Real Life Runners with Angie and Kevin Brown

439: How Your Athletic Identity Influences Performance and Running Injuries with Dr. Kate Mihevc Edwards

• Angie Brown

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In this week’s episode, I had the absolute pleasure of sitting down with Dr. Kate Edwards, a physical therapist with more than 15 years of experience and someone who brings so much compassion and clarity to the running community. From the very beginning, I knew this conversation would resonate deeply with runners who struggle with identity, injury, stress, or the constant pressure to “do it all.”

Kate shares how her journey into running medicine was shaped not only by her clinical background but also by her own experiences navigating significant health challenges. That perspective gives her a rare depth of understanding — one that so many runners will feel seen and supported by.

We spend a lot of time talking about athletic identity, because it’s something I see runners wrestle with every single day. It’s so easy for running to become the biggest part of who we are… until something shifts. Injury, life changes, burnout, or even a tough training cycle can shake that identity. Kate and I dig into why building a more balanced sense of self not only supports your emotional well-being but also plays a major role in injury prevention and longevity in the sport.

We also explore the true complexity of running injuries, RED-S, stress, fueling (especially for female runners), and why understanding yourself as a whole human — not just an athlete — is essential for long-term health. Kate does an incredible job unpacking these topics in a way that feels both empowering and practical, giving runners a clearer picture of how their body, mind, and lifestyle all fit together.

If you’ve ever felt “less than” when you’re not running your best, or if you’re craving a more sustainable, joyful relationship with your training, this conversation is absolutely for you.

Connect with Dr. Kate Edwards:
https://www.fastbananas.com/
https://www.instagram.com/katemihevcedwards/


05:22 The Importance of Athletic Identity

12:01 The Impact of Injury on Identity

13:41 Finding New Outlets and Coping Strategies

23:00 Understanding Running Injuries

26:30 The Role of Physical Therapists

28:13 Stress and Its Impact on Runners

35:51 Understanding Relative Energy Deficiency in Sp

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Speaker 12:

Welcome back to the Real Life Runners podcast today. I'm so excited to introduce you to Dr. Kate Edwards. She's a physical therapist, running medicine specialist, researcher, and a key member of the multidisciplinary care team for the Atlanta Track Club elites. The moment that Kate and I met, we clicked instantly. She's just one of those people and those clinicians that actually gets it, not just the physical side of running, but the emotional and psychological layers that most people never talk about that you all know. I'm. So passionate here about on the podcast, and that's exactly what we're diving into today. The concept of athletic identity, what it means to see yourself as a runner, how that identity can both empower you, and how it can also become a slippery slope when running becomes the only way that you define yourself. We covered so many great topics. We ta we talk about why so many runners struggle to call themselves. Real runners, why over 80% of runners get injured? How stress and nervous system load influence your, your ability to train, and the unique challenges that women, especially over 40 face with fueling hormones and performance. You guys are gonna love this conversation with Kate. We go way beyond biomechanics in our world as physical therapists, and Kate even shares her own powerful story of losing her ability to run after a life-threatening event and how she rebuilt her identity. Her health and her relationship with running from the ground up. So welcome Dr. Kate Edwards to the show. I'm so excited for you guys to hear it. Let's dive in.

Speaker:

All right, runners. Welcome to the show today. I am so excited to have Dr. Kate Edwards here with me. What's up, Kate? How are you? I'm doing great, Angie. How about you? I'm fantastic. I'm so excited for our conversation. So Kate and I have just met recently, and she is also a physical therapist that treats runners, and she and I just connected immediately when we started talking. so we are gonna dive into some really fun topics today. But before we jump in, Kate, please introduce yourself to our listeners.

Speaker 2:

Sure. So as you said, I am Dr. Kate MHE Edwards, and I'm a physical therapist and I practice running medicine. So what that means is I treat almost exclusively runners at this point, which is so fun, and I feel very lucky that's what I can do. So I own a running medicine clinic in the Atlanta area, and I work with the Atlanta Track Club elites on a multidisciplinary team that I help to build. So that's also really great because I get to work with all different healthcare providers to really provide the best care possible for our team. And not a lot of people get that kind of treatment. So it's fun to be able to do that. And I. They have a podcast and do research and really anything you can think of that's related to running except for coaching. Actually, I don't coach runners really. yeah, I don't coach runners. but, everything else, like I, I have been a runner for a long time and, I touch it in all different ways.

Speaker:

I love that. So how did you get into specializing in runners? because obviously you said you were a runner, or you have been a runner for years, but. what made you have this special interest in going into running medicine?

Speaker 2:

I think it really was my love of running. So running for me gave me so many things. So it helped me be a better person. It helped me, it taught me discipline, it taught me drive, it, helped me shape things when I felt out of control. Like the world around me was crazy. I loved a good training schedule. it kept me on track. So I think my experience with running and falling in love with running made me realize that. Somebody needed to treat runners. I was injured.

Speaker 3:

Yeah.

Speaker 2:

in college and saw a physical therapist. And then after that, when I was training for my first marathon, my coach was a physical therapist.

Speaker 3:

And

Speaker 2:

even though I went to school for something completely different I loved what she did. I saw how she interacted with people on the track. I saw how she thought about things differently than everybody else that I really had met before. And so I just. started following her to work love, love it, and showing up. And she was wonderful. And she let me do that. And eventually that brought me to the idea that, okay, maybe the career I thought I was going to do is not going to happen. And I'd rather be a physical therapist who treated runners.

Speaker:

I love that. So how long had you been running, like until, like when you got to that point, did you start in high school with kind of cross country and take the typical running path? No.

Speaker 2:

So I went to such a small school that we didn't have a cross country team. Really?

Speaker 4:

Yes. Oh wow. That is a small school.

Speaker 2:

It was very small. So I ran all through high school, but it was on my own. It was in the middle of the country, down a dirt road. I would run to town maybe, so I was running, but I, didn't have. Formal training until college. Okay. Which was really interesting. So I just, I ran and ran like for Gump. And then, and then I, my first race ever was a half marathon.

