Running Training: A Holistic, Evidence-Infused Philosophy

Running Training: A Holistic, Evidence-Infused Philosophy

by Chris Johnson PT

Consistency and Moderation Reign Supreme.

That’s the bedrock of my training theme.

Whether recovering from an injury or new to running, the initial goal is to have you run on non-consecutive days.

It’s also important you stay on top of wellness factors like sleep, which means stop scrolling – it’s time to hit the hay.

As you start stringing workouts together, your cardiovascular system will rapidly adapt.

However, respect that your musculoskeletal system will not adapt quite as fast.

I already sound like a broken record, though the cornerstone of success as an endurance athlete is consistency of training, so protect it at all costs.

Because if sidelined from training, the adaptations you’ve worked so hard for will go to pot.

Once you’ve proven tolerance to several weeks of measured training, it’s time to consider adding some intensity.

To run faster, one must hit the ground harder so do so sensibly.

Thanks to Dr. Dan Cleather, I often refer to these as “hot sessions.”

They demand you to be fresh otherwise, be prepared to learn your lesson.

10-15s measured strides are a sensible place to start.

These involve running fast and relaxed, and it’s OK if you let out a fart.

Tempo and interval runs also qualify as hot sessions, and initially should be performed on level ground.

These can also be done on a track if you like running round and round.

Of course, the long run is important and something that runners fret about.

If you’re looking to build durability, you can perform it on a rolling to hilly route.

An acronym I often share with athletes is F.D.D.I., which stands for frequency, duration, density, and intensity.

It serves as a great framework to reduce programming complexity.

Most of you understand what frequency, duration, and intensity mean.

Density is how much time we afford between.

If you look at my programming, I often advise runners to afford a minimum of 6hrs (if doing “two a days”) but ideally 24hrs b/w runs.

This ensures that bone regains its mechanosensitivity.

In effect, it safeguards against bone stress injuries.

Any runner who has sustained one can attest that they’re no fun.

Because, as runners, we’re stripped of the very thing we love to do which is run.

Now, back to training.

The ultimate goal is to help you build, maintain, and connect running qualities such as speed, the heart’s ability to pump blood or time on feet.

To build a running quality, challenge the runner with a session designed to create the appropriate stimulus once a week.

Once established, ensure you don’t lose it by checking that box every two-three weeks.

And, of course, it’s critical to ensure you’re fueling appropriately to meet your training needs.

Based on current research, we’re starting to appreciate carbohydrates reign supreme.

Asker Jeukendrup has created some excellent resources if you’re looking to determine appropriate carb intake.  

Here is a link to one infographic in particular that was great.

If there’s one thing a runner should do beyond running, it’s likely resistance training.

Lifting can be simple, and I’ll try to ensure this doesn’t come across as mansplaining.

Considering the seminal papers by Dorn et al. and Hamner et al., we should focus on building strength and capacity in the calves, quads, hammies, and hips.

To help accomplish this, we can pick a compound exercise such as a squat and deadlift.

Working in heavy farmer marches also does wonders and is often the missing ingredient in many strength programs.

Challenging runners with a power or plyometric-based activity is also essential since running is about elasticity.

These also take on greater importance when a runner is recovering from a bone stress injury.

Jumping activities are also crucial for bone health and critical for younger runners, given the bone growth “window of opportunity.”

Thanks to research done in racquet sport athletes the greatest benefits seem to happen before the end puberty.

However, don’t get carried away with extensive training in this form, and make sure you understand the runner’s past medical history.

The reason it’s crucial is that in addressing bone stress injury, we aim for loading impulsivity.

Power and plyometric training are also safe and vital as we age to stave off losing reactive strength.

All you need to do is observe a geriathlete runner to appreciate this manifests as a reduction in stride length.

Regarding specific exercises, pogo jumps, broad jumps, and simple skipping variations are often the most practical drills.

They’re also great because they’ll challenge your rhythm and timing skills.

Lastly, don’t be afraid to incorporate localized loading such as calf raises and seated knee extensions.

If you’re wondering what angle to focus on, it’s essential to understand the relationship between muscle length and tension.

For example, if we’re talking about the calf muscle complex, aim for higher loads and work into 15-20 degrees of ankle dorsiflexion.

And please, if you’re dealing with running-related pain or injury, just say no to pills and corticosteroid injections.

Localized training is also essential, especially if one has a history of lower limb tendinopathy, as it creates a situation where the tissues have no place to hide.

However, this places a greater responsibility on the clinician-coach to get the sets and reps right, so make sure you carefully decide.

Incorporating an upper-body push or pull is an excellent way to round out the program.

These can be performed horizontally or vertically, and I’m confident you’ll find many options through a search on Instagram.

So, to wrap things up, consider the following..

Most of your training should involve running slow sprinkled with some fast.

And remember, you’ll never survive if you’re always on the gas.

Sometimes, run solo, though I also suggest running with a group.

And always be wary of any coach who makes you run til you puke.

In Steve Magness’s wise words, the ultimate aim of training is to “disturb or embarrass your system.”

Consider using an autoregulatory approach because when it comes to your mind-body it’s important you listen.

Also, keep a few different shoes (different types and brands) in your weekly rotation.

There’s an excellent study by Malisoux et al. on this topic, so check out the reference section if you’re looking for the citation.

The idea behind using different running shoes is to expose the body to variable internal and external forces while calling on it to adapt.

And please be patient, as this is almost a rap 🎤.

Keep in mind running should be fun and is one of the most efficient and practical modes of exercise.

Whether you run for health or wellness, to race, or set a P.R., it’s up to you to decide.

Although you might’ve been told running is bad for your joints, research shows it does not lead to hip and knee arthritis.

If you run on roads, remember to run against traffic or stay on the opposite side relative to cyclists.

If you run regularly, chances are, at some point, you’ll likely deal with running-related pain or injury.

As my daughter likes to say in such instances, “Dad, I think you need to run more gingerly.”

And remember never to panic or incessantly worry about whether or not you’ll run again.

If you need any help, I happen to know a trusted running clinician 😉

Lastly, remember most runners don’t have unrealistic goals so much as unrealistic timelines.

If you have any questions about program design, please know I’m here to help. Contact me anytime.


