pain or exacerbates the weakness or the instability.

I was just going to say that's a really good point.

You know, with computers and the like, our posture has gotten worse.

And I would point out that the bike is one of the only sports that I can think of that really exacerbates that poor posture.

So if you're playing soccer or basketball or running or swimming or rowing or cross country skiing, there is a need to really open up the chest and stay functional.

Cycling is the one sport I can think of that absolutely condemns that good posture because of aerodynamics.

It's horrible for function off the bike.

Well, I still remember talking to Dr.

Andy Pruitt and he just said, if I'm walking down the street, I can point out the cyclists like, the kyphosis that you see is incredible.

They're all just kind of hunched over.

You can tell.

Yeah.

Well, there's other reasons you can tell.

Tan lines, skinny arms.

I think you're right.

I think the Kyphosis sticks out, too.

Yeah.

The tan lines.

I was just down in Tobago in the sun, and I'm watching all these guys sitting there on the bench making sure the pant legs line up perfectly.

They want that tan line.

Oh, yeah.

And they gotta cultivate it.

Right.

It's a badge of honor.

It is a badge of honor, exactly.

I would like to point out one other thing that you particularly see in cyclists that's less so in runners, which is there is no eccentric activity in cycling.

And I'm a big believer that you need that eccentric work work to, for lack of a better term, build some resilience, build some durability in the muscle.

And I think cyclists lose that if they aren't doing eccentric work off the bike.

Stacey, would you agree?

Yeah, I would agree.

I mean, we're all aware of this, but some of the downsides of cycling are that it's not weight bearing.

So bone health is one thing, but as you said, Trevor, there's virtually no eccentric loading of the upper extremities, some just holding our posture, but virtually none of the lower extremities.

And eccentric strengthening generates much greater force than concentric.

So in a way, I don't know, it's fair to say that we're losing strength, but we certainly aren't gaining strength or the tensile strength of the tendon structures that we get with impact and eccentric loading.

We also lose our balance.

I mean, you have to balance on two wheels.

But there is a.

I think it's called the gyroscopic effect, which is making me sound smarter than I am, because I really don't know what that is.

But there's something about the spinning that keeps us on the bus bike that we don't have off the bike.

And so it's really easy for us to lose our balance.

So I think those are the three critical flaws in cycling from a healthy person standpoint, from a health span standpoint.

So I think we've covered some of the things that you see in endurance athletes if all they're doing is their sport.

And I'm really excited to get into what you can do to help these things to keep yourself balance, to keep yourself healthy, and actually to keep yourself stronger in your sport.

But I do think we just need to take a couple minutes before we get there and say there are issues that you have where you need to go and see an expert.

And, Stacy, I just want to ask you, what are the signs where somebody you know in an endurance athlete where you say, this isn't Just take the routine.

We're actually going to give you some routines that we're going to put on the website to give a try.

But what are the signs of?

Those aren't enough.

You need to go see a pt.

You need to go see an expert and get some help here.

Yeah, I might answer that a little bit differently.

Not so far as the signs, but I think that it's really important to know the cause, the underlying root cause of what, what is responsible for your symptoms or the complaints that the cyclist has.

Because if you don't know the underlying etiology, you're just taking a whack a mole approach.

Right.

You may be having someone address the IT ban with soft tissue mobilization.

You might see a massage therapist or a provider of your choice, or you may be seeing a physical therapist for knee pain, but you're missing imaging that tells you that you have a meniscus tear.

Right.

So I think that the answer to your question, I'm going to just pose it a little differently, is to have a really good understanding of what is causing the symptom.

And so to help you figure out that biomechanical puzzle, where to start, Obviously at the top of the food chain is a sports medicine physician, not necessarily an orthopedic surge surgeon, but a physician who has training a one year fellowship in sports medicine because they can order diagnostic tests, an X ray or an mri, or they can order a blood panel so that you're not taking a whack a mole approach.

You know, right from the start what you're dealing with from there.

I, I think a physical therapist is a reasonable next stop.

And you know, all PTs are trained to be generalists and beyond that you specialize.

And so I would seek someone who is, got some experience in sports medicine.

But I will tell you, as a pt, bike training is a whole nother thing.

We never once talked about the bike in physical therapy school, not once.

And I'm sure that they do now.

The profession has evolved, but it's important to find a PT that knows how the body's machine interfaces with the bike machine, because again, cycling is a unique sport where those two machines come together and are really locked together.

And so physical therapists that really understand that interaction is important.

So those are the two places I might start.

It's really interesting what you're saying, because I think this is a big thing I've seen in coaching for a long time with physical ailments is we tend to be treating the symptoms of the real problem.

Right.

And if we can get to the root of the real problem, then we're not just treating the symptoms.

Now we're treating the real problem.

Like, I have a really destroyed shoulder from swimming and baseball and water polo in years of that.

So I ride protecting that shoulder, which kicks my body to one side, which puts pressure on my left hip, which fails my right hip.

So, like, how do I go down that chain and deal with and treat the cause of all of that instead of just, as you're saying, playing whack a mole with a bunch of symptoms?

So I'll give an example.

Let's say I'm seeing somebody with knee pain.

It might be that that knee pain is caused by some osteoarthritis, that there's actual changes in that patellofemoral joint.

Well, my solution or the solution for the athlete might be shorter cranks.

And certainly we'll do some other interventions.

But that is going to make the biggest difference because I'm not going to be able to change the joint surface quality with anything that I can do.

But let's say that that same person with knee pain, the origin is a weak glute.

Back to Trevor's story at the beginning.

Well, that's different.

I don't need short cranks.

Now I'm really doing functional strength training because that glute isn't really weak, it's weak while cycling.

Right.

There's two different things there, a true weakness or a functional weakness.

So I'm going to do what I call functional training to remind that glute how to fire to oppose those tight hip flexors.

Or we may find out that the glutes firing.

There's no osteoarthritic changes at the knee joint itself, but this particular cyclist has a really tight iliotibial band.

Well, in isolation, nothing else going on.

So now I might focus my inner mention.

It's some really good soft tissue mobilization for the IT band.

Or maybe I look at their cleats and I figured out they haven't changed them in a couple of years and I put new cleats on and their knee pain goes away.