Speaker:

Wow. You jumped right in feet first.

Speaker 2:

Sure did. I didn't know any better. Yeah. And I think that's actually what happens with a lot of runners is they It's true. Find it. They don't really have a structured background in it. And that's part of the reason I think injury occurs too.

Speaker:

Oh, 100%. That's why, and I think that a lot of runners do take that path of okay, I'm just gonna start running. And some runners, especially when they get into it later in life, they don't do the whole 5K, 10 K, let's build up to things. It's I need to be in better shape. I'm gonna sign up for a half marathon or a marathon, or I've got a friend that's running a half marathon. That sounds interesting. Let's do that. Yeah. And so they jump in thinking. It's just running, right? Like how many times have we heard that where it's oh, it's just running. Like I just need some pair of shoes and I just head out the door and go run. And yes, even though we have been doing it for our whole lives, since we were probably, what, two years old, a year and a half or whenever we started to not fall over when we started to go a little faster. Yeah, we've been doing it. But in order to progress and do so at a level where you're running faster or you're running longer or you're seeking some sort of performance goals, that's a totally different mindset. And skillset.

Speaker 2:

Yes, absolutely. The running, the running report that came out this year said that 75% of runners coach themselves. Wow.

Speaker:

75%. Yes. 75%.

Speaker 2:

And so that,'cause it seems

Speaker:

simple. Like it's very accessible, which is so fantastic.

Speaker 2:

That's what we love about it, is that it's so accessible. It's such a great way to improve so many aspects of our health. Absolutely. Yet there is a part of it which most people don't realize, that we really could benefit and do benefit from structured coaching. We benefit from understanding how our body works, And what are, signs and symptoms of overtraining and what. Part of, how much does emotional and mental health and stress impact our actual physical health? So there's so many aspects of it. Yeah. You don't realize when you just lace up your shoes and go out the door. And I certainly didn't realize that.

Speaker:

Yeah. In the

Speaker 2:

beginning, which is why I ended up injured.

Speaker:

Yeah, I definitely didn't either. And I think that, The big topic that we're gonna talk about today is athletic identity, and I'm super excited to dig into this because I also didn't, like I did, was not a cross country runner. I actually hated running. So I, was played volleyball, basketball, and softball growing up. And running was the punishment in all my sports, right? So it's like you missed a serve, you did this, like you had to go run for punishment. So I had a very negative, perspective on running. I really did not like it at all until I met my husband. And he he was a runner. He did the whole cross country, ran in college. And, he showed me that it could be something different and it could actually be something kind of fun. But for a long time I just ran. I would never call myself a runner. I never wanted that identity or believed. I think maybe not so much that I didn't want it, but so much that I didn't fully feel like I deserved it. that wasn't me, like runners were at this other level that I was not on. And what, that's one of the things that I love helping people with now is helping them understand that you. Are a runner, right? if you run, you're a runner. If you go out and you train and you run multiple times a week, you are a runner regardless of your pace, regardless of your distance, regardless of any of the baloney, you know how many medals you have on your wall. You're a runner. And when you become a runner, you have to start thinking like one. And that kind of leads us into, what our topic of the day is, which is athletic identity. And I know this is a topic that you're passionate about too, and I love that you take. A multidisciplinary approach with your runners and your athletes. So let's talk about athletic identity. what exactly is it? this topic that we're talking about today.

Speaker 2:

So athletic identity is this idea of who you identify as in the world, how you represent yourself in the world. What values do you have? Where do you see yourself in society? Yeah. And so it's very big. So if you're, it could be different for everybody. So sometimes CEOs, their identity is being a CEO or a mom. Stay-at-home mom, their identity might be a stay-at-home mom. For runners, it's often my identity is a runner because that's how I connect in the world. That's how I see my, the lens in which I see myself through. Yeah. And so when we see ourselves through this lens, it can become really big. Like we might only eat based on our training schedule. We might have, our whole wardrobe might be dedicated to running. It might be race shirts. It might be the only shoes we wear are running shoes. It might be. the bag that we carry around, says a race that we did. And what our social activity is doing our long run on the weekend and meeting our girlfriends for coffee. One of my favorite Saturdays. come on, let's be real. No, it's lovely. Yeah. It's exactly right. Yeah. And so that is a strong athletic identity when all of the things in our life Are related to the sport in which we do.

Speaker 3:

Yeah. And

Speaker 2:

it defines who we are. And so it can be a really good thing, or it can be a slippery slope.

Speaker:

No, I 100% agree. And it's funny because I feel like this is gonna be such like a fun thing for us to talk about because I'm on the end of where there's a lot of people that run but don't identify as a runner, even though they are doing a lot of the things that you describe, right? Like even though they're running races, even though they are always buying new running shoes or these kinds of things, but in their mind they've defined runner as someone that's. Faster, or someone that runs further or whatever it is that they've defined runner as, and they keep themself out of that box. And so stepping into that athletic identity can be such a game changer for those people. And then there's the opposite end of the spectrum, which is I think where you work a lot with where. Runner becomes your entire identity. Because we have so many different identities as humans, right? I am a mother, I'm a wife, I am a runner, I am a coach, I am a, physical therapist. Like we, we have so many different identities and all of them do have their own lens, right? I can put on my PT hat sometimes I need the PT hat, sometimes I need my coaching hat. And those things overlap, but they're not always the same. And I think that. It becomes dangerous, it becomes that more slippery slope like you're talking about when runner or whatever it is, stay at home. Mom becomes your full identity when you don't have anything else outside of that,

Speaker 2:

That's exactly right. And so we know, the research says that people who have a strong athletic identity Are able to push themselves harder in training. They're able to, Figure out how to put more work in when need, when it needs to happen. Yeah. And often they can be more driven towards that one goal. So it's great and it's very useful to have a strong athletic identity, especially for someone who's an elite athlete per se. Absolutely. However, what happens is when you put all those eggs in one basket, when you lose the thing that you love Which could be running, then you're lost. And that the research also shows that you become, you start to spiral and you can end up in anxiety and depression. And it really impacts your relationships in your life and all of the things and parts of your life. And so figuring out that kind of middle ground. I love how you, I actually say the same thing a lot that you just said about people who don't identify as runners. I think that if you put shoes on and you run outside, you are a runner. And you're doing it. And, it also is interesting to me a little bit, a side thing, is that when we look at running research. It often asks people who identify as runners, but you're missing out on all of these other people who actually run. And are runners, but they just don't identify as it true. So I think it can be really useful if you're somebody that runs to say, okay, I am a runner, and it gives you more confidence. As long as you keep all of those other things that you love active outside of the sport. Yeah. And then if you are somebody who truly identifies as just a runner, you need to find tools and fun things outside of your sport that you can do that, that allow you to be more than just a runner so that if something happens,

Speaker:

yeah.

Speaker 2:

That you have something to fall back on.

Speaker:

Absolutely. Because that's where injury becomes very like even worse than it already is, right? because it stinks to be injured. You're in pain. It is physically uncomfortable, but then there's the whole emotional side and Yes, and even this identity piece that goes with it. When you are, when you fully identify as a runner. And you're injured and you're not able to do the thing that you love. It's a lot of people are like, then what am I? Or what am I supposed to do? Because this is what I do. if I don't go out for a run for an hour every day and a couple hours on the weekends, I don't know what else to do with my life.

Speaker 2:

That's right. And so we had mentioned before we started recording that I, was a big, marathon runner. Yeah. And I did triathlon. And a year after I had my son, I was out for a training run and I went into ventricular tachycardia and almost died. Oh my gosh. And. I was very lucky that I didn't, my heart actually went back to a normal rhythm on its own, which is rare. And it took about nine to 10 months for them to diagnose me. So during those nine to 10 months, I was losing pieces of myself the whole time. So I was somebody that over identified as a runner. Yeah. So I truly. Put everything into it. it's my job, still is my job. Yeah. And I love it, my friend group. it was the way I managed stress. Yeah. It was the way I found worth self-worth for me. Like the faster I ran, the better I felt about myself.

Speaker 3:

Sure. The

Speaker 2:

more races that I won, qualifying for Boston, all of those things were really important to me. And then it came to a point where they, I nearly died doing what I loved and it, I slowly lost the ability to do so over nine or 10 months and I didn't know what to do. And I went into depression and I went, had a lot of anxiety and I had to have, yeah, a lot of help, speak to somebody about that. a sports psychologist, and figure out like, what is it that I need to do here? And through that process. I learned a lot of different things. I learned what it was like to be a patient, which I didn't love. True. And, yeah. Which helped me be a better provider. it does. Yeah. it absolutely does. and so that was great from an outcome standpoint, but terrible in the moment. Yeah,

Speaker 3:

for sure.

Speaker 2:

Two, I learned that I needed to find something outside of my sport and that helped me to teach my patients the same thing. So I learned that even though I hated meditation, like really hated it. I really hated it because I couldn't sit still.

Speaker:

Yeah. was so many thoughts going through your brain and you're like, I'm just doing it wrong. That's what's a waste of time's.

Speaker 2:

Yeah. Yes. But what I learned is that if you sit down even for a minute, you're winning. So I started to think about it. You're winning in terms of, oh, I'm winning when I meditate. Yeah, because it's

Speaker:

the process. It's not what's actually happening.

Speaker 2:

That's right. Yeah. So I learned that and then there were so many things I learned along the way, going through that process that helped me as a person and a patient, and it made me realize and reflect backwards that okay, my athletic identity was so entrenched that it was hurting me. So I had to figure out a different plan.

Speaker:

Yeah. So then what did you do? I worked

Speaker 2:

with a sports psychologist, which is really helpful. it was incredibly helpful. And, but

Speaker:

how did you start to shift like that athletic identity, right? Like with the help of your sports psychologist and the meditation and all these other things. if there's someone listening to this podcast thinking to themselves, oh goodness, this sounds like me. What? Would you suggest, like what's a starting point that, like how were you able to start to shift that athletic identity from being so entrenched as, I am a runner and this is everything in my life to, okay. You know what? I can open myself up to other things here as well.

Speaker 2:

it was really painful. Yeah. Because I had to try a lot of things. Yeah. Because nothing felt as good as running to me. And nothing, I didn't want to do anything else. So slowly over time it was trying different things. going to a yoga class. My husband actually, we laugh now, but I would go to this yoga class and they had a 30 day challenge To see how many yoga classes you could do in 30 days. Oh wow. And I was like, oh, I can't run, so I'm gonna win yoga. I'm gonna win. I'm gonna win at the yoga.

Speaker 5:

So by the way, it turns out yoga is not about winning.

Speaker 4:

Your yoga instructors are probably like, who is this girl? What is happening? namaste lady. come on, bring it down. Bring it down.

Speaker 5:

And now I'm actually really good friends with my yoga instructor. So funny. And she really helped me through the whole transition. Oh my gosh. But I was like going to win at yoga instructor. Oh my gosh. How many yoga classes did you do? Oh my God. I don't know. I went multiple. Oh, come on. You didn't know. No. So I like two a day

Speaker 2:

at least. Sometimes it was three a day, and then if I missed a day,

Speaker 5:

I was so upset because somebody else might beat me.

Speaker 4:

Oh my God. so I need a tissue right now. I'm literally like crying here because this is so funny.

Speaker 2:

and, but that's, it's funny because I actually know that this is what my patients do. Yeah, totally. and so I understand. yep. And, yeah, I, it's that competitive

Speaker:

mentality.