  1. Aagaard P, Andersen JL. Effects of strength training on endurance capacity in top-level endurance athletes. Scand J Med Sci Sports. 2010 Oct;20 Suppl 2:39-47.
  2. Alentorn-Geli E, Samuelsson K, Musahl V, Green CL, Bhandari M, Karlsson J. The Association of Recreational and Competitive Running With Hip and Knee Osteoarthritis: A Systematic Review and Meta-analysis. J Orthop Sports Phys Ther. 2017 Jun;47(6):373-390.
  3. Baar K. Stress Relaxation and Targeted Nutrition to Treat Patellar Tendinopathy. Int J Sport Nutr Exerc Metab. 2019 Jul 1;29(4):453–457.
  4. Bass SL, Saxon L, Daly RM, Turner CH, Robling AG, Seeman E, Stuckey S. The effect of mechanical loading on the size and shape of bone in pre-, peri-, and postpubertal girls: a study in tennis players. J Bone Miner Res. 2002 Dec;17(12):2274-80.
  5. Beattie K, Carson BP, Lyons M, Rossiter A, Kenny IC. The Effect of Strength Training on Performance Indicators in Distance Runners. J Strength Cond Res. 2017 Jan;31(1):9-23.
  6. Blagrove RC, Howatson G, Hayes PR. Effects of Strength Training on the Physiological Determinants of Middle- and Long-Distance Running Performance: A Systematic Review. Sports Med. 2018 May;48(5):1117-1149.
  7. Buist I, Bredeweg SW, Lemmink KA, van Mechelen W, Diercks RL. Predictors of running-related injuries in novice runners enrolled in a systematic training program: a prospective cohort study. Am J Sports Med. 2010 Feb;38(2):273-80.
  8. Cleather D, John D. The Little Black Book of Training Wisdom: How to train to improve at any sport. 2018.
  9. Devita P, Fellin RE, Seay JF, Ip E, Stavro N, Messier SP. The Relationships between Age and Running Biomechanics. Med Sci Sports Exerc. 2016 Jan;48(1):98-106.
  10. Dorn TW, Schache AG, Pandy MG. Muscular strategy shift in human running: dependence of running speed on hip and ankle muscle performance. J Exp Biol. 2012 Jun 1;215(Pt 11):1944-56.
  11. Eihara Y, Takao K, Sugiyama T, Maeo S, Terada M, Kanehisa H, Isaka T. Heavy Resistance Training Versus Plyometric Training for Improving Running Economy and Running Time Trial Performance: A Systematic Review and Meta-analysis. Sports Med Open. 2022 Nov 12;8(1):138.
  12. Hamner SR, Seth A, Delp SL. Muscle contributions to propulsion and support during running. J Biomech. 2010 Oct 19;43(14):2709-16.
  13. Hartwell MJ, Tanenbaum JE, Chiampas G, Terry MA, Tjong VK. Does Running Increase the Risk of Hip and Knee Arthritis? A Survey of 3804 Marathon Runners. Sports Health. 2023 Aug.
  14. Lambrianides Y, Epro G, Arampatzis A, Karamanidis K. Evidence of different sensitivity of muscle and tendon to mechano-metabolic stimuli. Scand J Med Sci Sports. 2024 May;34(5)
  15. Llanos-Lagos C, Ramirez-Campillo R, Moran J, Sáez de Villarreal E. Effect of Strength Training Programs in Middle- and Long-Distance Runners’ Economy at Different Running Speeds: A Systematic Review with Meta-analysis. Sports Med. 2024 Apr;54(4):895-932.
  16. Steve Magness Blog | Science of Running – click HERE
  17. Malisoux L, Ramesh J, Mann R, Seil R, Urhausen A, Theisen D. Can parallel use of different running shoes decrease running-related injury risk? Scand J Med Sci Sports. 2015 Feb;25(1):110-5.
  18. Manal K, Roberts DP, Buchanan TS. Optimal pennation angle of the primary ankle plantar and dorsiflexors: variations with sex, contraction intensity, and limb. J Appl Biomech. 2006 Nov;22(4):255-63.
  19. Noehren B, Snyder-Mackler L. Who’s Afraid of the Big Bad Wolf? Open-Chain Exercises After Anterior Cruciate Ligament Reconstruction. J Orthop Sports Phys Ther. 2020 Sep;50(9):473-475.
  20. Palaiothodorou D, Vagenas G. Inter-arm bone mass and size asymmetries in children tennis players are maturity status specific: a 9-month study on the effects of training time across pubertal change and somatic growth. Eur J Appl Physiol. 2024 Feb 28.
  21. Rhim H, Kim YH, Kim MG, Jang KM, Suh SW. Magnetic Resonance Imaging Findings of Knees and Spines in Recreational Runners Who Completed 1000 Marathons. Cureus. 2019 Dec 14;11(12)
  22. Robling AG, Burr DB, Turner CH. Recovery periods restore mechanosensitivity to dynamically loaded bone. J Exp Biol. 2001 Oct;204(Pt 19):3389-99.
  23. Rubin CT, Lanyon LE. Regulation of bone formation by applied dynamic loads. J Bone Joint Surg Am. 1984 Mar;66(3):397-402.
  24. Warden SJ, Edwards WB, Willy RW. Optimal Load for Managing Low-Risk Tibial and Metatarsal Bone Stress Injuries in Runners: The Science Behind the Clinical Reasoning. J Orthop Sports Phys Ther. 2021 Jul;51(7):322-330.
  25. Willy RW, Paquette MR. The Physiology and Biomechanics of the Master Runner. Sports Med Arthrosc Rev. 2019 Mar;27(1):15-21.
5 Essential Questions for Clinicians and Coaches

5 Essential Questions for Clinicians and Coaches

When someone asks me what I do, I relish the opportunity to share my passion by saying,

“I help people take ownership of their musculoskeletal situation(s),” or put more candidly, “Own their shit,” borrowing the eloquent words of my friend Steve Makofsky.

This month, I’m excited to share 5 potent inquiries I regularly use to help people take control of their choices, break free from inaction and passivity regarding behavioral change, and get on the other side of pain and dysfunction.

If you’re a clinician or coach, these questions will prove to be invaluable when seeking to challenge and empower individuals looking to you for help and guidance. They also represent diverse insights from various sources and philosophies. Feel free to spin them as you see fit.

1) Would you mind telling me about yourself and what brings you in today?

While it may appear a routine inquiry, this question is meticulously crafted to establish a foundation of trust and rapport. In my teachings on motivational interviewing, I often liken it to a gentle knock on the door when meeting new neighbors with a newborn—you wouldn’t want to wake the baby!