So I think that my point is you really have to find somebody whether that's a sports medicine physician, whether it's a pt, whether it's your coach.

Coaches are better sometimes than anybody at analyzing movement and figuring out the source rather than whack a molecule.

The last thing I want to add to all this for any of our listeners who are saying, well, you're kind of talking to professional athletes here.

This doesn't really apply to me.

I'm actually going to flip that around and say this is almost more important to the people who are just looking to be lifelong athletes.

You know, I'm 53.

I'm now getting very interested in healthy aging.

And I see so many of my friends that are having issues and just going, well, that's natural aging.

This stuff should be happening in your 50s.

We should all expect this.

And I just want to emphasize, no, that's not the case at all.

And these are the sort of things that if you can stay ahead of them, you can prevent a lot of what we think of as natural aging.

And an example.

Sorry to throw my father under the bus here, but to give you an example, my dad was a great athlete, but he was very much the old mindset of, you just do your sport.

You don't do any of this.

Get in the weight room, do functional work.

I actually tried to give him a functional routine, and he did it for a week and then said no.

And I went, why aren't you doing this, dad?

And he goes, well, it doesn't hurt.

It's not hard because I was giving him all just body weight stuff.

He goes, I don't see the benefit of this.

So he just refused.

But, you know, as much as I'm kind of making fun of myself for my glutes aren't firing and I'm having that issue, that's a relatively minor issue compared to the fact that I look at my dad when he was 53, he had already had a knee replacement and a shoulder replacement.

And that's something.

I'm not even talking to people about that stuff because I have spent my life doing a lot of functional work.

My joints are still in a pretty good place.

So that's why this is important.

This is going to help you age a lot better.

I would echo that comment, Trevor.

I mean, I see in my physical therapy career less than 2% of the patients that I see are professional athletes, probably less than 1%.

So this is for all of the population, not just the elites.

And by the way, I would identify an elite athlete as anybody who wants to move.

Not just Olympians or World Championships, anybody who moves as an athlete.

And so my job is to protect the health span of people just getting to the grocery store and reaching into a cupboard and picking up their grandbabies, not just winning a cyclocross event or a big cycling event.

So, absolutely.

You know, when you first start out in your career.

I graduated from PT school when it was Still a bachelor.

So I was all of 22 years old and I remember seeing some really high level athletes, Birke Biner, cross country, ski racers, triathletes.

And they were old to me.

My gosh, they were 40, they were 50.

I mean, you know, as a sassy 22 year old, that seemed forever.

And I wish I could go back and apologize to those patients because I just assumed that they were old and that's why they were dysfunctional.

And the other thing that I wish I would have done is paid more attention to what kept those people going, because that's where the art of functional training lies.

It's not just doing your sport, it's preparing your tissue in all three planes to stay pliable, durable and resilient.

The one thing that I think is really, I wrote it down because, you know, I was listening to Trevor earlier and he was talking about what's not working and I'm talking about what's not working and I almost.

And what my note was, is this age or is this just we're not doing what we need to do off the bike to stay in a place where we can be in a healthy health span when we're getting older.

And to me, as I get busy, you know, we're off mic earlier and I'm talking about my day and as we get busy, where do I put this in?

Right?

And I think that's what gets so hard as the athlete gets older.

Our responsibilities go up.

What we need to do gets up, goes up and where we're going to fit this, it just doesn't work anymore.

And then if we get to that point where maybe we do have the time to do it now we're older and we haven't done it for 20 years and now trying to get back into it, it's just not something that feels very good.

So I mean, to me, so much of this question is, are we really, you know, and this is to your point, Stacy, the, the functionality of what we're doing is this age that's causing these deficiencies or is this, we're not doing the work off the bike that's causing these deficiencies.

I would obviously lean to ladder.

It's both.

I used to, I used to tell my students, don't tell me it's both.

I don't want to hear that it's both.

It's not Grant.

It depends.

Right?

It depends.

It depends.

I used to tell my students, if there's a question on an exam about age and it's multiple choice, look for the answer that says worse, because that's going to be it.

So.

So nothing mechanically improves with age.

And I think that shouldn't be overwhelming and negative.

It should give your athletes incentive to get better.

Even though getting better after 40 looks like staying the same, and I think that's a key thing to educate your athlete on, is you are getting better by doing these things off the bike, you're warding off to some extent the ravages of age.

And in doing so, you're staying the same.

If you didn't do these things, you would be getting worse.

So.

Right.

My favorite point is when a master's athlete once told me they were in their late 40s, early 50s, and they said, My FTP hasn't gone up in five years.

And I said, has it gone down?

They said, no.

I was like, you're doing incredible.

I don't know how to tell you this, but you're doing great.

Well, look, I'll give you an example and what I would say, my answer to your question, Grant, is it's not inevitable, but as we age, the body becomes less forgiving.

And you know, the example I'm going to give you, people who have been listening to our show since the start know that back 2018, 2019, I had a real back problem.

My back was going out every couple months and, you know, we talked about it a bit on the show and you think, you know, that's five, six years ago now, my back should be worse.

I put the work into seeing a bunch of people to find out what's the routine, what can I do to help my back.

And I have found a really good routine.

And I have just simply said, yeah, I'm a busy person with a busy job, but I'm just going to get up 20 minutes earlier every morning and I go down to the weight room in my basement.

I have a 12 minute routine that is designed to protect my back and I do it probably five times a week and my back hasn't gone out in over two years.

But if I stop that routine, if I go a couple weeks without routine, my back starts grumbling.

I know it's just something I have to keep up.

You brought up two key points, really essential.

One is routine.

So if you're doing something and it's not part of your routine, you're likely not to do it.

And athletes know this, right?

They make training part of their routine.

So it's just a matter of putting these things off the bike into their routine.

And the second thing is to keep Them brief.

When I first started as a physical therapist, I thought it was my job to give the patient every single exercise that could potentially benefit them.

And the compliance was horrible because if you give someone 10 things to do and they do two, they feel like they failed and so then they do none.

But if you give them two and they succeed, they're gonna come back and say, can I do more?

Is there a third or a fourth?

And you might end up getting that patient.

Just like you said, Trevor, it's a 12 minute routine.

