>>rich: alright guys, thank you all for comingand whoever is on vc thank you very much as well. i wanted to introduce you all to dr.jordan metzl. he's here today to talk about his book "the athlete's book of home remedies".it's a terrific companion book for you guys to make sure that you're not going to hurtyourself like i did. but he's going to be here today to talk about all of his tricksand wizardry. but i wanted to read you the dedication of the book: "this book is dedicatedto the millions of athletes who wake up each morning at 5:30 with no fanfare and drag themselvesout of bed to keep fit. whatever your level or ability, may the information in this bookhelp you pursue your goals. the most important thing you can do every day is to keep movingforward." so with that and without further
introduction, i want to introduce you to,and it is his birthday so please be gentle on him, dr. jordan metzl. [applause] >>jordan metzl: thanks. rich, thanks so muchand it's great to see everybody. what a cool place. i mean i feel like i'm not nearly coolenough to be here. but it's a pleasure to be here, to be down to google. and i takecare of a lot of you guys when you hurt yourselves, up in my office and it's a pleasure to downhere and people conferenced in out in california or wherever else you are; the concept we'regoing to talk about today is how to keep yourselves moving and active and injury free.
so with that, i'm going to talk about this,which is about a three year project i did called "the athlete's book of home remedies"the concept being that i want you to stay active every day of your lives, starting nowfor as long as you go. and so we’ll talk about some of the themes about that. first thing is my website here, which is available,for the last five years i've been doing the medical column for triathlete magazine. havepretty much one pagers on everything related to running, endurance sports, anything, shinsplits, bonking, knee pain and those are kind of free. also have a number of videos availableon my site, and there's a newsletter we put out about four times a year. we don't sendyour email to anybody, so no spam, i promise.
although guys' spam filter's pretty good soi don't think it matters anyway. but, certainly happy to have you guys sign up. there's alittle registration tab. i'd be happy to have ya. now, let's talk about what we're going totalk about today. and that is that exercise is very much medicine, exercise keeps yougoing, exercise keeps you young, it keeps you healthy. and i want you to exercise everyday. now, part of that is what do you do to make that happen. so, this is a picture ofme at the iron man several years ago. i try and do one marathon and one iron man a year.for those of you who don't do iron man, you don't have to do the iron man but if you'reinterested, it's about a 2.4 mile swim, 112
mile bike ride and then a marathon. and thefirst question is, why the hell would you do that? and the answer is that i deeply believe,number one in goal setting and number two that basically it is about meeting a goal.everyone needs something that pushes them further than they think they should go. andyes, fitness is a great thing to think about in theory, but without a goal to do that,it's very difficult to make yourself take that next step. so if you're goal is doing a big swim, doinga ballroom dance competition, doing a 5k walk in the park, whatever it is you wanna do,the goal, you should set a goal for yourself. so we're gonna talk about how you meet yourgoal and i always have this, this is actually
my screen saver at work. for example thismorning, just to try and get down i had about 15 patients in the office, the last guy waslike "dude, i've gotta go to my thing, i'm late, come on" and started yelling at my nurses.well, i don't get many of that in new york but every once in a while i do and i theni just look at this and my god, this was mile 17 of the run. i'd already done the swim,the bike. it was about 90 degrees, the sun was going down and i was like i got 6 milesto go, i'm gonna finish this thing and most importantly my brother, jamie, who i do thesewith, is about a mile behind me and i'm gonna beat that guy for the first time ever. soi was pretty psyched about it, and so that was my goal. and so, i think the concept ofthis kind of stuff is it gives you some place
in your own psyche, of like i'm having a toughday at work, i'm having a tough time in my life and yet this is a goal that i've beendoing. so, i deeply believe in that stuff. so i think the concept was actually outlinedby the roman poet, juvenal, many thousands of years ago. who talked about, 'it shouldbe prayed that in the mind, the mind be sound in a sound body'. so, copore, 'mens sana incorpore sano', sound mind in a sound body. they go together and here in this great environmentwhere you guys have created such an incredible workspace to be creative and think about things,i know in the place out in california there's exercise facilities as part of what you doout there. you're all encouraged to be active and healthy, and that's part of healthy mind.and so i think these things go together very
much so i applaud you for the way you setthat up. let's look at the united states. 1985 in theunited states, states reporting 10-14% obesity are in the darker blue, less than 10% in thelighter. but let's look at the united states 86, 87, 88, 89, 90, 91 now darker blue, 15-19%92, 93, 94, 95, 96, 97 now greater than 20% 98, 99, 2000, 2001 greater than 25% obesity,2002, 2003, 2004, 2005 now greater than 30% obesity in the south east, 2006, 2007, 2008,2009. so basically, if you want to be thin, move to colorado. that's the bottom line ofthis. but as you can, we’ve had this march of obesity across our country. and this isan epidemic affecting everybody and part of the problem with the way we set up our healthcare in the united states, and if you've been
following this, we're going to hear more aboutthis in the next day or two from the supreme court. but we have a fundamental flaw in the waywe do business in the united states and that is that our system which spends billions ofdollars, more than you know about 15-16% of the gdp, estimated to go up 17-18%. the problemis we treat disease. so if you come in to see somebody with a heart problem and youcome in for your annual visit, they put you on medication that's paid for by your insurancecompany. then it goes on over time, and you need several tests that’s paid for by yourinsurance, you get a catheterization, that's paid for. you eventually get open heart surgery,that's paid for. your cardiac rehab, that's
paid for. yet we spend almost no money payingto prevent the problem before it happens. and so we have this concept of incentivizingdisease treatment, we basically treat and pay for disease, which is totally counterintuitive. now we do some great things in america, likecompanies like this, but we do have some problems in the way we think about things. in germany,for example, if you have a cavity, you have to go every six months to the dentist. andif you have a cavity and you've been going to the dentist every six months, the statepays for your cavity. if you have a cavity and you've not been going to your annual sixmonth checks up, you have to pay for your own cavity. and so the concept of incentivizinggood health behavior makes a ton of sense,
yet we really don't do it. so since our governmentchooses to incentivize things like home ownership or marriage or kids, we incentivize differentbehaviors just based on our tax hood. we've not, we're not at the place yet where we incentivizewellness, though i hope we are at some point. at this point the responsibility is all ofyours and all of yours out there. and so you have to think about incentivizing wellnessbecause exercise is very much medicine. so with that, i'm gonna show you why the casefor medicine is so significant with this great video which i brought along for you guys particularlybecause i know you'll appreciate how this is done. so let's look at this for a coupleof minutes to then get to the basis of what the book is about. now, on this— there itis down there.