Creating a safe space fosters authentic dialogue, essential for effective care, while providing a nonjudgmental environment for individuals to engage in movement and regain function. After this question, active listening, validation, summarization, and reframing all play pivotal roles in guiding the ensuing interaction.

2) AWE – “And What Else?”

Beyond one’s musculoskeletal complaints often lies a complex tapestry of interconnected factors shaping an individual’s well-being. Inspired by Michael Bungay Stanier, this deceptively simple question serves as a non-threatening gateway to deeper discussions, unveiling the intricate layers of their concerns. Through this inquiry, individuals are prompted to reflect on the holistic nature of their situation, allowing us to gain insight into their ecosystem and the accompanying allostatic load—a crucial determinant of their journey and outcome. Employing an acronym, such as AWE, adds a memorable touch to this transformative question.

3) What do you want?

Amid external pressures, my aim is to assist individuals in rediscovering and refining their aspirations. Through this inquiry, I seek to empower my clients to realign with their core values and virtues, enabling them to regain control over their lives and navigate towards a path of self-determination.

4) What steps will you take?

The key to change is taking action and I believe in helping people own their path forward. Remember…”Ink it, don’t think it.” By mapping the path forward and crafting a written plan, I instill a profound sense of empowerment and self-reliance.

5) How can I be useful, and what would you like to get out of this session?

As facilitators or perceived agents of change, our responsibility is to foster a collaborative path toward wellness. By listening carefully to my clients and understanding their needs and motivations, I can customize my approach with them to keep them proactively engaged as they work toward their desired outcomes.

Here’s a list of references and suggested reading on the topic:

1. Bungay Stanier MB. The Coaching Habit: Say Less, Ask More & Change the Way You Lead Forever. Box of Crayons Press; 2016.

2. Eger E. The Choice: Embrace the Possible. Scribner; 2017.

3. Fader J. Coaching Athletes to Be Their Best. John Wiley & Sons; 2013.

4. Greenleaf M. Mind styles and the hypnotic induction profile: measure and match to enhance medical treatment. Am J Clin Hypn. 2006 Jul;49(1):41-58.

5. Miciak M, Gross DP, Joyce A. A review of the psychotherapeutic ‘common factors’ model and its application in physical therapy: the need to consider general effects in physical therapy practice. Scand J Caring Sci. 2012 Jun;26(2):394-403.

6. O’Keeffe M, Cullinane P, Hurley J, Leahy I, Bunzli S, O’Sullivan PB, O’Sullivan K. What Influences Patient-Therapist Interactions in Musculoskeletal Physical Therapy? Qualitative Systematic Review and Meta-Synthesis. Phys Ther. 2016 May;96(5):609-22.

7. Schein E. Humble Inquiry: The Gentle Art of Asking Instead of Telling. Berrett-Koehler Publishers; 2013.

8. Is taking a history outmoded? Why doctors should listen to stories instead. Postgrad Med J. 2022 Mar 1;98(1157):236.

I appreciate you taking the time to read this, and I’m eager to hear your thoughts.

Taking The Plunge

Taking The Plunge

Why there’s never a better time than now to embrace your entrepreneurial spirit 

table of people working together to finish puzzle

I never anticipated that receiving a pin the size of a penny would spark my entrepreneurial journey, but that’s how it all started. Let’s rewind to my days in New York City. 

After spending eight years at the Nicholas Institute of Sports Medicine (NISMAT), one of the doctors at the institute offered me the opportunity to lead a new physical therapy practice they were opening. I found myself at a crossroads. I yearned to forge my own path but also cherished the camaraderie and intellectual challenge of being part of the brilliant NISMAT team. I decided to accept the doctor’s offer, which gave me a chance to make more money, continue my research, and stay connected with the NISMAT team. 

With the practice up and running, my anticipation for an end-of-year bonus grew as we reached the end of the fiscal year. However, instead of a substantial check, I received a modest pin from the practice’s administrator. This unexpected gesture forced a realization – it was time to start my own venture. 

Nearly 15 years later, after navigating the entrepreneurial landscape in NYC and currently overseeing two businesses in Seattle, I want to share my insights, failures, and lessons with you. 

These insights are also at the core of the Running Your Business mastermind, which Nathan and I are hosting for the third time in 2024. If you’re interested, you can visit our page to learn more. We’re also happy to coordinate a call to ensure it’s the right fit for you.

You’re Never Ready

The best time to plant a tree was 20 years ago. The second best time is now.”

– Chinese Proverb

Launching a business can feel like you’re on the precipice, wondering if the leap will lead to success or peril. Despite feeling like you’re about to dive into frigid, shark-infested waters, I assure you this is likely not the case. Reflecting on my entrepreneurial journey, the pivotal moment came when I mustered the courage to share my venture with my network. Friends and colleagues emerged ready to support and catch me if I faltered. Among those colleagues was Gary Cohen. In a transformative three-hour session, he kindled the entrepreneurial spirit within me, sketching out a 20-year vision on a paper table mat in an Upper East Side restaurant. 

Gratitude extends to others like Joe Masiello and Gabe Valencia of Focus Integrated Fitness. During a crucial phase, they provided a physical space on the 11th floor of 115 W. 27th St. and supported me as I got my biz up and running. If you’re reading this, know you guys are class acts. RESPEK 👊🏻. And of course, a sincere thanks to all the people who trusted me to troubleshoot their situation during my time in NYC. 

illustration of Business man walking through open door that says on background...Once you take that leap of faith and accept that readiness is a myth, you will find that opportunities materialize. 

Get Clear on Your Core Values 

“Once you have identified your core values, they become guide rails for your actions.” 

– Brad Stulberg

The term “core values” often gets thrown around casually but treating them lightly can be catastrophic for a new business. About five years ago, I realized the significance of not only having values but giving them life—putting pen to paper and articulating why they mattered to me. This exercise proved to be pivotal. Core values serve as anchors when you face tough decisions that impact the fate of your business. I challenge you to invest time in distilling your core values. Once they’re identified, post them on your desk, discuss them in your newsletter, and proudly display them on your website. This not only holds you accountable but reinforces a sense of purpose and direction on your entrepreneurial journey.

“There are no small jobs, only small fees.”

– Zig Ziglar

As a self-proclaimed people pleaser, I’ve grappled with the inclination to overextend myself, often going above and beyond. However, a hard truth emerges over time—delivering the attention a situation warrants requires immense effort.