I bet there's not more than four or five key exercises in that routine.

And so less is more.

And putting it into a routine is crucial.

I would say it's a seven exercise routine, but there are three that are crucial.

So if I have very little time, I go down, do those three exercises, it's five, five minutes.

And that was a trick, figuring out the exercises that have the biggest impact, because as you said, I didn't want a 25 exercise routine.

I know my compliance would get really bad.

So, Stacy, you sent to us a list that was absolutely fantastic of kind of the four categories of functional work, or off the bike work, whatever you want to call it.

So I think we're going to dive into each of these, but let's first just give us, please, a quick overview of the four.

It's mobility, flexibility, stability, and strength.

What do you mean by each of those?

Yeah, well, first off, I don't get to take credit for that brilliant outline.

That's movement hierarchy that someone else thought of and described.

I'm just repeating it.

So those are sort of the pillars of movement in a hierarchical sense.

So we think about this as a hierarchy.

Mobility is the base of the pyramid, and mobility is, is freely and fluidly moving through a functional range of motion.

And we'll come back to mobility because it's also the apex of the hierarchy.

Flexibility is really one component of mobility.

And flexibility is just defined as the ability of the muscle, the tendon and the ligament, so both connective tissue and contractile tissue to lengthen passively or to stretch throughout that range of motion.

And then we move on to stability.

And that's really an anchor.

It's the steady foundation of our pelvis, our lumbar region and our hip.

So the lumbo pelvic hip region and that stable foundation or that steady foundation, that anchor then allows movement.

So again, we're back to mobility.

And in order to have mobility on stability, you need strength.

So strength is just the force that can be produced and transferred and Then again, because it's a pyramid, we come back to the apex, and that's mobility.

So now we have this stable structure.

We've got strength, and we can move fluidly through a functional range of motion.

I love that description.

I particularly love that description because it shows that you need all four of these.

They really need to work in conjunction.

And if you only ever work on one without the others, you can get yourself in trouble.

I always love.

I forget the guests on the show, we were talking about flexibility, and they said, well, if all you ever do is flexibility without the strength and stability work, you just get a floppy muscle and you're going to get injured.

I love that term.

Floppy muscle.

Floppy, yeah.

Just thinking floppy.

I was thinking of a toddler.

And that's really a perfect example of mobility.

At the base of this movement pyramid, they have incredible range of motion, so they've got mobility with that regardless, and they've got flexibility, but they don't have the stability or the strength.

So once they acquire stability, they can crawl.

Once they acquire strength, then they can walk.

And once they acquire skill to bring all of those together, then they can run.

So, Stacy, that was a great explanation of the four.

Let's dive into them now, and let's start with.

Tell us more about mobility.

Mobility, by definition, I think of it as the three Fs.

It's freely moving, fluidly moving through a functional range of motion.

So free, fluid, functional movement through range of motion.

And by range of motion, we just mean degrees, right?

So your.

Your knee has maybe 140 degrees, and your elbow has maybe 130.

So that's what we mean by range of motion.

It's described by the joint geometry, and that's the base of the foundation, but it's also the apex.

So we'll come back to mobility.

So that's sort of the pieces of the pyramid.

And as you think about that, Pyram said it's helpful to think about it as a chain.

So each joint being a link in that kinetic or chain of movement.

And so if you lack mobility at one of those segments, it's gonna most definitely cause problems at an adjacent segment.

It might be above, it might be below.

So, Trevor, you'd notice that your glute was weak and you'd ended up with Achilles issues.

That's an example of failure of one segment in that kinetic chain.

And because of that, the load was distributed somewhere else, and that joint, the ankle joint in this case, had to take up that extra work, and it couldn't handle it.

It was overloaded.

So mobility is really the base of the hierarchy.

Every single segment has to be able to move or there will most likely be problems at other segments.

So that's the first one.

So let's shift to flexibility because anybody who's interested.

Episode 97, Going Back a bit, we had Menachem Brody on the show and he was pretty negative towards flexibility, saying endurance athletes, this might be something you want to rethink.

And I've seen research that says this actually hurts performance.

I've seen research that says it helps.

I actually was looking at a study last night that talked about.

And I know, Stacy, you're going to love this, talked about viscoelastic changes because this is your area of expertise that could potentially help performance.

So where do you stand on this?

Is this a good thing?

Is it a bad thing?

What are the dangers, what are the advantages and how should we approach it?

It's a really hot topic.

It has been through my entire career and I loathe that.

Your listeners love the answer.

It depends.

And so I'll just start with that one to satiate them all.

Yeah, exactly.

So when we think about flexibility, it is one component of mobility.

So going back to our discussion about the mobility exercise where we swing our leg forward and touch it with the opposite hand, think about the extensibility of the hamstring throughout that exercise.

If we don't have that extensibility of that tissue, we aren't going to be able to have mobility through the hip and knee to achieve that.

Right.

If we don't have adequate extensibility of the hamstring, we're going to have a really difficult time posturing on the bike.

If we don't have that length and we want to get aero, what we're going to do is flex from our spine.

If we can't anteriorly rotate from our hip because our hamstrings don't have that extensibility.

So I do think it is important.

Do you need to be Gumby?

No, that's more of your genetic predisposition.

That's going to come from your DNA's prescription for the type of collagen that you have.

You know, and we're not going to change that with stretching.

We're not going to change the inherent nature of your tissue.

There's a reason that we self select.

A gymnast probably isn't going to become a cyclist.

A cyclist probably isn't going to become a gymnast.

So there's some inherent flexibility characteristics that we can't alter.

But I do think that there's a role for flexibility, at least short term response to stretching, like you said, that deals with the viscoelastic properties of muscle.

So all I mean by that is that muscle is like silly putty, right?

It has an elastic component, you pull it and it comes back.

But silly putty also has a viscous component.

So by stretching, if you are pulling on that silly putty and you are holding it at a certain length, there's going to be a relaxation of the amount of stress of the force that that tissue sees.

That's a good thing.

That happens in a region of the stress strain curve where we function, okay.

Called the toe region.

And we don't need to get into that.

Likewise, that tissue is going to also creep.

So if we put a stress on that tissue, it's going to slowly lengthen over time or that silly putty is going to get longer.

