Cara Nichols interview OnMyWayToSpartaDr. Cara Nichols  (one of the 4 physical therapists who treated me in 2012) took a few minutes to answer some questions pertaining to running, training, and injuries. She graduated from the University of Kentucky’s physical therapy doctoral program in 2009.  She also has a background in collegiate athletics, running track and field at Western Kentucky University.  From her combined running experience and PT background, she enjoys performing biomechanical running evaluations, in which each patient is filmed running and while completing dynamic tests. These evaluations have aided both Division I college level athletes, the competitive runner, as well as the “couch-to-5k” individuals.  Cara feels from her background in manual therapy and experience as a collegiate athlete, she brings a new, energetic perspective to treatment.  Now to the questions. [Jeff’s note: I get the feeling that she had me in mind when answering a couple of the questions!]

Typically how many days a week should a serious runner train during the week?
This is a difficult question because everyone is different as to risk of injury, optimum number of miles prior to breakdown, strength, nutrition, sleep, and race distance, surface, #weeks until race day.  I would sit down with a runner and consider all these factors prior to recommending a training schedule.  Also, it is beneficial to know that 8/10 runners suffer an injury each year and I believe this is due to overuse. Runners usually do not enjoy cross training. We are very stubborn individuals and upon return to running pain free, we throw inhibition to the wind, despite what we promised ourselves while injured.  Therefore, this number needs to be decided by someone that can evaluate past injuries, frequency, when the injury occurred in the runner’s training cycle, etc. Or a conclusion can be determined by the individual.  I recently found my threshold to be less than 65 miles/week, with one day needed completely off and one other day for cross training.  I set a PR in the half marathon by sticking to running 5 days/week at 55-65 miles.  Then I began training for a full marathon and running 6 days per week at 68-70 miles.  Several weeks later I was injured.

What is your training regimen like?
Refer to part of the above answer but I can elaborate on that.  I meet a group of runners at 4:45 or 5am Tuesday, Thursday, Saturday, and Sunday.  Speedwork is Tues and Thurs of 8-10 miles. And the workout may be anything from 800m repeats to steady states up to 6 miles.  Saturday is usually 8-10 and then Sunday is a long run. I am usually on the lower end of long run distance, keeping my long run at 14-16 unless training for a marathon. I attempt to perform strength training 2x/week, consisting of pull-ups, push-ups, single leg squats, lunges, heel raises, and balance on a wobble board. When I cross train, it’s usually on my bike trainer for 45min-hour.

What physical injuries/ailments do you encounter the most from patients?
Back pain is most common. Most individuals today sit at computers or at a desk majority of their work day and then return home to sit some more. Also, Americans today have excess weight on them and when you combine weakness, extra mass, and immobility together, usually their back or lower extremities begin to scream at them. This is my theory as to what elicits majority of back pain–lack of exercise, strength, lack of movement in general. However, it is not known what truly causes back pain. A doctor would never admit that and would probably spout off several reasons, including disc herniation, degenerative disc disease, nerve root impingement, osteophytes, etc. Low back surgeries are performed frequently to remove irritable discs, clean up disc herniations, and relieve nerve impingement, but individuals pain remains the same or worse compared to individuals that elect not to undergo surgery. Therefore, it can not be surmised that the above listed pathologies seen on MRI and addressed in surgery are the culprits in our battle with low back pain.

What is your single best piece of advice for runners?
Stay healthy because if everyone were to have uninterrupted training, we would continually build on each month, each year, each race. That’s key to consistently running well.  Also, it’s very important to always change an element of your training.  You want to confuse the body on a monthly basis.  The body resists change and it will become very efficient at whatever you are asking of it.  Runners are creatures of habit and this often is the single most limiting factor I see with distance runners.  They perform the same training program over and over, expecting a different result (improvement). 

Is there something that most runners do that they shouldn’t do?
NEVER run with weights! Also, do not increase your mileage more than 10% per week and never race prior to adequate preparation in order to prepare your body and prevent injury. Usually, I would say it’s more what they should do rather than should NOT do. And this has to do with knowing and listening to their body more.  Ideally, I would want every runner to learn from injury and know when they need rest or “catch” an injury prior to becoming injured.  This plays into knowing some anatomy and understanding basics as to how to treat themselves.  If runners would learn some basics in strengthening exercises specific for runners, stretching/foam rolling at key locations, and receiving deep tissue massage regularly (at least 2x/month), we would have about half the injuries.

Is there something that most runners don’t do that they should be doing?
Ha! See above

Are there any non-running training exercises that you feel are crucial to avoiding injury?
First, building strength at the core and hips would be most beneficial, with progression towards more specific plyometric training.  However, most individuals are not ready for plyometrics and therefore must begin with non-weight bearing exercise.  Then progress to unilateral strengthening (single leg squat, split lunges, unilateral dead lifts) and when form with these are perfect, progression towards plyometrics is optimal.  For core strengthening, hanging sit-ups, planks on unstable surfaces, and back extensions are just a few that I try to perform on a regular basis.

Given the debate over minimalist running vs stability shoes, orthotics, etc…, which ‘side’ do you tend to agree with and why?
This is a difficult question because as a PT we are trained to place most individuals in a built-up shoe for “proper” running mechanics.  I believe this need for stability is secondary to other issues, such as excess weight or weakness along the kinetic chain.  Only if someone had a deformity of the foot or a very rigid foot, would I place them in orthotics.  On the other spectrum in regards to minimalist shoes, I believe there are very few individuals that can run in five fingers for multiple reasons: 1) we are a society that is not accustomed to barefoot activities, from an early age we are in shoes. 2) we are generally overweight 3) strength deficits at our hips, core and especially at our feet and calves from always wearing increasingly padded or built-up shoes.  Therefore, I like to find a shoe that provides the necessary cushion for my foot to optimize performance (five fingers are so minimal they hinder your ability to run fast) and that also have a minimal heel to toe drop.  The shoes made in the 1970s were great, they had a lower consisting of a flat sole with minimal cushioning and a simple upper and runners wore them until the upper pulled away from the lower.  If you run with optimal form and strike the ground at mid-foot/forefoot, you can wear a shoe until it literally begins to fall apart.  I am convinced we were made to run barefoot but beginning this at age 30, is not feasible for a majority of people. Therefore, wear a shoe but not a boot, such as asics kayanos.

Do you have any specific shoes that you recommend for trail runners or obstacle racing training?
No, just because I do not do much trail or obstable running but you could follow the same principles that I listed above in selecting a shoe.  I have heard great things about inov-8 and the merrell glove but again the merrell glove may be too minimal for many individuals.

Anything else you want to say?
Thanks for allowing me to do this. And if anyone has questions, feel free to contact me at my email address