In my practice, connecting with patients or clients is more than a scheduled appointment. It involves giving undivided attention, working systematically to devise a comprehensive plan, and following up with a detailed email summarizing the session. I also make myself available for any questions or situations that may arise. If I were to bill solely for the time spent during the appointment, it would be a disservice to myself and my customers, as their situations wouldn’t receive the attention they deserve.

Life is About Relationships…Hard Stop 

Illustration of avatar icons connected by string with writing on background that says...Critter…the most important thing in life is relationships. That's all you have when you strip everything else away”

In high school, I had the privilege of being coached in tennis by Whitney Snyder, affectionately known as “Whit.” His unique life perspective, shaped by his father’s role as a pioneer in the steel industry during Pittsburgh’s heyday added a profound layer to his insights. 

Whit emphasized that relationships are the most critical aspect of life and it resonated deeply with me. He lived by this principle, evident in his weekly calls with each team member to discuss tennis strategies, team roles and to delve into personal aspects of our lives, such as prom plans or remembering to get a Mother’s Day card for our moms. 

While the allure of transactional relationships may be tempting, my aim is always to cultivate what Edgar Schein terms level 2 relationships. In contrast to level 1 relationships that maintain professional distance, level 2 relationships thrive on openness and trust. Just as I encourage clients to share personal information, I reciprocate by being open and honest, embracing vulnerability when necessary. I am also committed to actively maintaining connections with mentors and coaches who have positively influenced my journey. Personal and professional relationships contribute a profound richness to life—a depth that transcends mere transactions.

If Use Value Isn’t > Cash Value, the Offering is Weak

My close friend and insightful thinker, Ryan Debell, once shared a fundamental truth in the realm of entrepreneurial ventures: when the use value exceeds the cash value, success becomes inevitable. If you’ve ever wondered why a venture faltered, a product failed to resonate, or people hesitated to invest in your time or offer, it likely traces back to a breach of this universal law. 

This principle resonates profoundly in every product, offering, or resource I create and the litmus test is straightforward: when my clients reflect on the services they compensated me to provide, do they feel that it was money well spent? 

In the rare event that customers or clients feel their money wasn’t well spent, I gladly issue a refund. Violating this law induces distress and invites negative energy. Upholding this principle not only safeguards the integrity of my ventures but ensures a harmonious and positive entrepreneurial journey.

Take money, power, and status out of the equation. Then make your decision.

One of the most profound pieces of wisdom I’ve ever received was from a gentleman named Wilfred. During the latter part of his life, I had the privilege of working closely with him.

In a reflective moment over lunch before his passing, Wilfred shared a nugget of advice that has become an anchor in my decision-making process. He remarked, “Look around… nearly everyone here is preoccupied with money, sex, power, and status. If there’s one thing I’ve learned at this point in my life, it’s that it’s all bullshit. If I can leave you with one thing, it’s that anytime you go to make a decision, take these things out of the equation, and you’ll never make a bad one.”

These poignant words, spoken by someone who had amassed a fortune but realized its inability to bring solace in his later years, left an indelible mark. Since that day, I’ve adhered to this advice and it’s proven to be a north star guiding me toward choices aligned with authenticity and fulfillment.

Map out Your User Journey

One critical step I admit to overlooking during the early stages of my career is mapping out a client’s journey with my business. Committing to this process can reveal potential bottlenecks and allows for refining specific touchpoints, ultimately elevating the overall client experience.

For instance, when a budding entrepreneur schedules a session with me, my initial step is to conduct an online search using their name. If the search results are empty or if I fail to land on their website, it raises immediate concerns. If a website is present, it’s important to evaluate how seamless the process is for visitors to understand the offerings and schedule appointments. The user journey must be frictionless, especially considering many patients are already stressed about pain and injury. Making the process easy for them becomes paramount, especially if you operate as a fee-for-service provider. 

Never be Afraid to Ask and Take Initiative

“Ask for what you want and be prepared to get it.” 

– Maya Angelou

During my time playing competitive tennis as an undergrad for the University of Delaware, I grappled with a serious shoulder injury. Throughout my recovery, I collaborated with world-class physical therapists, which made me realize that studying physical therapy and the rehab process was something I wanted to explore. While it was not my major at the time, I took the initiative to identify researchers at UD who were studying areas I was interested in and then headed to the physical therapy department to communicate my interest. I ended up connecting with Dr. Lynn Snyder-Mackler, a leader in ACL rehab. After sharing my story and interest to pursue a career in physical therapy, I asked to volunteer in her lab. That pivotal moment marked the beginning of my journey and changed the trajectory of my professional existence. 

I challenge you to summon the courage to ask for what you want. The worst-case scenario is a rejection, which, far from being a setback, might serve as the very motivation to fuel your pursuits. 

Don’t be Afraid to Fail

Illustration of target with many missed arrows and one on the bullseye. Background says...I have not failed. I’ve just found 10,000 ways that won’t work”

Failure is an unwelcome companion on the path to anything worthwhile, yet it’s an integral part of the process. Even if it involves a substantial financial loss, failure holds value as long as it imparts lessons that are applicable to the future. When I reflect on my initial triathlons where mechanical issues led to DNFs or the early days of teaching courses with minimal attendance, I recognize that while these experiences bruised my ego they also fortified my mind. 

Embrace failure, learn from it, and let it propel you forward on your path to success.

Take Care of Yourself

There may be no simpler advice for ambitious entrepreneurs. When I first ventured out on my own, it was during the “Crush It” era when Gary Vaynerchuk inspired young entrepreneurs to hustle at all costs. As much as I appreciated Gary’s message about hard work and hustling, I also knew deep down that adopting this approach was not sustainable. 

Similar to training for marathons or long-course triathlons, achieving success as an entrepreneur demands consistent, measured efforts day in and day out. Like endurance training, embracing incremental gains and navigating road bumps become essential. Though my persistence remains unwavering, I’ve come to appreciate the importance of carving out time each day for training. It fortifies me physically, sets an example for my kids, heightens my intellect, and bolsters my productivity.

So, whatever your endeavor, prioritize physical activity. The mode of exercise is less critical than some social influencers may suggest. It’s about community, connection, and exploring movement in a way you enjoy while staying mindful of wellness factors. And when in doubt, I recommend farmer marches and going for a walk—a simple yet effective way to recalibrate both body and mind.