Okay?

So those are two properties, stress relaxation and creep, that are important to our tissue.

I don't know necessarily that they prevent injury.

There's not data to suggest that stretching prevents injury, or at least there's conflicting data.

But I do think it helps us move more fluidly through the range of motion that we are asking our bodies to move through.

It makes that more comfortable.

There is an analgesic effect of stretching called stretch tolerance so that our bodies are more happy to move through that.

And this is a silly analogy, but it makes sense to most people.

Your bladder has a stretch receptor, right?

And for people that use the bathroom all the time, they feel like they have to pee all the time.

And if you can get your bladder a little bit more full, you become a little bit more tolerant to that.

A little bit more stretch tolerant doesn't mean that you overfill your bladder, that you don't know to pee.

It just means you're a little bit more comfortable with a semi full bladder.

And I like to think about that as a stretching analogy is that the tissue isn't going to over stretch and get injured.

It's just that within the capacity that it needs to, it's a little bit more comfortable.

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So a couple things you've touched on that I find really interesting is one, the fact that the muscle tissue itself, so if you disconnect it from the tendons on either end, you take off the fascia.

It is silly pumpkin.

It is highly pliable.

So it's not really the muscle that you're stretching.

But another thing that you mentioned briefly earlier in the show that I want to ask a little more about, and let's see if I can pronounce this term.

It does seem in the research, one of the things that you get from stretching is what's called sarcomerogenesis.

I just butchered that because, yeah, that's a tough term.

But the idea is when you stretch, I don't want to go too much into the physiology, but you have sarcomeres in your muscles.

That's where the contraction happens.

So the more sarcomeres you have, effectively the stronger the muscle's going to be.

And stretching can cause your muscles to develop more sarcomeres.

So can you talk a little bit more about both the importance of the connective tissue and that potential adaptation to stretching?

Yeah, and you didn't butcher it at all.

Sarcomerogenesis, you nailed it.

So as far as.

Yeah, as far as stretching, you certainly do.

Well, I'll back up.

When I first started prescribing stretching, I thought, and I told patients that we were stretching muscle.

And later in my development, I realized that that was sort of a misnomer.

The muscle is certainly stretching.

So I do a lot of single fiber work under a microscope.

So you strip all of the connective tissue off and you do experiments on just the muscle tissue.

And certainly you can get it to stretch.

But.

But when you stretch a muscle, the units of the sarcomere that are contracting, they lose their ability to optimally contract.

So you're really not wanting to stretch the muscle per se, you're wanting to stretch the connective tissue.

And there's connective tissue around each muscle, fiber around each muscle bundle, and around each muscle.

So three layers of connective tissue.

And then you have the tendon, which is also a form of connective tissue.

And so we're stretching.

We're really stretching the connective tissue, not.

Not necessarily the muscle per se.

So that is a good point.

And like we talked about before, that tendon structure and that connective tissue structure is viscoelastic.

So time under tension, slow stretching, long holds, is optimal to address those viscoelastic properties.

So the sarcomeurogenesis, if we can go back to your glute example, when you're sitting on a bike or any chronic posture for a long period of time, Tissue on one side shortens, hip flexor.

Tissue on the opposite side becomes stretch weak.

So just like we talked about, the hip flexor needs to be optimal in that shortened position.

So we lose sarcomeres, the functional unit of muscle.

And so the actin and myosin are optimized that they can find each other for contraction.

Well, the glute on the other side is stretched, and so the actin and myosin can't find each other.

And so what the glute says is, ah, let's have some sarcomerogenesis.

Instead of taking away those sarcomeres on the front side of the hip flexor, we're going to add them on the posterior side.

And now, because we have more sarcomeres through stretching, that muscle effectively got longer and those contractile proteins can find each other again.

So when we stretch or when we work eccentrically, which is a different kind of stretch, that's a cell signal to add sarcomeres.

In series, our sarcomerogenesis building of the genesis, the creation of new sarcomeres.

So let's switch to a bit of the practical side of this.

When somebody wants to work flexibility, what is your recommended approach to this?

Like, how do you feel about static versus dynamic stretching?

How do you feel about things like yoga, Pilates?

What do you feel are the best approaches to build flexibility in a healthy way?

Oh, I have so many feelings on that.

Good to start.

Kind of to go back to your previous convincing concern about stretching being detrimental, Static stretching is really where most of that research comes from.

And there is evidence that stretching in almost all forms of muscular performance, force generation, power output, vertical jump, sprinting, is compromised with static stretching.

And the idea there is something called hysteresis, another big word.

And that just means loss of energy through heat.

So if you take a spring and you stretch it, hysteresis would say that the energy to come back in that spring is somewhat lost.

So there is valid research on that.

And so I'm not advocating that people do static stretching.

And static just means, you know, passive.

The muscle's not contracting, you're just trying to lengthen through it.

Yeah, that's probably not the best thing to do before you go do a track sprint or a high jump.

But that's not to say that stretching is bad.

It's just that that mode of stretching prior to high power output isn't the best idea as Far as leading to injury, it's not stretching itself, it's hypermobility.

So if you have a joint, let's say you're a gymnast or a swimmer, and you've got a lot of mobility in that joint and a lot of flexibility, because someone like a swimmer or a baseball pitcher or a gymnast has taken that joint through almost extreme range of motions repetitively.

The passive structures, they don't need to be stretched any further.

So if you attempt to do that, yes, you may injure that joint.

So hypermobility or stretching, whereby the joint is beyond its normal range of motion, can be detrimental.

But the converse of that is, if you have somebody who has limited flexibility, they can't put that joint through its normal excursion because the connective tissue is not very extensible.

That's going to create several problems.

One, your nature's WD40, which we call the synovial fluid in the joint.

If you can't move freely because of your lack of flexibility, you don't get that shot of WD40.

That's not a good thing.

So you're hindering that joint health because you haven't created milieu that allows it to move through its full excursion.

And as we talked about before, now you've got limited mobility at one joint.

What do you think happens at the joint above or below?

So if you have a hamstring muscle that is not adequately extensible, it does not allow mobility, passive mobility, in other words, flexibility.

And you're sitting on the bike and you're trying to get aero, you're going to get that from your lumbar spine because you can get it from the hip because that hamstring is pulling so tightly.