>>dr. mike evans: hi i'm dr. mike evans andwelcome to this visual lecture i'm calling "23 and a half hours"- >>jordan metzl:--any suggestions from backthere? alright hold on, we're gonna, i want this to work so badly i'm gonna just minimizethis. we are having some technical issues, let's watch this quickly on this thing. [pause] >>jordan metzl: this will enlarge that? >>mike evans: hi i'm dr. mike evans and welcometo this visual lecture i'm calling "23 and a half hours" so i have a big interest inpreventive medicine, you know which can mean
a lot of things from cancer screening to eatingmore fiber to having a good social network, and i mean that in the old sense of the word,weighing less, drinking less, smoking less, controlling your blood pressure, cholesteroland so on and so forth. so all these things are incredibly important, i wouldn't wantyou to minimize your efforts in any one category. but i want to know what comes first, whathas the biggest impact, what has the biggest return on investment. [cash register cha-ching] >>mike evans: what makes the biggest differenceto your health? so i did my research and i found an answer at least for me and it's tricky,cause you know all these things are sort of
overlapping. but i picked up this interventionbecause of its breadth, it worked for so many different health problems and that's whati found so cool about it. so just to kinda walk you through a quick list, so this interventionin patients with knee arthritis who receive one hour of treatment three times a week reducetheir rates of pain and disability by 47%. in older patients, it reduced progressionto dementia and alzheimer's by around 50%. for patients at high risk of diabetes andcoupled with other lifestyle interventions, it reduced progression to frank diabetes by58%. post-menopausal woman who had 4 hours a week of the treatment had a 41% reductionin the risk of hip fracture. it reduced anxiety by 48%. in a big meta-analysis, patients sufferingfrom depression 30% were relieved with low
dose and that bumped to 47% as we increasedthe dose. following over 10,000 harvard alumni for over 12 years, those that had the interventionhad a 23% lower risk of death than those who didn't get the treatment. it's the numberone treatment of fatigue and of course, the kind of outcome of choice there, my favoriteoutcome is called quality of life which is really all of the above. [ascending harp chord] >>mike evans: and really about making yourlife better. and this treatment has been shown over and over again to improve quality oflife. so, the question is what's the medicine and what is 23 and a half hours? so, the medicinewas exercise, mostly walking.
[high chime] >>mike evans: so not triathlons and let mejust put it a different way. what i think i'm asking you to do is if you think aboutyour typical day so there's 24 hours and so you might spend most of your day, you knowthis varies obviously, but you know couch surfing - [boxing bell, computer keyboard keystrokes] >>mike evans: -sitting at work, obviouslysleeping. and what the evidence that i'm going to show you kinda tells me is, the best thingyou can do for your health is to spend half an hour of being active-
[clock ticking] >>mike evans: - maybe an hour and that ifyou can do that you can realize all the benefits i've described in the previous slides. solet's just take a quick walk through some of the literature. so steven blair, he's aprofessor at the arnold school of public health at the university of south carolina, and helooked at this in what's called the aerobic centre longitudinal study, which followedover 50,000 men and women over time and along the left side of this graph is something calledattributable fractions which is kinda fancy word but it's the estimate of number deathin a population that would have been avoided if that specific risk factor had been erased.so for example, turning a smoker into a non-smoker
or couch potato into a daily walker. and alongthe bottom is the typical risk factors, you can see that hyper-tension's incredibly importantand so on so forth, but the one that was most, that kind of implied the most risk was thissort of mysterious crf, which is cardio respiratory fitness, which is really low fitness. so lowfitness was the strongest predictor of death. and this important that most of the trialswe see, to be honest, are funded by pharma or other companies because they’ve got adrug for hypertension or high cholesterol or diabetes, we rarely see fitness throwninto the mix and so it's nice to see a trial that's not so siloed. [bicycle bell]
>>jordan metzl: the concepts of that, theconcepts of that i think are very helpful. and i apologize if our, i may have to switchback and forth here a couple times. this was made, our hospital does not support ibookyet, so unfortunately i had to design on my old dell. alright, so, we're gonna talk about what ido now. so hopefully i've convinced you that you gotta move. you gotta move every day andit's gonna be helpful for you, it's gonna be helpful for everybody around you, it'sgonna be helpful for your job, for your life for everything that you do. that you'll setsome goals for yourselves and make that happen. now let's talk about some of the pitfallsof what you and so that you don’t get hurt
and then at the end i have promised i willanswer your injury questions. so i'm sure we have plenty of runners and people withplantar fasciitis and iliotibial band syndrome etcetera. here. and you get to ask your questionsas soon as you're done listening to this stuff. alright, so what's my job? well my job isbasically to make sure people make good decisions about their fitness and activity. and i tookthis picture when i was out giving a lecture in wyoming last summer. and so i was out injackson, wyoming and i saw some bright lights down the road. and in fact there was a rodeodown there. so i walked down there and i was like alright, well i live in new york citybut i can appreciate a good rodeo probably as much as the next guy. and they had likethe horses and the bulls and all that stuff.