“Professionals base their decisions in denominators, not numerators”

-Dr. Malachy McHugh

Early in my career, I was called out by my mentor, Mal McHugh while delivering a presentations at a NISMAT staff meeting. I had drawn erroneous conclusions from a study, having only read its abstract. This experience taught me a vital lesson—speaking authoritatively on a subject requires a thorough understanding of the pertinent research.

Many individuals discuss topics without realizing the wealth of published research critical to claiming expertise. Beyond one’s specific field, it’s equally, if not more essential to explore unrelated subjects. This broader reading often facilitates the discovery of analogies and parallels that enrich my professional work. While folks love to ask, “What do you do for a living?” I find greater value in knowing what someone is reading and what captures their interest. If you haven’t yet embraced the joy of reading, I encourage you to do so. Nothing has proven more valuable in my life than immersing myself in the pages of a book or research article.

Focus, Grasshopper

green grasshopper

Our most precious and finite resource is time, a commodity often squandered. While I’m not immune to distractions, I’ve honed a highly effective Pomodoro workflow strategy, working in focus for 25-minute blocks throughout the day. By consistently completing 6-8 Pomodoro blocks daily, I accomplish substantial tasks.

An element of my routine that I find particularly enjoyable is incorporating short breaks for exercise or movement after each 25-minute work segment. This enhances my productivity, and by day’s end, I’ve also engaged in meaningful strength training. This approach also leaves me feeling physically and mentally primed for activities like swimming, biking, and running.

I advise activating the, “Do Not Disturb” mode and diving into your work. You’ll be astonished by the enhanced productivity and overall sense of well-being that a structured routine can bring. Remember that while not every day may unfold as planned, like training, success is about the collective body of work.

Barriers to Entry Are Minimal

The present offers an unparalleled opportunity to embark on your entrepreneurial journey, and with the advent of AI and the abundance of user-friendly, no-code tools, launching a business has never been more accessible.

If certain business aspects don’t align with your strengths or interests, consider outsourcing them. A wealth of individuals are passionate about the tasks you might find tedious, and they can efficiently handle them for a reasonable fee.

If I can navigate this path, I’m confident you can, too. If you’re teetering on the edge of entrepreneurship, it’s time to trust yourself and take the plunge. Even if you discover that entrepreneurship isn’t your calling, the lessons learned will be invaluable and will undoubtedly shape your future endeavors.

I appreciate you taking the time to read this, and I’m eager to hear your thoughts.

8 Ways to Help Runners Regain Confidence and Trust in Their Body 

8 Ways to Help Runners Regain Confidence and Trust in Their Body 

As a physical therapist, nothing’s worse than seeing a runner who has lost confidence and trust in their body. Luckily, I know how to get runners back on track. Using my 20+ years of experience, I’ve outlined the 8 most important strategies to keep in mind when working with runners who seek your guidance and help in the face of a setback. 

1 – Leveraging “Non-specific Effects” & Refining the Runner’s Journey 

It’s important to appreciate that a lot goes into a physical therapy session beyond the specific intervention(s). Believe it or not, the context of an experience (AKA “non-specific effects”) is responsible for more than 4x the variance in treatment outcomes in medicine and rehab. 

When you think about the last time you went out to dinner…

  • How easy was it to make a reservation, and did you receive a confirmation? 
  • When you arrived, were you greeted by a friendly host or hostess and promptly seated at your table, or did you have to wait? 
  • Was the table clean and comfortable? 
  • Was the server upbeat and warm in their demeanor and patient with you while anticipating your needs?
  • Was the food brought out in the appropriate order on time and warm like it just came out of the oven? 
  • Was the waiter delayed in bringing you the check, and did they accept all payment options? 
  • Did they thank you for dining with them and mention they look forward to seeing you again soon?

As you can see, a lot goes into a good dining experience beyond the actual food. The same goes for every physical therapy session I have with a runner. By taking the time to understand the factors at play, you can leverage certain effects to improve buy-in, eliminate potential friction, enhance outcomes, and give runners ownership of their situation.

2 – “Inductive Foraging” & Asking Open-Ended Questions

“You can run all the wisdom of science and technical knowledge past an athlete, but behind that sits their heart, values, motivation, and doubt.”

-Stephen Rollnick

When first connecting with clients, create the time and space for them to share their story while posing calculated open-ended questions to help them reflect on their situation. 

Did you know that the average time before a physician interrupts a patient is typically 11-23 seconds? Additionally, consults are often rushed, and clinicians can often come across as abrupt, distracted, or sterile. 

I can’t help but think back to an experience I had with an orthopedist about a knee injury. After patiently waiting 45 minutes past my scheduled appointment, I finally saw the doc, who seemed to be in a hurry. He spent less than 30 seconds asking me about my knee before quickly examining it and telling me nothing was wrong and that I should “put some holy water on it.” Can’t make this s#*% up.  

As much as I want to get to the clinical examination and testing of a consult, I learned early in my career never to rush that initial conversation because it helps build rapport and open communication. Listening to patient stories, connecting, and approaching care through shared decision-making improves my clinical reasoning. This is why my PT consults are 75-90 min long and sometimes longer, pending the situation and needs of the runner.

Below are some powerful questions I routinely incorporate into my physical therapy sessions that I thought would be helpful to mention. The more I can get people to talk openly and honestly about their situation while remaining present, engaged, and genuinely curious, the better. 

  • Would you mind telling me about yourself and what brings you in today?
  • Why do you think you’re in this situation, and why seek help now?
  • What steps are necessary to move forward from this point?
  • What obstacles might hinder your progress in overcoming this situation?
  • Who is part of your support system as you address this issue?
  • What is your vision for the coming weeks and months? How do you see things unfolding?
  • If I turned out to be the most helpful PT for you, how would your life change due to our work together?
  • What would you like to walk out of today’s session with?
  • Is there anything else you’d like me to know about you to put me in the best possible position to help you?

Asking these questions invariably garners trust and connection while paving the way to a meaningful and successful outcome. 

3 – What’s Point A? 

As the great teacher and legendary strength coach, Dan John likes to ask, “What’s Point A?” 

As much as we want to rush to “point Z,” which means healthy and consistent training for most runners and perhaps running with reckless abandonment for others, clinicians often fail to clearly identify “point A” during the initial consultation. 

Running has predictable performance demands – it also involves relatively high loads performed repetitively over long durations. This is why completing a comprehensive evaluation is imperative for identifying point A.