And so now you create a situation where lack of mobility at the ham, at the joint controlled by the hamstring creates stress or strain on the low back.

So I think that it's really difficult to just be in one camp and say flexibility is bad.

Well, yeah, it's bad.

If you do a long static stretch before a power lift.

I don't think you can just say it's good either.

You can't give flexibility exercises to a shoulder of a swimmer that's hypermobile.

So I think you really need to define why it is and what it is that you're trying to make flexible.

And in my world, I'm giving flexibility exercises where I think it improves mobility.

Hey, Trevor, it depends.

You were just waiting.

It always depends.

Oh, it just depends.

I've been waiting the whole time she was saying, saying that to Just chime in and go, hey, Trevor, it depends.

Grant's favorite term.

There we go.

Yes.

So, last question.

On the flexibility side, how do you feel about things like yoga and Pilates?

I have changed my view on yoga and I can't really speak to Pilates because I've never done it.

I initially really didn't understand yoga, and most things we don't understand, we're fearful of, so we don't like them.

And that's where I started.

I think that when you going back to our discussion about what it is that you're actually stretching, when you realize that it's the connective tissue more so than the contractile tissue, you realize the connective tissue isn't in one plane.

Right.

So if you're stretching your hamstring, I was taught as a PT to flex at the hip and extend at the knee.

So you're pulling that tissue over both joint ranges in the sagittal plan.

But that's so silly because that fascia works in a transverse plane, in the frontal plane and in the sagittal plane.

So things like yoga address stretching of the tissue in a multiplanar capacity, which is exactly what we need to do.

You can modify your hamstring stretch to be triplanar, but we don't usually do it that way.

So I like yoga for that reason, and it depends if I have an isolated muscle that has been injured and I know that it has a chunk of non contractile scar tissue in the middle of the muscle, absolutely.

I'm going to stretch that muscle in a uniplanar way to get at the orientation that's most restricted.

But in general, a triplanar global stretch is better.

So that's my feeling on yoga.

It's terrific for sort of an everything approach.

But don't forget to isolate if you have a specific need at a specific joint for a specific tissue.

So we're going to move over to disability, but before we move there, I just want to let everybody know Dr.

Brixim was really kind to us.

She's actually put together three routines which we'll put on the website.

She's actually going to write an article for us explaining mobility, flexibility, stability and strength with links to those routines.

So please go to the website, look for these.

They're great workouts.

And she put together one that kind of combines the mobility and flexibility work.

So that'll be on the website.

And with that, tell us a little more about stability.

I will.

But can I say one more thing about flexibility?

Because I feel like I dropped the ball.

So we talked about static stretching.

And static again, meaning passive, or the muscle itself isn't involved in contracting, you're just lengthening it while the contractile properties are quiet.

But there's also this whole concept of active stretching.

And I don't mean active like we talked about dynamic.

I mean active stretching, where you're using stretching, the muscle itself, properties of the muscle, namely the Golgi tendon organ or the gto and the muscle spindle in a way to sort of trick the muscle into giving you more length.

That active stretching is rooted in something, a big fancy word called proprioceptive neuromuscular facilitation.

So the proprioceptors are these GTOs and these muscle spindles.

The neuromuscular just simply states we're using the nervous system to trick the muscle facilitating the muscle stretch using these GTOs and muscle spindle.

And it came out of work done in the late 40s and early 50s by a neurophysiologist and a physical therapist who were treating polio and other conditions.

And we have sort of taken that and applied it to athletes with musculoskeletal abnormalities or impairments.

And I'm a huge fan of PNF stretching, especially after exercise.

And it's something that the athlete can do themselves.

And in that handout that you alluded to, I've touched on that a bit.

So I am a huge fan of active stretching or PNF stretching way more than I am static stretching.

So give us an example of how you do a PNF stretch.

Yeah.

So if you're stretching your hamstring, let's say you're on your back, so you're on the floor, lying straight out.

And the target hip, say it's your right hip, you're going to flex your hip to 90, and you're going to flex your knee to 90.

Okay.

And then you are going to clasp your hands, interlace your fingers behind that right thigh, and you're going to use your hands as a blockade.

So I am going to actively contract my hamstrings to extend my hip, but I'm not going to actually allow any motion at the hip to occur because my interlaced fingers behind the thigh are blocking that motion.

That's called an isometric contraction.

So I'm contracting the hamstring to extend my hip, but I'm not moving.

I'm not going anywhere.

And I forcefully do that, like 80%, maybe of my max contraction.

So I hold that 2, 3, and then I relax.

My hamstring.

And when I relax my hamstring, I'm going to use my quadricep actively to extend my knee.

So my foot's coming up towards the ceiling.

And when I get it as far as I can, I'm going to hold that statically for 20 seconds.

Seconds.

Then I'm going to repeat that two or three times.

And when you do that, it's shocking the length that you can achieve that you couldn't on the first repetition.

You can also get fancier.

And instead of using your fingers interlaced behind your thigh, you can use like a yoga strap.

And now put it around your ankle.

Okay, so now you can fire your hamstring and you're resisting with the strap.

And so now you can extend your, your hip and you can flex your knee, right?

Because you've got this strap that's resisting that.

And now when you relax it, so you hold it, two, three.

You're tricking the proprioceptors.

And when you relax now, you can fire your quad and you can use your hands to pull on that strap to take up the tissue length that you've achieved.

And you can usually get an additional five, sometimes more degrees out of that muscle than you could with just static stretching.

So that's an example of an active stretch.

You're using the muscle actively to gain more extensibility or flexibility out of it.

All right, let's shift over to stability.

So now tell us why this is important.

This is the low hanging fruit for the cyclist.

I feel like this is where, Trevor, you were probably alluding to some of this in your seven exercises exercise, 12 minute basement workout.

So when we say stability, I think of, this is the anchor point.

So I've got a foundation from which to move.

And if that foundation is not stable, well, look at the Leaning Tower of Pisa.

Right?

So you can't move effectively if you don't, if your body doesn't know or can rely on a stable foundation from which to move.

So if we are going to transfer force through the pedal or through the water in a swimmer or through our feet like a runner, we need to do that from a place of stability.