but the first thing, the next night i wentback there actually, i saw the demolition derby the first night. the second night theyhad one pen full of kids and one pen full of sheep. and my immediate thought was whatevercombination these two things are gonna combine is probably not gonna be a good combinationand in fact, they would take one kid, put a bicycle helmet on this kid and put him ontop of, or her, on top of a sheep, put a rope around the sheep, open the gate and they hadthis wyoming fan favorite called mutton busting. and no kids were harmed in the making of thisslide, but basically these poor kids are holding on for dear life, between kinda 6 and 10 yearsold and i immediately thought this is probably not the best use of childhood fitness andactivity incentivization but yet everybody
was ok in this. so my basic job is to helpmy patients be active and help them understand when they're doing something stupid. and thati thought was probably something a little bit stupid.so how do you do that? and so when i see somebody, we see a couple different categories of injury,number one is called an acute traumatic injury. so i just got a call on sunday, actually iniceland, from one of my patients who's getting ready to be in the olympic trials for gymnasticswho i've taken care of since she was quite small. and she landed and hurt her wrist soi was worried about an acute injury like a fracture. and so sometimes athletes need toknow, be they an olympic athlete or somebody just getting ready for whatever, you know,is this twist of my knee that i did something
i have to worry about and how do i know? andthen, more commonly, about 90% of injuries in sport medicine are what we call overuseinjuries. so it's not one thing, but it's i've been training for the marathon and myshins start to hurt or my knee starts to hurt or i'm swimming a lot and my shoulder hurts.and how do you recognize when one of those injuries is more serious? and the answer iswhen pain changes your mechanic of movement then i start to worry about those kind ofinjuries. so i'm gonna just make some comments on running,i know here in new york city, this is certainly is the most common. who's a runner here? let'ssee, we've got some, yeah i know and i see a lot of you runners in my office. and i'msure out in california you have even more
runners. and so i'm gonna talk about runningin particularly and some of the common things that we do and i'm just gonna make a couplecomments on running and then we'll do some questions. so what does it take to basically make youa healthy runner? and i'm gonna talk about gear, goals, injury recognition and then lastlythe important part, which is prevention. prevention of running injuries so you can keep moving.so we've seen a lot recently about new trends and fads in running gear. and basically runningis a great sport because it's so inexpensive. all you need to do is buy a pair of runningshoes. just curious, who's read the book "born to run"? several in the room and so the conceptof this book is basically that less is more.
that by minimalizing or giving you a pairof minimalist shoes or even this shoe on the left here called a newton, which tips youforward a little bit, you can basically shorten your stride and quicken your cadence. andthe answer is, the answer is that we think that's probably true that having a highercadence and a shorter stride is much less injury producing. so what you should be doingis, you don’t need to be buying minimalist shoes to do that, just try shortening yourstride and quickening your cadence. and certainly some shoes, such as like the five fingeredtoes shoes can help make that happen in the short term and i can answer questions abouthow to know if you want to do that or not. but the overall concept is that a shortenedstride and a higher cadence is a good thing
to start thinking about for basically reducingyour risk of running injury. what about goal setting? well i think goalsetting is very helpful and some of the problems we see from goal setting are, well first ofall not setting goals at all. so you definitely want to give yourself a goal, whatever thatis, a 5k race in the park. you're lucky to be living in new york, i was surprised howgreat the sports scene is in new york. for those in california, you know, they're kindaspoiled because they can roll out of bed and go do a big bike ride right out of their door.but we have an amazing sport resources here in new york and probably the best runningclub, the road runners club is probably the best road running club in the world. and justamazing races every weekend all over the place
and so it's been a great place to do. so youwant to give yourself a goal and the concepts of some of these charity programs have convincedpeople you can train for the marathon in three months and not get hurt. and the answer is,that you know, unfortunately that’s a huge part of my business even though i try andteach people how not to come in to see me. but unfortunately these people say alrighti can do the marathon in three or four months and the answer is that most people can't,they get hurt because they don’t have enough base training or experience. and they’venot gone through the building phase of how it takes to build strength, bone strengthand muscle strength which we'll talk about next.