Speaker 2:

Exactly, and that was so I didn't lose the competitive mentality. and since then, I can run a little bit. I, but it's nothing like before. Yeah. So I still do yoga. I strength train, I walk, but I run once or twice a week. And it has to be with somebody. I have a rare genetic heart disease and an implanted defibrillator. Okay. Is what they found out. But I can run, but I've found other outlets. my business actually became a great outlet because now I have two companies. Of course, they're about running, so I'm still involved in the world. Still there.

Speaker 3:

Yeah. I'm

Speaker 2:

still there and I still get to relate to my people.

Speaker 3:

But

Speaker 2:

I do it in a different way. And I get to help other people do this thing that they love. Yeah. And not everybody would be able to do that. That's very true. Like some people, if they can't do it, they don't wanna be around it. And they can't get through that. I worked really hard with a sports psychologist about that, and luckily I was able to Stay with it. It's just in a different way. And I had to reframe what I thought it meant to be a runner. And that was hard too, because I thought, again, wrongfully, I thought that being a runner was. going to the Boston Marathon Yeah. And running 50 miles a week and, being really fast. And a runner is somebody who puts on their shoes and goes out the door. How did you make that shift? Practice, practice over time and a lot of journaling about it. A lot of talking about it, A lot of, reflecting on why Why did I feel this way and why were these my beliefs? Yeah. And who put them there. And then realizing that I did it to myself and it really wasn't running's fault and it was really that I was trying to not address other things in my life and I was using running. And this isn't what everybody does, but I did.

Speaker:

But a lot of people do.

Speaker 2:

Yeah.

Speaker:

A lot of people do. Let's be honest, right?

Speaker 2:

Yeah. A lot of people do. I was using running to avoid other things.

Speaker:

Yep. Yeah. And I think that whether it's avoiding. Stress, whether it's avoiding uncomfortable conversations or realizations that you might have about your life, whether it's avoiding, talking about food or your food obsession or food, eating disorders. there's a lot of things that can, that we can use Running for, this is one of the double-edged swords I think of running, right? it can be so good for us in so many ways, but it can also, when we There's a very fine line sometimes, right? And we can flip over into where running can become a more toxic type of thing in our life when it's replacing other things, when it becomes the only thing that we can think about when we are so devoted to that, that we lose everything else in our life. And there's people, and I know that sounds extreme, especially probably to a lot of listeners of this podcast, but. It does happen, and I think it's important and whether or not it's running for you, it could be something else, right? There's people that use something and I think that's where like part of what's coming up for me right now is like addiction too. Yeah. There's a lot of people that use running as a substitute for addiction. so they, which arguably is a better thing, right? if versus, drug addiction or addiction to alcohol or something like that. Running is a quote unquote healthier. Obsession or addiction, but it also can become unhealthy, right? Like it's running can become an unhealthy thing physically, mentally, emotionally, psychologically. And that's, I don't think, not everybody realizes that.

Speaker 2:

No, because so many people, I, it is a very common thing for people who struggle with alcoholism Yeah. To pick running, and so all they're doing again, it's better for sure. But what they're doing is they're swapping this a, an addictive thing for another addictive thing. And, and nobody wants to tell'em to stop because they realize it's so much better and they're in a better path, but Right. But the thing that's missing there is that talking with somebody is working on that psychological or that mental health aspect. Yeah. Which luckily mental health is something we talk about now.

Speaker 3:

Yeah.

Speaker 2:

But it, you have to decide to do it because you might not be ready and you might not want to. I wasn't. Yeah. I think

Speaker:

it, it's yeah, it's the whole idea of running is my therapy. Running is my therapy. There's so many runners that say that because they're, they don't wanna talk about their problems, so they'll just run because there is that dopamine and adrenaline and the things that get released, right? there are those good hormones that get released in our body that make us feel better. Yes. At least temporarily, right? Yes. But it's not addressing the underlying things, and that's where it becomes more problematic.

Speaker 2:

That's right. And there was actually a couple, and I think this is what you're referring to, a couple research papers that showed that running can actually, mimic so antidepressants In a lot of ways. Correct. and so people are like, oh, this is great. I can just do this. And it doesn't mean you can run instead of taking antidepressants. I think a lot of people, read that paper in that way. And that's not what was meant to be said, I don't think. because I think you do sometimes if you need them you can take them. But, I think it's really interesting what running does from that mental emotional standpoint and it's such a lovely thing. So I don't wanna get down on running in any way, because obviously not at all. Obviously we both love it. It's just really, like you said earlier, finding that fine line of Okay. What is it that I do need to address here, and am I ready to

Speaker:

Yeah, absolutely. My husband, I think, went through this too.'cause he was a runner in college and then kept getting injured and so he had to quit the team because he just was in a chronic injury. It just wasn't working out right because of the college load that he was in and whatnot. So then it was like he went through so many different identity shifts with this going from collegiate competitive runner into, okay, now. I'm running on my own, what does that look like? running, so this block after college of okay, I like running, but do I still wanna be doing it? At what level do I wanna be doing it? And then we had kids, right? And then it's okay, now I'm a dad and a runner, right? There's all these different transitions and shifts, even in his running journey that is much different than mine. But we have to kind of transition and figure out how running fits in with us at different phases in our life.

Speaker 2:

Yes. And if we're, and if we're healthy about it, yeah. Then that makes it easier because they're like, oh, okay. It's not everything, but it's something that really supports me and bolsters me. Yeah. So I'm going to find time for it. However, I'm not going to, obsess about it, so it impacts the rest of my life negatively.

Speaker:

Yeah, absolutely. And One of the big pieces of all of this, I think, too, and one of the reasons we're talking about identity is its relationship to injury, right? Yeah. Because runners, unfortunately, what is it? Over 80% of runners get injured. Yeah. And those statistics depend on which study you're looking at. vary, but I like to just say over 80% because it is. A wildly high number that is how many runners get injured. And touching back on what we started the conversation with earlier, why does that happen? Like why are runners getting injured? And I would love to hear your perspective on this,'cause obviously I have my own, but, why do so many runners get injured?