And it's really been in the literature.

Unlike stretching, the literature is fairly concrete and unequivocal about injury prevention with stability.

So one of my mentors, Dr.

Tom Best, he was a sports medicine physician at the University of Wisconsin who I did my PhD with, he did this study in the early teens and it looked at hamstring injuries.

And basically what it showed is that if you have a athlete with a hamstring injury, that athlete is going to have less chance of recurrence if they work on core stability and agility drills than they are if they simply stretch their hamstring and strengthen their hamstring.

So that's not injury prevention primarily, but it's secondary.

It's recurrent injury prevention.

So the other studies, they were sort of hallmark studies in the late 90s by Hodges.

He looked at patients with low back pain and he looked at recruitment and he said, geez, in all these patients that have low back pain, they end up moving their arms and their legs, so both upper extremity and lower extremity movements.

And they initiate that movement before they fire their core.

And I'll talk about what that means in just a minute.

And when he looked at people that fired their arms and their legs, movement patterns that didn't have low back pain, lo and behold, they fired their core prior to movement.

So they initiated basically contractions of what we call the transversus abdominis and the multifidi, the front door and the back door of the core cylinder.

And I think that's really good data to suggest, you know, that the core is, at least in this population, it was a little back pain, but I think other people have shown that to be true across the board for other types of injuries and pathologies.

So that's my feeling on core.

When you're talking about stability, would you say core is the most important part?

And it's a bit of a leading question.

You might disagree with me, but I think if somebody has a weak core and it's not firing correctly, it's impossible to be stable.

So I always feel it's at the core that stability starts hurts.

I agree, and I'm sure everyone is.

Well, I'm not sure because I didn't understand core when I first started as a pt and I again, I'm sure my patients out there are thinking, ban, can I get a refund?

Like, what was she doing in the early 90s?

But I thought core meant like a, like a six pack abs.

I thought that's what core was.

And so you know, crunches.

And I'm not saying crunches are bad, I'm just saying that's what I thought core was about.

And it wasn't until later.

And now I think it's really commonplace.

But in the PT world, this came later for me is the core is really a cylinder.

And if you think of a cylinder, the front door is this tra.

The transversus Abdominis, it's your belt muscle.

It's the front door of the cylinder.

The back door are your multifidi.

And these are the small muscles that run between the spinal segments that cause rotation or stability of the spine.

That's the back door.

The floor of your cylinder is your pelvic floor and the ceiling is your diaphragm.

And we sort of ignore the diaphragm because the diaphragm, it has to contract and relax because that's how we breathe.

So, you know, you kind of have to let the ceiling do what the ceiling is going to do.

But if you can really keep that cylinder contracted, you're increasing the pressure in that cylinder.

And that pressure acts as a stabilizer for the spine.

And so those four muscles, muscles are what I talk about is our core stabilizers.

And then beyond that, we've got what I refer to and what others refer to.

There's some discrepancy.

It's not that this is right or wrong.

I call global stabilizers.

And that I think of is our six pack muscles, our internal obliques, our external obliques on the backside, our spinalis.

So the core provides this stable foundation of the lumbar, low pelvic complex, right?

And then the global stabilizers provide postural alignment of the vertebral column.

All right, so that's next, you've got, you have our base, and now we have our alignment of the vertebral column on our stable base.

And the next, we go to our global mobilizers.

So core stabilizers, global stabilizers.

And now I think about our global mobilizers.

And that's where the hip becomes part of this lumbo pelvic complex.

So our rectus femoris, the one quad muscle that crosses the hip, our iliopsoas, our hip flexors, our glute meat, our glute max.

These are the more superficial muscles from the core that connect the trunk to the extremities.

So those three groups of muscles are where the low hanging frame, fruit for everybody is.

And if you can get those to coordinate, then you can start thinking about strength and power through the pedal or strength or power through a swim stroke or strength and power through throwing a baseball or swinging a tennis racket or kicking a soccer ball.

But unless you've built from the core stabilizers to the global stabilizers to the global mobilizers, I think you're really losing power and losing your status as far as preventing injury.

I think that's where the money is, at least in my World, in my thought.

But I will say, I mean, there might be some people listening to this going, well, I'm a cyclist.

You're locked in on the bike.

There isn't that much movement.

So how important is this?

But I can tell you I've seen cyclists with really bad stability, really weak cores, and you see it, their knees are moving in every direction.

They're kind of flopping around on the saddle battle.

There's just no stability there where if you look at somebody with really good stability, their feet are pedaling in circles, but the rest of their body is just solid.

There's no movement whatsoever.

And when I see that person has poor stability, you go, yeah, you're the one who's going to start getting knee pain pretty soon.

Yeah, it all goes down the line.

Right.

You know, at some point.

And it's the same thing with foot stability and mobility as Stacy was talking about earlier.

It'll climb, climb up the line.

Because I'm usually a middle to back of the packer, I have the opportunity to watch lots of cyclists go by and of course, I don't get to see them afterwards, but I can probably predict which ones are going to end up injured.

And every once in a while, there was a woman that just blew by me at Big Sugar that was on the podium.

So clearly she's very good at her sport.

But.

But I don't know for how long, you know, watching her go by.

All I could think of was you were on the age group podium.

You could have probably been on the pro podium if you could figure out how to put the force you're generating through the pedal in one direction rather than having it go in every direction because your pelvis is completely unstable.

And yet when I do a bike fit, a lot of times it's a puzzle to figure out, is there something about the bike that's making you unstable and we can change that, or is it you're unstable and it doesn't matter what I change on the bike because it really is going to take you getting off the bike and working on core stability in order for you to perform.

And that's really a fun biomechanical puzzle looking at two machines and which one is the problem?

Sometimes it's both.

And so for anybody who's listening, who's going, well, how do I work stability again?

Dr.

Brixham has put together a great workout for us.

I recommend taking a look at it.

We'll have it on the.

I think you made an important point just going to do it a Bunch of crunches and getting a six pack ab doesn't necessarily make you stable.

So we've got the final aspect here.

Dr.

Brixham, let's talk about strength.

Yeah, I'm happy to.

It's probably where I spend the least amount of my time.

I often send athletes to strength and conditioning coaches for more personalized training.