now what this guy taught us was that basicallynot every body is built for everything and some bodies are built better for some sportsthan others. and so if you have a running body, and for girls, that's probably, or women,that's probably about 5'2 and 90 pounds and for men, it's about 5'6 and 120 pounds. andif you don’t have that body, which basically almost nobody does unless you're an amazingkenyan marathon runner, then you have to change the way you train and change the way you thinkabout what you're gonna do. now, i think nothing i can tell you illustratesthis point as well as this video. which hopefully this will work. this comes every year in japan,they have the running of the sumos and these guys are built, these guys are built exceptionallywell for sumo wrestling but they're not built
very well for running. so were going to seewhat this looks like, hopefully. oh come on dude. i gotta pull out the sumo, i'm sorry. [pause] i won't pull up all but i gotta pull up therunning sumo. where is he? here he is. so this is what the running sumo looks like andthe concept of the running sumo which is pretty dramatic footage. in japan they do all kindsof interesting stuff and having their sumo wrestlers run down the street and video tapethem, it's one of the interesting things they do. so this guy's really not built for running,i'm sorry to tell you. that’s not what you want to look like. this guy's built greatfor sumo wrestling but he's not built for
running. and so the concept of this is thatnot everybody is built for every activity. and basically darwinian selection will kindof tell us what you're built for. so the further, the concept is, the further you are from theidealized running body, the more problems you're gonna have.so the optimal training program, as far as i'm concerned is a gradual build, some combinationof mileage and strength training and cardiovascular training all the while. you can't run everysingle day, nobody can. and you wanna have a good time. so let's talk now about injury, which is sortof the thrust of what the book's about. about recognizing and preventing injury and so iwant you to think about when an injury is
serious. and the answer is if it's a baseballplayer, if it's a runner, if it's a swimmer, a gymnast, i ask my patients the same thingof any age and i take care of people from kinda 8 year old elite level gymnast to kindof 85 year old lady that ran a marathon this year. and the commonality of all these isthey want to be active and move. and i want them to be active and move. so, when an injuryis serious, is it changes your body's ability to do the sport regularly. so if you couldthrow a baseball well but then your elbow hurts cause you're throwing the baseball improperly,i wanna see you. if you're running and your shin is hurting so much that you can't runproperly, i wanna see you. so the mechanic of movement and the change in the patternof the mechanic of movement is really the
key issue that i see when an injury happens.so when it comes to running, i wanna talk to you about three things; training and youranatomy and the biomechanical factors that go into injury and i'm gonna pull out a coupleof these videos to show you. now, the overall concept that i'm gonna kindof impress upon you is call the kinetic chain of the body. and you so you kinda learn thesong "the shin bone is connected to the knee bone" and the answer to that is true, thatall the bones are connected and we can't change your anatomy. so if you're built a certainway because your grandparents and their grandparents and their grandparents all the way back, that’swho you are. i can't change how much cartilage you have in your knee, i can't change if youhave a bulging disc in your back. i can't
change if you, you know, i can't change thosefixed anatomical factors. what i very much can change in you and this talk is a lot aboutempowering you to change this, is you can change your kinetic chain, and that is themuscular forces around those bone and ligaments and tendons and muscles. the muscles are thedynamic stabilizers, the stronger your muscles, the strong your kinetic chain. so if you have plantar fasciitis or iliotibialband syndrome, part of what we do with you is get you started on a good functional strengthtraining program to strengthen that entire chain and as that chain gets stronger, yourpain will go away and stay away. so the answer is if your back hurts from a bulging disc,don’t sit on your butt. the answer is, start
to work on strengthening. and that's a lotabout what this book is about and what i'm gonna talk to you guys about. so injuries happen, i'm just gonna push ahead,i don’t care if i'm in pain, i'm not listening to my body and all the sudden injuries happen.and that’s often how injuries happen and they can be overuse injuries in the tendonsuch as this achilles which as a big thickening in the tendon like a partial tear. mri hasbeen very very helpful to help us diagnose these kind of injuries. this is a big crackin the hip; this is somebody with a stress fracture. just saw one of those this morning.somebody training for the iron man who got a stress fracture in their hip. again, thisis not an acute injury so you won't know you
have this. you'll know that the more you dothe more pain you're having. and the pain is changing how you move because it hurtsso much. and that's when you gotta get it checked out. so let's now talk about prevention which iskind of the thrust of what this is gonna be about. so what are the ways you can preventinjury? and first of all you wanna gradually build your training. we're gonna talk aboutrunning form. and then lastly were gonna talk about preventive strengthening and the roleof preventive strengthening. so there's, this graph kinda shows how muchstress you're putting on your body and the frequency of how much you run. and the concepthere is there's what's called the injury threshold.