Speaker 2:

So I think everybody's trying to find this one reason why runners get injured. So I had said to you, this recent paper that came out was a great, it's actually an incredible paper to come out. And something that we learned from where it's talking about that if you increase one run a week by more than 10% Yeah. Then you're at higher risk for injury versus overall. that 10 or 15% overall in the week. And when that paper came out, I was excited and also. terrified because all of a sudden everybody was saying, oh, we can get rid of the 10% rule. It's just this one run That impacts our injury rate. and I, I. No. Sat with it for such a long time and I, and, but I heard so many people talking about it and saying that on podcasts and in the, in our running world. Yep. So what does running injury, how does running injury happen? Yes. That's one one thing. That's one thing. That's about actual training load. Yeah. And how we load the body and yes, that can impact injury. We see that in the research. But right. Running is multifactorial, like running injury is multifactorial, which means it, IM is impacted by our stress, how much we sleep, whether or not we're eating enough. Timing of our nutrition

Speaker 3:

Yep. Is

Speaker 2:

important. It's about, strength and resilience and consistency. And, how, so how we look at our entire week, it's about have we had a previous injury before and did we rehab it appropriately? And all of these things matter when it comes to running injury. And that's why it's 80% of the population. Because even though we're looking for one quick fix, there isn't one. it can be any of these things. It can be related to shoes. It could, so it's a really hard question, why do we, why are we run or why are we injured?

Speaker 3:

Yeah.

Speaker 2:

But the reason is it's different for everybody. It's individual and it's multifactorial.

Speaker:

Yeah. But. Kate, nobody likes nuance. Come on. that's not, Instagram worthy, right? Like I know it depends. actually, right? Like everybody, and that's, but that's the culture that we're in. I think that's the problem, right? Everybody wants to point to one thing. Everybody wants to know the answer when there's not one answer. There's not one answer for one person, let alone one answer for every person. Like even if you look at one runner, it's not like there was one reason that runner got injured.

Speaker 5:

Oh, no, absolutely not. In

Speaker:

that one runner, there's probably multiple things, at least a handful of reasons that led to that injury and probably a handful of Weeks and months and years and God knows how, you know how long Yes. Leading up to that injury too. And I think so many people forget to address these things. And this is one of the big things that like will get me going, put me on a soapbox because it's like, me too. They're as physical therapists or as special as medical professionals. We are often told to stay in our lane, right? Yes. We are told that this is your zone of practice. You treat movement, you treat the body, you prescribe exercise, and I'm like, y'all that. It's not that simple. We know, and I'm sure you have plenty of athletes that have just come into your clinic time after time with the same darn thing because they're not addressing. The other things that are at play here, sure, we can give you calf raises and calf stretches and some clamshells and like the exercises that you need to strengthen the muscles. But if you're not eating enough, if you're not getting enough sleep, it doesn't matter how many exercises you're doing, you're still gonna be getting injured.

Speaker 2:

100%. Yeah. And as physical therapists, our number one thing that we say is, it depends. And people hate it so much. I know. I know. And I say it every time I teach. Yeah. I say it all the time. But it's true. It really does depend. And it's so much messier. Look at, humans are messy. Our emotions are messy. Our movement's messy. We're just messy. And that's what injury is. Yeah. And we just have to accept it. And yes. it could be your biomechanics, it could be your strength. Yep. It could be your mobility and how your training load. All of those things are important. And those are all things I'm going to address with you as a physical therapist. But that doesn't matter if you're not meeting your basic needs. It just doesn't, and it's not easy to address your basic needs. It's not easy to do the things that it takes sometimes. But we have to decide is it worth it?

Speaker:

absolutely. and tying this back into. Our athletic identity. a big piece of injury is stress management. Yes. And what's going on with our nervous system? Because like your nervous system will regulate how your body's able to shift over into recovery mode. So if you are just overloading the body day after day with training or. Restricting your food or not getting enough sleep or just a lot of stress. because I think that a lot of runners also see running as stress relief. They see it. Yeah. Some people say it's therapy, but almost pro. I would say almost every runner, like I don't like to make too many generalizations, but most runners I think will tell you that running provides stress relief and it does. It totally does. Yes. But what they don't realize. Is that if you're going out and running the majority or all of your runs, in some cases at an effort level, that's too high. If you don't understand, training by effort level and understanding how important easy runs are and those kinds of things, and you're going out and you're just pushing yourself every day. You might feel better right after the run because of the stress relief, because of the hormones that we talked about before with the serotonin and the dopamine and those kinds of things that get released. But overall, you're increasing your stress load on the body, which is then getting you closer to injury, which is then gonna put you in the direction that you don't wanna go.

Speaker 2:

And if you think about it, I always say stress is stress. Yeah. So your body can't tell the difference between a 20 mile run. And if you are having financial trouble, or if you're moving, or even if it's good stress, like you're getting married, your body doesn't know the difference. So we have, like I always say, you have a bucket and you put your mental stress. In there, you put your emotional stress in there. And you put your physical stress in there and that physical stress is what you talked about, like your actual training And the load on the body. But at some point it's going to overflow. Yep. And when it overflows, it doesn't matter which one of those stresses you put in the bucket. It just matters that it overflowed.

Speaker 3:

Yep. And

Speaker 2:

that's what we're really talking about. And then there's this other piece of putting stress on yourself to complete your training schedule. So if we are told, a lot of times, if we say, okay, my coach said I have to run five times this week, and you've got all these things going on in your life, in that fifth run, you're stressing about getting it in. Yeah. Now, is it useful? I don't know. Probably not, because now you've added so much mental and emotional stress into that bucket. that physical stress might throw you over the edge. So when we're looking at running injury, we're looking at all of those things. And we're looking at not in one day, we're looking at three weeks, six weeks, 12 weeks before that. And how it's all, accumulating.