Want a copy of my Physical Performance Tests & Clearance Considerations sheet I use as part of my comprehensive evaluation? Enter your e-mail below.

Otherwise, you risk giving a runner the greenlight only to have them report hobbling home during their first attempt. It also helps determine whether a runner is a candidate for PT or needs to be referred to a more appropriate provider. 

Another benefit is that the assessments can help you develop a bond of mutual respect and trust. Plus, when the approach is collaborative, patients feel acknowledged and optimistic about their abilities. Remember, this objective portion of an assessment is to show runners what they can do more than what they can’t. Just as much as I’m making a mental note of specific impairments or deficits, I’m verbalizing and highlighting a lot of the things that bode well for them.

Finally, it’s also important to watch runners run. Although you’re probably thinking, “DUH,” you’d be surprised how often medical professionals fail to do some form of running gait assessment. 

By the time we wrap up this part of the consultation, I have a clear sense of where a runner is on the injury-to-performance spectrum as well as the best next steps to position them for a safe and timely return to training and competition. My primary responsibility from here is to communicate the findings clearly and concisely so they have a refined understanding of their situation and the best next steps. 

4 – Load the Tissue with the Issue & The Prisoner’s Dilemma 

I consult a lot of runners who are spinning their wheels or can’t seem to get on the other side of a finicky running-related injury. A common denominator in nearly all these cases is failure to load the tissue with the issue.

This is why when crafting a home exercise program for runners, I developed “The L’s of Loading.” It’s ideal for runners with limited time and resources who would benefit from having a simple and actionable home program. Think of it as the 20% of Pareto’s principle

Below I’ve broken down the L’s of Loading.

  • Load the tissue with the issue – often in the form of isolated single-joint exercises
  • Life movement – push, pull, hinge, squat, carry
  • Linkage exercise – a drill that challenges the kinetic chain.

For example, suppose a runner is recovering from Achilles tendinopathy, and their symptoms have stabilized. In that case, a simple program that might be appropriate based on The L’s of Loading is as follows:

Ironically, after I challenge runners to directly load the tissue or region that’s been bothering them, they often remark, “Is it weird that things feel better after doing the exercise?” Nothing like having a runner discover their pain is malleable as it elicits buy-in and confidence in the program.  

Except for certain situations or precautions (i.e., stress fracture), generally aim to “Load the Tissue with the Issue” because taking an avoidance strategy typically doesn’t work. 

To read more about The L’s of Loading, you can download the PDF by entering your email below.

5 – Reframing – Highlighting Strengths & Mitigating Threats 

“The mentality distracting habit of always looking for faults is so powerful that this shift to focusing on strengths take some getting used to.”

-Jonathan Fader

Most physical therapists and medical professionals are trained in an impairment-based model that emphasizes a runner’s weaknesses or deficits. This approach can often stoke anxiety and have the runner walk out of the session with their tail between their legs. 

Rather than rattling off a laundry list of deficits, focus on what’s going well for the runner. For example, I recently consulted a trail runner who came in complaining of right kneecap pain after connecting with a new coach in March who had him running more volume and ‘vert.’ There was no specific event or incident that caused his knee pain. Rather, it was a gradual onset, likely aggravated by long back-to-back runs in the mountains. Despite having some stiffness in his foot and ankle region and being a bit wobbly on that side when performing a lateral step-down, he had several things working in his favor. So I said…

“Based on the lens that I got into your situation and our work today, you have so many good things going for you…

  • You’re getting zero pushback during the day with routine activities of daily living (ADLs).
  • There’s nothing wrong with your knee joint as full, pain-free ROM and no swelling in or around the joint.
  • You can run, hop, and squat on your right leg with no reluctance. Sure, you had some low-level pain though it wasn’t getting worse, nor did it cause you to alter your mechanics.
  • Simply bumping up your cadence during the treadmill run also took away nearly all your pain, showing you that nothing sinister is at play.
  • If I were in your shoes, I’d carry on but be sensible. I suggest having you run every other day on level ground to rolling terrain for the next couple of weeks. As you prove tolerance to the training, we can start nudging.” 

Strive to reframe feedback and data for runners in a positive light while being transparent about the reality of their situation because nothing’s worse than being given false hope. 

6 – Communication Heals

“All I did was identify with the patient and give a few encouraging words. It wasn’t anything specific, but I knew it made a difference. 

-Austin Smith

If there’s one thing I’ve learned in my 20+ years as a physical therapist and coach, it’s that empathetic communication heals. Taking the time to listen and engage with runners in a curious and non-judgmental manner is the cornerstone of effective care. 

Not only is it critical to be present, but word choice, language, tone, explanations, metaphors, and stories convey critical messages and can infuse optimism or sow doubt. 

My primary goal with runners is to ensure they feel heard while shifting their attention away from pain, fears, and anxieties and toward healing and recovery. At the same time, I am realistic and transparent about their situation. My aim is to inoculate any unhelpful narratives or thought viruses they may have about themselves and their situation while reminding them of their body’s remarkable affinity to adapt and overcome so long as we create the right ecosystem, respect biology, and appreciate the role of allostatic load.

Just as much as runners come to me for help, it’s also essential to put it back on them. They are the ones who have run into trouble and likely have the best insight as to why. As I always tell runners, “You’re the expert on you, so I’d love to get your thoughts.”

Something as simple as the phrasing of a question regarding whether or not they did their home exercises could make a world of difference. 

For example, rather than asking, “Did you do the exercises I gave you?” Try framing the question as, “How have the exercises been going?”

If you work with runners in any capacity, I challenge you to listen carefully while being surgical with your words, stories, and explanations. And remember to put it back on them by asking, “What do you think?”

And never forget, as the great Louis Gifford said,

“Reassurance is a bloody good painkiller.”

7 – Guardrails & The RTF Rule 

“Runners don’t have unrealistic goals; they have unrealistic timelines.”

-Curb Ivanic

One of the most challenging and critical aspects of my clinical work is helping runners protect themselves from themselves.

Trust me when I say that left to their own devices, runners often make bad decisions and invariably violate The RTF Rule…Rush to Failure.

This is particularly true in working with runners dealing with bone stress injuries (BSIs), commonly known as stress fractures. 