no injury and injury. and how do we take thisline and push this out so you can basically have more frequency of running- [whip sound] >>jordan metzl: we want that. alight, we wantthat line out there. how do we keep ourselves here – >>jordan metzl: -so that we push that thresholdout. and the answer is, we're gonna change how we run and we're gonna change how muchstrength we have. those are the variables we can change. so when you think about running, basicallyyou're never on two feet at a time except
for at the start and the end of the race.and other than that, running is a series of plyometric jumps from one leg to the otherand there is no exact right way to run. but basically what i can tell you is that i takecare of a number of both triathletes and runners and in my office, the triathletes are hurtmuch less frequently, even though they train about four times as much. and the answer isbecause they do much more functional training as part of what they do. so in this, i'm notgonna pull these out and play them, but basically i have somebody's here who is stepping downoff a box, let's make sure these are not gonna work – >>male voice: ok whenever you're ready stepdown-
alright, not gonna work. so, she steps downoff this small box, one side versus the other, and the one leg that’s not hurt, she stepsdown very evenly, and the other side her knee is all wobbly when she steps down and theanswer is that as she starts to wobble in that knee, the stability of her hips and herknee joint is affected. so she's not strong enough on this side she's hurt with. so ifyou're getting knee pain from running, the answer is you have to strengthen the musclesin the kinetic chain on that side of the body particularly because what ends up happeningover time, is that this cartilage starts to rub on this femur bone and you start to geta lot of achiness underneath your knee called runners knee which is pretty much the mostcommon knee problem that i see.
so how do we talk to people about improvingtheir running form? and we talk about things such as running drills, running uphill i love.the concept of running uphill is you shorten your stride and quicken your cadence and soyou should be somewhere between 85 and 90 beats per minute. meaning the left or rightfoot should hit the ground 85 to 90 times per minute. most people don’t do that. mostpeople over stride. so by shortening the stride and quickening the cadence the landing forceis much else. that’s why the barefoot shoes make a differencein even some of the shorter training is that you keep your weight over your forefoot toyour midfoot instead of heel striking. which gives you a much shorter stride and a quickerturnover. so try running uphill and see how
different it is. in fact i teach an outdoorstrength training class, i teach a strength training class every two weeks in centralpark, i don’t know what time you guys get up but we do it at 6:15 in the morning. andif anybody wants to come, please come up here afterwards and give me your email and we'llsend you our invitation to come try this thing. we have about a hundred people at a time andwe do this in central park and it’s a lot of fun. we do some combination of runningdrill and preventive strengthening called plyometric which we're getting to next. sorunning drill, number one, preventive strengthening, number 2. stretching is way over rated. alright, soall of you who are spending your whole life
stretching for running way overrated. strengtheningis way more important. so we see a lot of people that stride out way, way too far intheir running stride and what ends up happening is they land with all their weight on theirheel and they have these different kinds of problems. so this, and i may pull this outto show you, but basically what we're doing now is much of this functional motion screenand we're using a lot of the great stuff you guys are helping us develop which is, in medicinenow, taking the technology of what it looks like to move. and i'm gonna show you, i knowyou guys will be into this so i'm going to pull this out really quickly. just to showyou. i gotta get him outta the way. i gotta close him, he's too distracting.
but just to show you what this looks like.so we're doing a lot of more of this functional movement. and we can basically put markerson people and check where they're landing, how they're landing, where their maximum impactis and many of our athletes that come in with these problems are essentially over striding,so you know you can pay some, i dunno, 150 or 200 dollars to come to our hospital andget this done. or i can just tell you now, shorten your stride and quicken your cadenceand do some strength training and you won't get hurt. and that’s free. so try that firstbefore you come up here and do that. but that’s the concept of using technology which i thinkis pretty cool to really make, you know, movement patterns a lot healthier and safer for people.which is i think really neat, and obviously
you guys are so helpful with that for us.so as i mentioned, stretching, way over rated. strengthening, way underrated. so then let's lastly talk about this functionalstrength training and prevention to make you run better and much less injuries as well.so what i'm big into is this functional training called plyometric training. and plyometrictraining is basically using your body weight and rapid muscle contraction and elongationto essentially build functional strength. it makes people faster, it makes them hurtless. it reduces the reaction force between your, basically, joints and the ground somuch less compression force, it protects your joints and your body. and most importantlyyou don’t need a fancy gym. you can do this
anywhere. now, when the book came out, i did this functionalstrength workout called ironstrength. and so the way this thing is set up, is it kindof talks about every injury and then i have a whole section in the back called ironstrengthwhich is this functional strength training workout and video. and the video, since thisis a rodale book, has a link up on runner's world which free. if you just type in runner'sworld and put in my name, or ironstrength and my name, it will pull up and you'll seethis ironstrength workout online. and that correlates to ironstrength workout in thebook. and basically what that’s gonna do is teach you how to do this functional strengthtraining on your own.
you just follow us along the first month,january this was up, we had, for us it was impressive, i know for you guys that's like'dude, that's nothing', but we had like 1.7 million unique views which, is that? that'spretty good isn't it? so i get a little nod for that? alright, thanks. i don’t knowif that’s a lot, it seemed like a lot to me. so i was impressed with that, runner'sworld, i mean runners are dedicated readers, voracious readers. so we had a lot of peoplelooking at that stuff. and this ironstrength workout is a really helpful tool and i likeit because it takes this and makes it so that people can kind of use on their own. whichi think is pretty cool. so i want you to try this thing and then come try it live withus in central park.