So the few things I'll say about strength training for the cyclists, we touched upon them briefly at the beginning for bone health, it's critical because cycling, cycling isn't an impact sport for tendon strength.

It's critical to really bring about changes in tensile strength for the tendons.

For muscle strength, we're really strong in the quads, but we're only as strong as the biggest gear and the biggest hill we can climb.

So there's lots of strength to be gained off the bike as well.

And as we talked about this crossover syndrome, gaining strength in those stretch weakened muscles.

So from a postural standpoint, we've become kyphotic and those shoulder retractors have become strong in a lengthened position.

But when we get off the bike and we try to stand up, they're really weak where they're supposed to be strong.

So I think a strength in that sense and I really leave the reps and sets to more of the strength and conditioning professionals.

But certainly there's a difference between what we do in the off season versus what we do in season.

And just a quick shout out to Stacey Sims.

I think she has done a lot of really groundbreaking work in strength training for women.

So we have to be cognizant of sex differences and also age differences.

And so I think strengthening doesn't necessarily become more important as we age.

It should have been important when we were young so that we're not making up for lost time.

But because most of us don't think about strength when we're young, because we feel strong stress.

Strength therefore becomes relatively more important as we age because whether we like it or not, sarcopenia will happen, the natural loss of muscle.

So the more we can put in the bank early on, the more savings we have to draw from as we age.

I think a really good point there that is really interesting is the individuality of a strength program.

How important it is to have that conversation between the athletes athlete and the strength conditioning professional to really make sure that it's tailored to that athlete.

And we can do some general stuff that's going to help all cyclists.

We can do some general stuff that's going to help most runners but if we're dealing with some of these discrepancies, a true tailored individualized program is going to be very, very helpful.

I remember reading a fascinating study that talked about orphan fibers, which, where so when you think about your muscles, you actually have to think about neuromuscular units.

So there's a nerve that connects to multiple fibers, and when it activates, it activates all the fibers.

You can't just contract a single fiber.

You contract them as a group.

And if we don't do strength work as we age, you get what are called orphan fibers.

They just disconnect.

And what will happen is they'll eventually connect to another neuromuscular unit.

But if that happens a lot, over time, you end up having fewer neuromuscular units, which means you lose some fine control of the muscle because there's just fewer units to control how much of a contraction you do in the muscle.

And that's something that we associate with aging.

But they've shown, keep up the strength work, do these sorts of exercise on your muscles, and you can prevent a lot of these orbits orphans.

So you can prevent a lot of what we think of as aging.

That's exactly right, Trevor, and a great point.

So I like to think of strengthening as hardware versus software.

So if you're doing strengthening exercises that are more low weight, high rep, you're really working the hardware.

You're trying to hypertrophy, you're trying to build more of those muscle fibers or the size of the muscle fibers.

But when you're lifting high weight, weight, low reps, you're really working on the software, meaning the central nervous system, which is exactly what you're talking about, are those motor units.

And so working the software is really where I like to see athletes spend their time in the off season.

And working the hardware is more where I like to see that athlete working in the in season and where I'm very comfortable.

So I, I kind of leave that to the strength and conditioning specialist.

What I, I hope that a lot of cyclists do listen to this podcast is think about functional strength.

So this is using your body in three planes.

The transverse plane, which was rotating.

The frontal plane, which is like a jumping jack, and our favorite sagittal plane, which is cycling and running.

So it's strengthening throughout all three of those range of motions, which is how we function.

If you think about reaching for something on a high shelf, you're flexing your abd ducting and you're rotating.

And so using low weight or body weight, really, and you can do this at home with nothing more than a band and a physio ball.

And I provided just some basic exercises that are my go tos.

Functional strength should be year round, not just the off season.

But if you're somebody that really doesn't like to get off the bike in the in season, a real focal point for the off season season.

So yeah, we've actually done past episodes on strength.

I love some of the ways you describe this.

Working the different planes is really important, not just the planes that we use in cycling and running, why it is beneficial.

So Dr.

Brixton, let's just shift over to what are some of your practical suggestions for working the strength side.

And again, really appreciated this.

You put together a great strength roll routine that will be on the website.

So anybody who wants specific exercises, go check that out.

But what are your overall practical recommendations here?

Sure.

I think most of your listeners are probably familiar with the foundational movement.

So squat, lunge, hinge, push, pull, plank, rotate.

And when we think about cycling, we're always pushing.

So from a practical take home pulling, if you're in the weight room, spending more time on the pull.

So for upper extremity that would be things like bento over rows or seated rows, and the lower extremity things like deadlifts, double leg or single leg deadlifts or pulls, we've hit this.

But the planks working on core stability, which we often neglect during the season.

And then I think the idea of more functional training and all that that means is if you take one of your foundational exercises like a lunge, rather than just lunging forward forward in our sagittal plane, try lunging backward.

It's still sagittal plane, but it's a different movement puzzle.

And it speaks to that whole plasticity, your ability of your brain and your body to figure out new puzzles so that when you face them out in the real world, meaning off the bike world, that you have that plasticity to face that challenge and adapt structurally and functionally or do a lateral lunge, or do a posteromedial or a posterolateral or a anteromedial or an anterolateral lunge, in other words, the whole star drill.

And I think that that's an incredible exercise just to take a foundational movement and change the planes and you'll see how your tissue doesn't like it.

And if your tissue doesn't like it, it's because it hasn't seen it.

And if it hasn't seen it, it's probably either become stretch, weak or or functionally shortened.

So it's a good idea to remind your tissue that it can work outside of how it does on a bicycle.

Great suggestion.

And I bet I have an exercise that I love to do.

It's something I actually do at the office when I just need a quick break that I got from dancers, which is doing lunges.

But first you lunge forward to 12:00, then you lunge to the side to 3:00, then you lunge backwards to 6:00, and you have dancers that'll actually just kind of go all the way around the clock to make sure that not only just able to do the lunge, but in multiple directions.

Right.

That's exactly what I was probably not very good at articulating is that star drill.

I think my other favorite is in physical therapy, we call it a chop and a lift.

It goes back to that proprioceptive neuromuscular facilitation, or pnf.