Speaker:

Yeah, absolutely. I'm smiling because I use the exact same analogy with I love it. All of my. All of my athletes, my stress bucket, like all of my clients will tell you. they'll tell you about the stress bucket.'cause that's one of the best things I think, And we have to figure out how to poke holes in the bucket. We need to figure out how to relieve the stress before it overflows, because the overflow is what's gonna lead to the pain and the injury in the burnout that so many people experience. I think that this is one of the reasons why it's so important that we as healthcare providers and running coaches and even just, even if you don't have a professional that you're working with, which why don't you first of all like work with a coach or a physical therapist or somebody like you. You need people on your team, Yes. Why it's so important for us to treat the person as a whole rather than just the body part. Right? People are like, oh, what exercises can you give me for my Achilles issue? And I'm like, it's not that simple. sure, I could give you some stuff, but if I just give you exercises and we don't address the whole thing, yeah, the likelihood of that coming back is very high.

Speaker 2:

Exactly. So we know that eccentric loading of the achilles tendon is really important. And improves the outcomes of Achilles tendinopathy. But then also, what about, like you said, the nervous system? So I think about when I even talk about like neural mobility in the body, I still think of that as, okay, that's neural mobility, but. That nerve runs through the thoracic spine. The thoracic spine, and its impact on breathing. So we think about the mechanical stimulus of breathing, but then also the vagus nerve. Yes. And then what's happening? so it all is related and it's just we've tried, I think in the medical world what's happened is things have been divvied. All over the place For so long. Yeah. That it's become tunnel vision. And when it's tunnel vision, and like you said earlier, we have to, stay in our lane. yeah. We do have to stay in our lane to some extent. But a lot of it overlaps. Like lifestyle medicine right now is what we do as physical therapists. Absolutely. Yeah.

Speaker:

Yeah. Absolutely. And I think that It is interesting, and I think that is one of the breakdowns of the medical system, the Western medical system, is that they have, on one hand it's very good, right? Because we have all these specializations, we've got orthopedic surgeons, and we've got, neuro neurologists and all sorts of amazing people that are experts in what they do. But I think that we're, that in a way makes it even worse because. Even those specialists, when you go see them, they just will, sometimes they won't, not, won't even recognize that there's something else going on because they just wanna do the surgery and other times they'll just refer you and then people are just going from this doctor to this doctor trying to figure it all out and they just need somebody or something to help them bring it all together. And I think, that was always my goal as a clinician. It still is my goal always as a clinician is helping them see how all these pieces fit together and how. The other things in their life are really impacting their recovery.

Speaker 2:

I think that's what I do best. Yeah. Is just absolutely being the one who's driving it and looking at everything and bringing it together and Yeah. If I need to refer someone'cause I work multidisciplinary teams all the time. I love that. and I will refer, but first I'm going to look at the big picture and say I'm not just gonna send them to somebody to send them, I'm gonna send them because they have X, Y, and z. That means they need to see them. so I, I think that's a really important piece and that's what, I do well in my clinic does well, and I think actually that the idea of running medicine, so people don't really know that it's fairly new. So I had to explain it the other day to an agent, a running agent, and so I was like, okay, running medicine is Orthopedics, but for runners, but unlike orthopedics, we zoom out. And we look at the big picture. Yeah. Put all the pieces together so that we can figure out this injury in front of us.

Speaker:

I love that. And so who do you have on your multidisciplinary team?

Speaker 2:

Yeah, so it depends. So for the Atlanta Track Club Elite, so we have a sports psychologist, a sports dietician. We have the running coach, we have director of high performance, we have a chiropractor, we have physical, my whole physical therapy team. And we have two physicians, a female physician and a male physician. Both are, one is primary sports med and the other is sports med and orthopedics. So it's really cool because we actually talk every Wednesday. and go through how can we help all of our athletes. I love that in different ways. And so we actually just started this year, our initiative was to really initiate red screening from the get go and have everybody go through. Specific Red's testing. Yeah. And we are tracking all of our injuries and, red's information in the front. And we're looking at, and we're using the Red CAT two, which is just a que like basically a system and how to, how to decide if runners are at risk. And it's a red light, green light system. Oh,

Speaker:

fun.

Speaker 2:

So it makes it pretty easy because you can say, okay, these athletes are in the yellow, these are in the orange, these are in the red or the green. And who do we need to follow and what changes do we need to make before they get injured?

Speaker:

I love that. Can you just, you were talking about reds. Can you just explain that for the listeners in case there's anyone that's unfamiliar.

Speaker 2:

So relative energy deficiency in sport. And so essentially what it is, it's a constellation of symptoms that impact all of your body systems. So what happens a lot of time people get lost in the medical system because they have GI issues, they're having a hard time. Sleeping. Yep. Their performance maybe is, is impacted. They are, maybe they have a bone stress injury and all of these things can fall under reds and can be signs and symptoms of reds. But if you don't understand that's a possibility, then what happens is you get shifted around and sent to a lot of different people. So reds is really. it can be a diagnosis of exclusion, but that's why looking for it early on and noticing any signs and symptoms help us to prevent on On the, on the backend. Yeah. And a lot of times we talk about, for female athletes their cycle. So if you've lost your cycle, that is a huge indicator that you're far into reds already.

Speaker:

Yeah. So reds is relative energy deficiency in sport. How do we. what does that mean exactly for people that are maybe, oh, sorry. No, it's okay. Like I just wanna like really break it down to a simple level is

Speaker 2:

No, I'm glad. Sorry, what? What

Speaker:

leads to relative energy deficiency?

Speaker 2:

Low energy is, has to do with nutrition specifically. Yeah. So not getting enough calories is really where it starts. So when you don't fuel your body appropriately And then it starts to set off a cascade of issues, when it comes to your hormones and your endocrine system and the rest of your systems. Yeah. In your body. So it's really about. Getting enough fuel and timing your, is also timing your fuel appropriately because there is some research that says that if you, even if you're eating enough calories in total, if you're not timing them around your exercise, you're also at risk for reds.