so, lastly i'll just kinda make a couple commentson this and answer some questions. so the concept of this is it's kind of a full bodyresource. we did both an ebook and an ibook and the apple, on the ipad we have the embeddedvideos. but the paperback is actually really neat and i appreciate you guys having somepeople here and i understand there's some kind of thing that ran out but there's a wayto get more and rich'll tell you more about that at the end. i did bring one signed freecopy for somebody and the question is who's gonna get the free copy, the signed copy?and the answer is who here has run more than 20 marathons? anybody? [audience giggle]
>>male #1: michael >>jordan metzl: michael? alright anybody runmore than 16 marathons? michael, get up here, dude, you just won yourself a free autographedbook. [applause and hoots] >>jordan metzl: congratulations. [inaudible from audience] >>jordan metzl: good, if i hit it big time,it's signed, it'll be worth something someday. now for those of you, and i'm giving thisto rich this actually just came out today, this is not related to this book topic butit's similar concept. in is it, i did this
thing with the american academy of pediatricsand it's called "home based strength training for young athletes." it's basically encouragingparents to start strength training with their kids. starting at age eight and it's a highrepetition light weight training. in kids sports we're seeing problems of a lot of youthsports specialization and increase in injury risk. and so we want parents, the best trainersare not professionals, it's parents and so i want parents to do this with their kids. rich, who invited me, gets to take this homeand start. how old's your daughter? >>rich: i've got three. >>jordan metzl: anybody old enough? good.
>>rich: the oldest is nine. >>jordan metzl: perfect. alright, so the conceptof kids doing strength training is something which is, people think is that, the answeris it's great. it starts to build bone density, functional strength and is a great thing todo. so, enjoy that. so the concept of this book is to teach youguys how to recognize every injury you'll get, number one. number two, how you can takecare of it at home on your own. and number three, do you need to see a doctor? and thennumber four, do you need surgery? and as you know, kind of the nexus of medicine and technologyhas been uniformly great. but for example 50% of the population has a torn meniscus,60% of the population has a bulging or herniated
disc. knowing when that herniated disc ortorn meniscus is problematic and when it's not is very difficult for somebody who's notin medicine to know. and so, what i really want to do is educate my athletic patientsand athletic minded people of how you can make the make best decisions for yourselves.because dr. google, i'm sorry, gives a lot of information. some of it's great, some ofit's not so great. but a lot of it's out there. and so you guys do such a great job supplyinginformation, but it's a lot of information. and helping people kind of disseminate whatis helpful i think is very important for people. so with that, i would say please registerfor my site so you can stay in touch if you want. and i'd love to answer any questionsabout these topics or your own running related
issues or just sports in general or anythingabout the quality of life, health, and happiness. who's got some questions for me? don’t beshy about your own injuries. yeah? >>male #2: [inaudible] shoulder injury forstrength training- >>jordan metzl: oh i'm sorry; you gotta goto the mic so we can hear. [unintelligible] >>male #2: for like a shoulder injury, doingstrength training. what is the, what's the general guideline? is it, this doesn't seemlike to be like, this never really fully goes away. so when do you start pushing again? >>jordan metzl: so some general concepts andwhat i'm after in this kind of book and video
is a lot about what is called functional training.what does that mean? what it means is, if i just do bicep curls, i'm just strengtheningmy bicep, right? or leg extensions on a leg extension machine, i'm just strengtheningmy quad. and you know, for a long time people did that kind of training and many do at anumber of gyms around the area. but the problem is it's not very helpful nor very efficientand it seems to kind of not do much in terms of what's called functional. and so functionaltraining is doing, like in our video we have multiple body motions at the same time withhigh repetition, light weight training. and so it's not like you're doing big weightsbut it's higher repetitions of a light weight which, over time, builds almost equivalentstrength. and so the answer to a shoulder
injury, you know, depending on what is, isthat kind of get rid of the irritant in the shoulder. so sometimes we do injections ofa little steroid into a bursa or whatever the problem is. and then do this functionaltraining around the joint. and it's high repetition and light weight training which almost counterintuitive to the way people think about training. and it really seems to change that kinda waythat people do it. so you can effectively train, and in the shoulder, particularly,is very amenable, the strength around it. and just knowing what to do should help alot. so give it a try and let me know. >>male #3: yeah, i'm curious about recuperationfrom particularly like long distance running or specific workout. so, in particular ice,the use of ice and ibuprofen.