For anyone who’s dealt with a BSI you can probably attest to the fact that once you remove running from the equation, things calm down quickly, and within a matter of a few days or weeks, you’ll think that because you’re pain-free, you’re good to plug back into training where you left off. WRONG. I can think of countless occasions in recent years where runners discontinued the plan of care because they had to get back to training for a big race or to ensure they were ready for the upcoming season. Not only did their plans not pan out, but many of them went on to develop a second BSI. While we’re on the topic and to better understand how bones heal and realistic timelines to return to running as a function of stress fracture locations, check out my buddy Nathan’s posts HERE & HERE.

As much as we hate to admit it, biological healing takes time, and there’s no magic potion or elixir to expedite the process despite what’s presented in the media.

So revel in the process and understand that biological tissue and processes take time. A good rule of thumb is that however long you think it’ll take to get you back to training, multiply it by a factor of 2. And as you plug back into training, an excellent acronym to help progress your running is F.D.D.I. – Frequency, Duration, Density, Intensity. For example, an early goal is to get runners back to running every other day at conversation pace. From there, we can start nudging their runs until they work up to one hour of continuous running. A sensible way to progress things is to incorporate back-to-back running days. And finally, so long as a runner isn’t experiencing any pushback, it is appropriate to layer in some short bouts of intensity in the form of strides or intervals or incorporate some hill work into the equation.  

Lastly, I always make it a point to normalize that you’ll feel sluggish and sore as you resume running, especially if you’ve had a more extended layoff. So be patient and forgiving with yourself, and know you’ll be back to full force in due time. 

8 – Mapping Out & Signing Off on the Plan 

Diligent follow-up and follow-through will set you apart from the crowd and communicate excellence.

-John Maxwell

At the end of every consultation, I make it a point to summarize the session and outline my suggestions regarding the best next steps.

I also make sure to get the runner’s seal of approval by having them verbally agree or sign off on the plan because it’s up to them to take ownership of their situation, and it’s critical that we’re on the same page.

Before parting ways, I also allow runners to voice any questions or concerns that may not have been addressed during the session that they feel are critical to helping them move forward.  

Following the appointment, I then email them a detailed roadmap that outlines what they should do over the next three to four weeks in terms of exercises and training-related modifications while again reminding and highlighting the things they have working in their favor and how we’ll segue them from their current status back to running in the manner they’re capable.

In this email, I also include private video hyperlinks to the exercises and any equipment they need to perform their home program. Considering the volatility around certain RRIs, this email must be crystal clear while also providing some autonomy in the way of decision-making for the runner. For example, I often say here are the exercises I want you to do. The order is not critical so long as you get them done, so feel free to plug and play as you see fit. 

Another helpful thing is to map everything out on a big whiteboard during the session so runners can appreciate the various moving parts. They can also take a picture of the board as a reference they can always return to. So between that and the follow-up email, they should have a clear path outlined.

CLICK HERE to access this template I created to help you summarize your findings and outline a plan moving forward. 

Thanks for taking the time to read this, and hope it helps improve your outcomes in working with runners. If you’re a runner spinning your wheels and want to connect, please reach out HERE, and I’ll gladly help you or get you connected with the right person if you live outside of Seattle.

6 Takeaways from Running an Impromptu Marathon

6 Takeaways from Running an Impromptu Marathon

How I ran a 2:50 marathon on a whim while staying healthy and in control throughout the race

Race pic courtesy of the Eugene Marathon

On May 1st, I completed the Eugene Marathon. While I’ve completed plenty of Ironman Triathlons, this was my first ever attempt at the distance as a standalone event. I did this race in support of my good buddy, Johnny Kvietkus. This was his first race back following a horrific car accident last summer. Although his sister and nephews would be there on race day, I thought it’d be fun to accompany him. I also had to honor a pact I made with one of my athletes, Tonya.

My friend Johnny and I at Seward Park

I promised her if she qualified for the 2023 Boston Marathon during this year’s race (which she did with flying colors), I’d toe the line with her next April. Since I’m not getting any younger, I thought I’d better get my qualifying time sooner rather than later. So I threw caution to the wind and registered three days before the race.

Outside of one 14 miler, my longest run in the past two years was the weekly 12-mile jaunt I do to my in-law’s house for Sunday dinners. I was also sidelined from running for eight weeks in late 2021 due to an unexpected knee issue, which I fortunately recovered from.

If you are prepping for your next marathon, here are six key takeaways from my experience for you to consider as you begin ramping up your training.

1) Stop trippin’ over the long run

You can’t cheat the volume going into a marathon. But to avoid leaving several critical boxes unchecked, don’t structure your training around the long run. When it comes to tackling marathon training, my friend and PT extraordinaire, Mike Studer, sums the long run up nicely saying,

Stay on your feet for the length of time you project the marathon to take. For example, if your goal marathon time is 3 hours, you may only need to cover 20 miles in long slow distance during your training cycle.

If running long and slow was all that mattered, I wouldn’t have had the strong race I did. Sure I faded a bit towards the end (see below), but I think the other types of runs were integral to my success.

The green line on this chart shows my pace, which you can see slowed toward the end of the race with several stops at aid stations before powering through to the finish. 💪

As my good friend and colleague, Joel Sattgast says,

The long run is an opportunity to demonstrate confidence, mental more than physical. If a runner can complete 20-22 miles, then what’s 4-6 more?

For example, I often include the following sessions during a typical week:

  1. 45 – 60 minutes at conversation pace, including anywhere from 5-15, 10-30 second strides.
  2. 45 – 60 minutes at conversation pace with a mishmash of hard intervals ranging from 1-5 minutes in duration.
  3. 60 minutes at conversation pace on rolling to hilly terrain or a 30- 45 minute tempo effort.
  4. 90 minutes of running over to my in-laws with an occasional pitstop at Fremont Brewery, turning the final mile into a beer mile 🤫🍻
  5. 20- 30 minute transition run off the bike AKA T-run (remember, I’m a triathlete).

These runs challenge coordination, heart and lung function, tissue capacity, power and confidence. As you review these workout sessions, keep this rate of perceived exertion (RPE) chart in the back of your mind.

RPE Chart

This RPE chart is from my latest project RunWell, which launches in June — check out our teaser!

2) Practice for race day and fuel like you mean it

It blows my mind how much runners and triathletes worry about factors that are out of their control while neglecting what they can rehearse such as nutrition and pacing.

Although I didn’t register for Eugene until a couple of days before, I started considering the race about two weeks out. Given the situation, I knew I needed at least one long run to rehearse nutrition and pacing. A week before Eugene, after a short walking warm-up, I put in a 14-mile effort slightly faster than my projected marathon pace. I knew if I could hold a brisk effort, I’d have the confidence to get it done on race day.