Speaker:

Okay. When you say timing around exercise, you mean before, after, or both?

Speaker 2:

Both. Yeah. Yeah.

Speaker:

Yeah. and also carbs. So it's getting, say that again. And also carbs. Carbs, yeah. And making chicken. carbs are your friend as a runner, right? Yeah. To take this one step further, right? Knowing that losing your cycle is one of the hallmark signs of reds, that really starts to point us more in that direction when it comes to females. But I work a lot with women over 40. Yeah. And we're getting into perimenopause and Yes, post menopause, right? And so they are losing their cycle just because it's that time, right? Like it's that time of our life, right? Where that's what's happening. We've got our estrogen levels declining, we've got, things going on hormonally. Because of that. How do we know if is, if, is this perimenopause, is this reds, like what's going on here? and how important is fueling in perimenopause and menopause? Because there's a lot of women, that start gaining weight because of these hormonal changes, especially around the belly. And what's the first thing they do? Restrict calories. Restrict their diet.

Speaker 2:

Exactly. Yeah, I know. And actually this is a really interesting time. For the menopause transition because we actually have research now and amazing.

Speaker 5:

I

Speaker 4:

know. It's imagine I love it. And so there's so many more than half the population that experiences it,

Speaker 2:

oh, I know. It's, I know, it's crazy. This is a soapbox we could go on for sure. when it comes to this menopausal transition, we finally have research. It's not. It's changing every day. Yep. But we know that when we're looking at reds menopausal, or people in the menopause transition are very, susceptible to reds because, they're trying to restrict calories because of weight gain. Yeah. And we have to look at it as the constellation of symptoms. So losing your period is a sign, it's actually. If you've lost your period, you've, you are way past. You've definitely been in reds for a long time. Yeah. So we really shouldn't use that as a sign. So we can actually even take that off the table. It's the other things. It's the, and unfortunately some of these symptoms are, symptoms of, changes in your hormones, Because you're in the menopause transition. So it can get super convoluted and Exactly. complicated. But it is. So brain fog is actually a sign of reds, but it's a sign of. the menopause transition, right? Yep. So it's just having somebody to talk to, again, this is where you have that point of you need someone on your team. Having someone to talk to, to look at all those signs and symptoms Yeah. And also how you're performing

Speaker 3:

And

Speaker 2:

putting them together. Yeah. And seeing like how many of those risk factors do you have and how many are maybe because of the hormones. It's really, and again, this is, it depends, it's based on you individually.

Speaker:

Yeah, and I think that's where it gets so complicated, right? Because, and that's one of the reasons that I wanna keep talking about this because totally women don't understand that it could be both. some women are going through this and oh, it's probably just perimenopause, and they get blown off by. Their healthcare practitioners or whatever they're seeing on social media, and they're like, I guess this is just perimenopause, I gotta put up with it. And it's no. And also you don't have to go directly to hormone therapy either, right? Because then there's so much on social media right now about hormone therapy. Which can be a useful thing for some women. Yes. And it has been demonized for the past 20 years, and I'm glad that we're talking about this more and I'm glad that people are seeing this as a useful option for them. Yeah. But that's not where you have to go right away, especially if you're an athlete. And this is one of the big things that I think it's important for us to know as runners. Is that we are weirdos. Oh my God, I love that. we're not the general population, right? No. The general population is sedentary. Yes. And unfortunately, the majority of the general population is overweight or obese. That's not the running population. And so the same rules don't apply for us. That's like the whole like eat lesson, move, more narrative that has been propagated for decades. That's not what's right for us as runners. Can you talk on that please?

Speaker 2:

Oh, there's so many places to go. So many places.

Speaker:

I know. This could be like a two ea, two hour podcast. Easily.

Speaker 4:

That's okay. We like Rich Roll style.

Speaker 5:

We should just, meet

Speaker 2:

halfway. Yeah. And get

Speaker 5:

some coffee and just record. That could be like, it'll be an eight hour podcast, probably. Perfect. I've

Speaker:

got a, I've got a. Seven hour drive to Tallahassee tomorrow. So for the Hey, cross country state meet, we'll just start recording. That's right.

Speaker 2:

So when it comes to, women in the, in the menopause transition, we do need to eat. We need to eat, we need to fuel our body. We need to eat before we exercise. Stacey Sims talks so much about this, and Celine Yeager. The feisty network, they're really great when it comes to education around menopause. Yeah. Especially, women who are exercisers. And we know that fueling is one of the number one things. We are losing muscle mass. Yeah. And to combat that, we need to eat protein. And, but also we need to eat carbohydrates to fuel our body to keep. Going forward when it comes to endurance exercise and, bone stress injuries are linked to not enough carbohydrates and bone stress injuries are very common in this, in our population as well because of the caloric restriction. And because if they had, if they were restricting earlier in life, if they were ever on, if they ever. Or breastfeeding or if they ever had to, do IVF or any of those things that changes how, how our bones are and if they weren't doing strength training early on in life. So all of those things matter right now. And yeah, we need to fuel our body. We need to load our body, and we need to make sure that we're paying attention to all these things, but. We don't wanna stress ourselves out either.

Speaker:

exactly. and that's where it gets complicated, right? Because it's oh my gosh, I have to eat this and run this and sleep this amount. Like the, especially like with social media, it's like you've got coming at you from all angles, right? And it becomes more stress on you too, right? Like we, it. Completely to sim We have to simplify things too for people,

Speaker 2:

and that's what I do. So I it sounds like this is exactly what you're doing with your clients. Yeah. But that's what I do with my clients as well, is I'm like, okay, I know you've read all this stuff and all of this research is great and I'm so glad that we have it.