>>jordan metzl: sure. so basically inflammationis both a good thing and a bad thing. so inflammation is helpful when something gets irritated orinflamed, its very helpful for us. cause it kinda, it's a body marker, hey, we got a problemhere. when somebody does something, so there's helpful and hurtful inflammation. so an achillestendon, you go out for a long run, you get some achilles tendinitis. over time if thatgoes on and on it can actually start to, like a cavity, start to wear down that tendon andyou get tendinosis and then a chronic partial tear. so you get a whole kind of host of problemsthat happens over time if something's just chronically irritated. so there's chronicinflammation and there's kinda something after doing a particular event. and the answer isthat you know, we love the george costanza
special. which is getting in an ice bath,which is a very helpful way to get in something cold for you know, if you can make it 5 minutesin an ice bath. and much like boiling a frog, though i've never done it, but what they sayif you're going to boil a frog, which hopefully nobody here or in california has ever done,is if you just put the frog in water it jumps right out but if you put the frog in and graduallyturn up the heat, it stays in there. i don’t know if that's true or not but that's thestory. and so with cold water and ice baths it's the same thing. get in there and startdumping some ice in and over time as the temperature lowers, supposedly, and i do know this, it'sactually much more able to tolerate that. so i think for post-run recovery, nothing,anything over and hour and half, nothing beats
an ice bath. so getting into a cold bath will definitelyhelp expedite your recovery as well as getting a carb and fat something in your body withina half hour. that's called the golden half hour after a big work out. so don't wait twohours, take a nap and then go eat. you basically start to, your turnaround will get quickerif you refuel that muscle glycogen within a half hour of your exercise. so those arethe things: ice and getting that fuel in right away are the two really helpful things. >>male #3: are you against ibuprofen in general? >>jordan metzl: i'm not at all, i think basicallyfor longer stuff i guess there's what i do
and what i say. what i say is, you know, probablynot a great idea for big doses for sure. if you wanna pop one here or there before youdo stuff i think that's probably ok the problem with ibuprofen and you know, much, you knowmany of these are sold over the counter, is they think alright, well it's like advil,it's candy coated, i can just take that, but these are drugs. and if you take enough ofthose, you can cause a real problem. so a little bit here and there i don’t thinkis usually problematic, you know a lot can be a big issue. but they can certainly causeulcers, too. so you have to be careful not to do any lots of that stuff on an empty stomach. >>male #3: thanks.
>>jordan metzl: sure. >>male #4: so, you and everybody else sayswalking is a great regular way to stay in shape without having to put a phenomenal amountof effort in. i don't like walking, i like bicycling, is that just as good? >>jordan metzl: so, that's a great questionand the answer is that i generally find people are the most compliant with their exerciseprescription if they like what they're doing. and so if they feel like i have to run causethis guy told me i have to walk around but i hate it, i love biking then they're gonnanot do it and nothing, anything is better than nothing. in the relative scale of expenditure,you know hard running is the most time effective
per whatever you can do. a hard run. but ifyou're like hating every step and you're not pushing yourself, it's terrible for you. soif you can get your, it's all about getting your heart rate up. and if you can push yourcardiovascular threshold and really get your heart rate up and move, by biking, then that'sterrific and there are a number of places to do that. so if you like and you'll do it,that’s a great way. and i do think the merits of group exercise, like spinning particularly,are very helpful and people will push themselves a lot harder if there's a group around. soyou know, getting, that's why our strength training class is so much fun, is cause everybodybasically kicks each other's butt. which is helpful, really makes it work a lot better.so if you can find that dynamic in a spin
class or even a bike thing, you'll get muchmore cardiovascular out of that. >> male #5: hi, thanks for coming out today. >> male #5: well you know, it band. just,it is what it is but, to make that a general thing, are there any pains that you wouldsay are ok to push through? or any time you have a pain should you just stop when it occurs. >>jordan metzl: two good questions and i'llanswer the second part first. and so the pain issue is when your it band pain is changingyour running mechanic, then it's time to stop. if it's a little bit achy here and there,i don’t worry about it. so my telltale thing is if pain changes your mechanic of movementis number one. now it band is basically a
muscle called the tensor fasciae latae musclethat runs on the outside part of your hip across your hip joint and your knee joint.and the typical person with it band syndrome is somebody that comes in saying "i'm runningabout, you know, two, three miles or a mile and about 10-15 minutes in i feel like somebody'sjabbing something into the side of my leg" and that's typically classic it band syndrome.and the answer is number one, flexibility. so i have a whole thing in this ironstrengthworkout section called the foam roller workout and anybody friends with a foam roller? severalof you, good. and so the foam roller is a great at home deep tissue massages that youcan do pretty much every day to loosen up the muscle, the it band along the outsidepart of the leg. the second part, then, is
building this functional strength. and inthe book in our it band section we have what's call the big butt bonus. and it doesn't meanyour butt's gonna get big, so don't worry. but it means your butt's gonna get strong.and in the big butt bonus section we have all these glute strengthening exercises tobasically keep your pelvis stable. the video i didn't show you of this woman stepping downoff the box, you know she was somebody who had a lot of it band problems and as she waskinda running, her hip was dropping on the hurt side and her pelvis was unstable whenshe was running. and that caused some chronic it band problems over time. so strengtheningis hugely important. and the final thing is, there's a little fluid filled sac called abursa, which can form between the tendon and