So if you're in a squat position and you take a kettlebell or a medicine ball and you start with that ball between your feet, and as you lift, you come up your right shoulder like you're throwing something up and back over your left shoulder, return to that starting position, and then come up and over with that ball over your left shoulder.

So you're incorporating trunk rotation, neck rotation, shoulder mobility, and you're getting your squat in there.

That's a really nice upper body, lower body combination exercise that I do.

And you can do it with bands, you can do it with a ball.

But it's one of my go tos to add some rotation.

You know, the last thing I'll say on this, it was really in the 70s and 80s that you saw gyms start to pop up and strength training became really popular.

And back then, the belief was really about joint isolation.

So you just did one movement.

Think about bicep curls or getting locked in and just working the hamstring or just working the quads.

And I know one of the criticisms that you saw was you'd get these people who looked great.

You know, they had great muscle form on their body.

Sorry, wrong word, but you know what I mean?

But there's just no mobility.

They looked good, but they just couldn't move around very well.

And I think one of the biggest changes you're seeing now in strength work is working multiple chains, working in multiple planes, multiple directions.

So not only do you build some strength, but you can move that strength in multiple directions and have a lot more function with it.

That's exactly right.

I'm not opposed to isolating muscles.

In fact, in rehab for physical therapy, we do that often.

You know, if you have your ACL reconstructed, we're going to isolate your quad and we're going to isolate your hamstring and rehab those because they become weak.

They're also really helpful for people who are intimidated in the weight room because those single station machines guide you, and so they kind of restrict you from doing a movement that may be outside of your realm because you're locked into that machine.

So they have a place they minimize the need for balance, which is both bad and good.

If you have a client with poor balance, it's difficult for them to do strength if they have to maintain their balance.

So those machines are helpful.

But if you're looking to build balance, those machines don't ask that of your body.

So isolating has a place, just like everything.

It depends.

But I think what you said about being strong without being functionally strong is the key for me.

So if you only do leg extensions or only do hamstring curls, that quadricep and that hamstring only function in the way that you trained it.

Well, we don't do much with our feet off the ground.

So if you're training those two muscles on a leg extension or hamstring curl machine and then you go to run.

Well, the motor unit recruitment, the software hasn't been built because you didn't teach your body to use that muscle in a functional capacity.

You taught it to work in an isolated capacity.

And that's rarely how we function.

So it's not that they don't have a place, it's that you can't have it be the only way that you strength train and expect to increase your performance or your health span.

Great answer.

So, and again, love the routine that you built for us.

That's going to be on the website.

I recommend to everybody to check this out.

All right, well, everybody hate to say it because I've been loving this conversation.

We've gone over time, but I don't mind because I think this is such an important conversation.

Conversation.

That said, it's probably time to shift to our take home.

So before I ask each of you your key point, we do have a question for our forum.

So anybody who's been really interested in this episode, please go to the forum.

Answer this question.

Let's get a good conversation going.

And that question is, do you do anything structured outside of your primary endurance sport and have you found it helps or hurts?

Hurts.

So basically asking all of you to come in, say what you've been doing and whether it's been beneficial or you're recommending something, don't try this.

I tried it.

It didn't work.

Would love to hear what you have to say.

And with that, Dr.

Brixham, you listen to the show.

So you know how we often finish up.

Each of us has one minute to give their most salient point from the whole episode.

So let's start with you.

What is your one minute take home?

Try to keep it under one minute.

I think the first thing is for movement literacy, you really have a toolbox, and you want as many tools in that toolbox as you possibly can get.

And so mobility, flexibility, stability, strength, and skills are all tools.

Try not to keep using your favorite tool and so acquire the tools that you don't have.

My second is that that if you have a movement dysfunction, try to avoid the whack a mole approach.

Really find a good diagnostician, somebody who can get at the etiology at the root cause of your dysfunction and treat that rather than trying to, you know, potpourri it and do a little bit of everything.

And the last thing is that exercise truly is medicine.

So dose it correctly.

Too much of an ingredient is not necessarily a good thing, and too little is not necessarily a good thing.

And a key point is that that exercise for medicine changes as we age.

So as you get older, don't expect that the medicine stays the same.

You might need more strength, you might need more flexibility, and you might be able to get away with a little less of the aerobic endurance that you've built over the decades.

That will remain important.

But you can maybe spend 10 minutes less there and 10 minutes more with your other tools.

And lastly, well, I did say lastly.

This is part of that same thing as we age, realizing that getting better looks like staying the same.

And so try not to be frustrated by that, because you are improving.

You're offsetting the ravages of age.

And so you look like you're staying the same, but you really are getting better.

All right, Grant, what about yours?

I think my take home on all this is just kind of what I mentioned earlier, that it doesn't have to be this, this I'm getting older, so everything's going to start to fall apart.

We are going to have that inevitable loss of some strength and maybe even some stability as we get older.

But what we're doing and what we can put into the equation on our own time off the bike and really purposeful efforts can really delay that.

It's dramatic how much more power can be established when we get the right muscles firing and the right, right way.

And it's very vital that we take the time and we prioritize some of this off the bike work.

I know for so many athletes we're always going to prioritize the bike first, but there are so many things here that can meet these big gains if we're prioritizing off the bike work.

All right.

Well, I guess my take home, what I found interesting is when we proposed this episode, the working title was off the Bike Work in the Off.

And what I noticed is we didn't talk about the off season at all.

We're just talking about important work both for performance and for healthy aging.

And so I'm glad we didn't really bring in that off season component because this is something that's really critical to be doing all through the year, I'm going to say, for all ages.

But as you get older, you are going to notice if you don't do this sort of work.

And a lot of things that you might think of as, well, I'm in my 50s.

That's normal aging.

It actually isn't.

These are things that you can prevent.

But you know, the last thing I'm going to say here is, Dr.

Brixham, I love that you pulled it all together.

There's these four components, mobility, flexibility, stability and strength.

And they all work in unison.

You can't really be healthy and just work on one of those.

You have to work on all four together.

Well, Dr.

Brixham, real pleasure to have you on the show.

Thanks for joining us.

Thank you for having me.

I appreciate it.

That was another episode of Fast Talk.

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Stacy Brixham and Grant Holicke, I'm Trevor Connor.

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