My pre-marathon 14 miler

A breakdown of my pre-marathon 14 miler

Given the energy demands required to run a marathon, I knew it was also critical to have a clearly defined nutrition strategy.

Everyone is different, but I’ll provide a window into my approach starting the day before. In reality, however, it begins well before in terms of hydration and sound fueling for energy availability.

Fueling the Day Before Eugene

After a 25-minute shakeout run with Johnny on Saturday morning, we went out for a late morning breakfast where I had a monster pancake, a plate of hashbrowns, an egg and one piece of bacon.

My breakfast the morning before the marathon.

My breakfast Saturday morning

For the rest of the day, I snacked on pretzels, nonfat yogurt, and pita during the afternoon before having a sensible pasta dish with some chicken in the evening.

Race Day Fueling

On to race morning…4:30 a.m….RISE & SHINE CAMPERS!

I made sure to get up early and start fueling at least two hours before the start of the race at 7 a.m. Giving your body this amount of time to digest is crucial to ensure everything can break down, exit the gut and be used by the working muscles once the gun goes off.

My waist belt of choice for the marathon.

My go-to Solomon waist belt

For breakfast, I had:

  • 1 cup of organic unsweetened apple sauce
  • 1 banana
  • 1 plain bagel
  • 14 ounces of sports beverage and then sipped on water to thirst before the race

For the race, I took seven Huma gels on board and stowed them in my favorite Salomon waist belt, the Pulse. The Huma gels are 100 kcals and consist of ~22-26 grams of carbohydrates.

My target for the race was ~60g of carbs per hour, so I planned to consume a gel every 20 ish minutes and then rely on what the aid stations had for the home stretch. Long story short, I nailed my nutrition!

It’s worth noting: I’ve trained my gut over the past several years and have a cast-iron stomach, so please exercise caution in adopting my exact approach because it may not be appropriate for you.

3) Strength training is essential

If there’s one thing a runner should do beyond run, it’s strength train. While running should comprise the bulk of your training as an endurance athlete, strength training ensures we have the requisite capacity to withstand the performance demands of running. This is especially true for masters level (over 35 years old) and geriathlete (over 55 years old) runners. Incorporating strength training:

  • Improves movement economy
  • Reduces or delayed fatigue
  • Improves anaerobic capacity
  • Enhances maximal speed

I don’t know about you, but what runner wouldn’t want that?! When it comes to running, our bodies need to withstand:

  • Cumulative loads given the repetitious nature of running
  • Peak loads considering certain tissues and regions need to withstand upwards of 8x bodyweight force
  • Energy storage and release since running is a plyometric activity

My strength training included some combination of the following movements and exercises based on where I was in training:

  1. Farmer’s marches (check out my recent post on marching drills)
  2. Squats
  3. Deadlifts
  4. Single leg drill (step-ups, toe taps, long lever bridge)
  5. Calf raises
  6. Push press
  7. Jump rope

While there is still a lot of research to be done on strength training, it’s something I strongly advocate for runners. I like to think of strength training as “coordination training under load.” If you don’t already prioritize strength training, any type of strength training is likely to create a positive stimulus. Aim to layer it in 2 – 3 x per week, ideally on non-running or lighter runners days.

4) Prioritize consistency and moderation

Despite many athletes being enamored by heroic or jaw-dropping workouts on social media, nothing promotes physiologic adaptation like measured training day in and day out. If you get overzealous and trip something off such as a muscle pull or tear, be prepared for your training to get derailed.

While adding intensity to a training cycle is important, make sure to get into a rhythm before revving the engine. Furthermore, when preparing to layer intensity into your sessions, be sure to come into the workout centered and ready.

Full disclosure: My marathon performance was the culmination of years of consistent and moderate training while peppering in calculated intensity, which ultimately allowed me to go deep in the well.

5) Focus on what is in your control

Speak to any marathoner, and you’ll learn about the dreaded 20-mile mark. Of course, the “goin’ gets tough,” but don’t let it get to your head. Every course is different and the conditions always vary. The main thing you can control is how well you pace the race leading up to the last 10K.

My mantras for the Eugene Marathon.

Mantras are an important tool to help keep you focused throughout your race.

Stay conservative early at the start, avoid going out too fast and focus on nutrition. Study the course and race accordingly. For Eugene, I made sure to write mantras in permanent marker on my hand to keep me honest but anchored for each segment of the race. There were two hills that hit during the first half of the race and so it was important to stay sensible early on. From there, the course was relatively tame. While my mantras were generally spot on, I should’ve labeled the fourth one GRIND because it sure as hell wasn’t a PUSH at that point.

6) Find a shoe that gives you a boost

Although I typically downplay the role of shoes, if you find a supershoe that feels comfy, springy, and light, you’d be silly not to use it. Worst case scenario, you’ll have a psychological advantage on race day.

My shoes of choice for the Eugene Marathon.

My shoes of choice for Eugene, the Saucony Endorphin PRO 2

Having done a lot of personal testing comparing various metrics (heart rate, pace, effort) between traditional running shoes vs. those with carbon plated technology, I’m someone who undoubtedly benefits from the latter.

For this race, I went with the Saucony Endorphin PRO 2, and they were divine.

If you want to experience what it feels like to run on mini trampolines, this shoe has you covered. Rumor has it that the ASICS METASPEED, the next shoe I’ll introduce into my rotation, is also the cat’s pajamas. I promise to report back.

Aim to find a shoe that weighs less than 440g (pair), feels comfy and has a carbon plate. Otherwise, be prepared to hit the F8 recalculate button post-race, wondering how much faster you could’ve gone and the precious seconds you left on the course.

Huge shout out to Rachel Lee at the Run Shoppe, who takes care of my running shoe fetish.

Final Thoughts

The most obvious takeaway from the race is how much less of a logistical headache a marathon is relative to an Ironman. I’ll continue to race long course triathlons, but the marathon was a much more enjoyable experience and vibe. You also don’t have to deal with a bunch of stressed out type A triathletes staring at your calves and quads trying to size you up going into the race. There’s nothing relaxing about racing a triathlon. I sometimes wonder why I do them in the first place. Based on my first marathon experience, I can’t wait to race Boston and put in a focused training block to avoid running a second impromptu marathon.

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