Speaker:

Yeah. And that you're educated, let

Speaker 2:

look at you. Yes. And you're educated, but let's look at you. Okay. If you are spending all of this time trying to, do all the things you've read about and seen on Instagram, you're actually making yourself worse. Yeah. Because you're so stressed out. So let's pick one thing at a time. Yep. And start there. Yeah. let's do, okay. Maybe you put some protein in your coffee. Some people don't like that because it makes it like. It's gross. So don't do that then. Or maybe you pick a certain kind of bar that you can grab before you, before you eat, or I mean before you exercise instead of planning a whole meal for the whole week. And trying to get that in. So there are little changes you that you can make that can simplify it. don't focus on all the things. Focus on one thing at a time.

Speaker:

Yeah, absolutely. And I think it's so funny'cause some of my clients will come to me and I tell them. you need to run slower and eat more. And they're like, huh? Yeah. Wait, what? I came to you'cause I wanna get faster. And I'm like, I know. I understand yes, but like you're not eating enough to support. The goals that you have and the training that you wanna do, and you're running all of your runs too hard. So you're just putting so much stress on your body and not giving yourself enough recovery. So I actually need you to eat more and slow down and take more rest days. And they're like, what is happening right now? Like it completely throws people off because we have this mentality of like more and more. Like more is better, harder is better. And I think that's such a destructive mentality. Going back to our athletic identity right at the beginning. Nice. that's a big piece of what we were taught as athletes. Whether or not you grew up as a runner or as a team sport athlete. like me, do doing ball sports. It was like always give 110%, no pain, no gain. And people try to apply those same things. To their running especially to their running in their forties, fifties, and sixties. And that just doesn't work. Like it might be helpful every now and then, like in the middle of a race, right? pull out that no pain, no gain, right? get yourself that, that race time that you want, but not on your 10 mile easy run that you've got going on.

Speaker 2:

No. There is a place in time for you to push yourself and for you to push yourself hard. Absolutely. There's no question, and I don't want people to think that's not what we're saying, like we want you to push yourself and reach your goals, however, to get there, a lot of times I spend my day telling people to do less as well. Okay. Back it off. And then the most amazing part though is when. It works. And yeah, and you can change that mindset and you can show the results. So many people do PR when they give themselves enough rest, And they give themselves enough fuel. And it's the people, and we actually are seeing this on Instagram. Some of the professional athletes now are talking about that. Like Emily Infield has been talking recently a lot. About how she's fueling her body better and she's feeling better. And so we just need more people to talk about the fact that often you have to do less to do better.

Speaker:

Yeah, absolutely. Oh my goodness, this has been so much fun. It has. I feel like I said, we could just keep going all day long, but I wanna respect your time and the time of our listeners. So even though we've talked about lots of different fun things today, is there anything else that you feel like we haven't addressed that you wanna leave our listeners with before we wrap up?

Speaker 2:

I think we really did a good job of looking at go us Yeah, go us of looking at runners from like that holistic standpoint. Yeah. Yeah. I do think, we didn't talk a lot about strength training or a lot about biomechanics, but because we're both PTs, I think it can be assumed that we do all those things. And that those things are also important. It's just we're having a conversation about all of these other things because they're not talked about and they're not taken seriously.

Speaker:

Yeah. I feel like that's a pretty good reason to have you back on the podcast. Then we can talk about the more technical biomechanical stuff if people want that too.

Speaker 5:

That would be super fun actually. Yeah, I was just doing that yesterday. That's awesome.

Speaker:

Yeah, our episode this past week was all about like hips and single leg control.'cause I don't always do a ton of that.'cause I like to dig into some of these other topics that people don't talk as much about, but. that's, that part's important too, right? Yeah.'cause we want you to be able to push yourself safely. Yes. And we want that when you do push yourself for it to actually be effective. And if you're not addressing all of these other things, you're just pushing yourself and you're not getting the bang for your buck, essentially. Like you're just pushing yourself, but you're. Either spinning your wheels or even moving backwards in some cases, and that's not what we want. We want you to be able to push yourself and then see the good results of that, and that requires a lot of this other stuff we talked about.

Speaker 2:

And so if you're going to do a lot of, or spend a lot of time in the gym and working on your single leg strength and working on your biomechanics, it's wasteful if you're not taking care of all the other things first. it's, I shouldn't say it's completely wasteful'cause you will get some benefit from it. But doing the things here where you're taking care of your body Yeah. Can only help the other things that you're doing.

Speaker:

because there's so many times I've, people come to me and they're like, I'm doing all the things, but I'm not seeing the results. And I'm like, okay, let's take a step back then. Yeah. what are you doing? How much are you doing? How often are you doing it? How much sleep are you getting? Like all these other factors that we talk about because it's very frustrating when it feels like you're putting in the work and you don't get the results. And it's a lot of times these things that are maybe more hidden that people don't always relate to their training, that are playing some of the biggest roles in it. Absolutely. Kate, thank you so much for being here. How can our listeners connect with you if they want to learn more from you or reach out?

Speaker 2:

Sure. So you can go on my Instagram or my website. They're the same. It's Kate Miek Edwards and mi is spelled M-I-H-E-V-C. So it's kate mi edwards.com. And then, that's my Instagram handle and all of the things that I do are on my. Site because it's just easier to put'em all in one place. Yeah,

Speaker:

exactly. and we will link all of that in the show notes as well. So those of you that are running or driving right now and didn't have the time to write down that middle name, you can probably also search up Kate Edwards and Pro probably find you as well. Yeah. But I could put running

Speaker 5:

and running. It'll probably come up just running and

Speaker:

Kate might even. Exactly. So we'll put all that in the show notes though too so that our listeners, can connect with you. Thank you so much for your time. This has been so fun.

Speaker 2:

Yeah, this has been great, Angie. I really enjoyed it.

Speaker:

Me too. All right. Talk to you soon.

Speaker 2:

All.