the bone and sometimes we have to give a littleshot of cortisone in that it band, just in that bursa. but again, if you don’t fixthe mechanical factors, it'll just keep happening. so, it band is very fixable, it's very frustratingfor a lot of runners but very fixable with the right stuff. >> male #5: thanks. >>female #1: hi, what about an injury or apain that is there only when you rest, not when you actually exercise? >>jordan metzl: that's easy, keep moving.that's the – [audience laughter]
>>jordan metzl: [laughs] umm >>female #1: yeah but like an acute pain,you know the sciatic? >>jordan metzl: so it's not uncommon actually,people go out, they work out and they get some pains afterwards. and so, it sounds likesciatic type pain, here's my guess. when you're sitting on it, it hurts the most? >>female #1: yeah. >>jordan metzl: ok, gotcha. so pain in thebutt, yeah? >>female #1: yeah. [giggle] >>jordan metzl: ok, so what's happening isthat the sciatic nerve, in the hip/glut section
we have two kinds of sciatic pain. sciaticpain can come out of the back and what happens is you get a bulging disc in your back whichpushes in nerve and shoots pain down your leg. and those hurt all the time. or you canget the sciatic nerve running through the butt muscle and the butt muscle, called thepiriformis muscle, will squeeze that nerve after you've worked out. and basically justshoot this pain down the back of your leg, especially when you're sitting on it. andagain, a little bit of anti-inflammatory medicine can make that feel better but the key is building,sorry, but building a stronger butt. and the stronger your butt muscle gets, the less thatmuscle will want to squeeze on that nerve. and so, you need a stronger butt, and that'sthe answer. and then the last thing is i have
a whole bunch of stuff in there on some differentstretching, the figure four stretch is helpful. that's where one case where flexibility canmake a difference to loosen it up. but to really fix it you gotta start, those plyometricjump squats, you will first hate them, but one you learn to love them it will make thisgo away, i promise. >>female audience member #1: ok, thank you. >> male #6: i'm asking on behalf of my wifewho's a cardio junkie. who can probably do with some rest, because she's worked herselfinto a really bad back situation. so what are some of the exercises you can recommendfor somebody who really thrives on the adrenaline, thrives on the sweat, thrives on the cardiobut needs to back off a little bit.
>>jordan metzl: alright, so we've got a wifeat home, my wife, but says the wife at home, alright fair enough. so the wife at home who'sthe cardio junkie and i will say just by way of this, that yes there are junkies of exercise.exercise junkies is a real thing but as i always say, i'd rather somebody be addictedto exercising than anything. so be proud of your wife, but that being said you know she'snot doing enough functional training and so the cool thing about this ironstrength workoutis, i promise you, you're gonna go home, you're gonna earn a lot of brownie points at homehere. cause you're go home and say we're gonna try this together. and i promise you thatwhen she gets through her like fourth set of burpees, she's gonna be having more cardiothan she ever had doing the other stuff.
so the nice thing about this is it's bothcardio and functional strength as well. but i generally find people who only do one setof thing without that kind of cross training built in, get hurt all the time. and so thisconcept of total rest days, i really don't buy that so much. i think you can do lessand more and different kinds of stuff. but i think the concept of functional traininginterspersed with cardio is so helpful. so i think, try this and let me know. she willthank you and it's a huge work out. this'll be as much a workout as running. >> male #6: it's in the book? >>jordan metzl: well the pictures are in thebook and the workout's online. that’s that
ironstrength on runner's world. alright? >> male #7: hi, thanks for the book. my biggestproblem with marathons is in the closing, you know, last three or four miles, hamstringcramps. i don't know what it is that i'm doing wrong. i've done a lot of marathons, i'vehad some success but i can't seem to fend that off. >>jordan metzl: gotcha. so muscle crampinghappens for basically for two main reasons. so i'll talk about both. less commonly butsometimes related to muscle cramping is actually strength. so people aren't strong enough,so i think some of this functional training that i've been talking about will definitelyhelp with some people. but actually, surprisingly,
more commonly for muscle cramping that's nutritional.and when people think about nutrition and muscle cramping people think alright i'vegotta eat bananas because i'm getting muscle, who here has had bananas for muscle cramping?everybody got force fed bananas. and the answer is the potassium is bs, that basically wedon’t have a lot of data, we have a lot of data on sodium. and salt is the culpritfor most people with muscle cramping. and so what i'm gonna have you do, basically what'shappening over time, i'm betting in your marathons, is you're not salt loading enough and you'renot pre-salt loading and when you get that lower salt sodium hyponatremia the first symptomis muscle cramping. so my bet is that you're what we call a saltysweater. everybody in this room sweats a different
amount and different concentration of sodium.and if you're a salty sweater you know it cause when you're done with a long run youkinda look like you should be like a human deer lick or something. you've got that whitestuff all over, not a good look. so you're a salty sweater, so if you are you need tobasically give yourself more salt along the course, and so there, you know everythingfrom pretzels to there are these little salt caps and i want you to try some of those andi bet you that with some strengthening and with the sodium, it's one of those two things,i'm betting. and you can try an experiment and see, that if it's late in the race usuallyit's just that you're losing too much salt and you have not kind of built up. you canactually pre-salt load the day before in addition
to your pasta, some extra salt and then duringyour exercise more than an hour and half, start putting some more salt into what youdo. and then some races have, gatorade makes a great product called endurance formula gatorade,it's double sodium. and that has double salt and that will help a lot in terms of sodium.so try some more salt and i bet that makes a big difference. >> male #7: cool, thank you. do you recommendsalt caplets or just a standard salt packet? >>jordan metzl: the salt packets don't workcause when you get sweaty it just kind of disintegrates so they make, a number of companiesmake these little, there's one called saltstick, there's one called endurolyte and these kindof sodium containing capsules and you just
carry those along and pop one or two of thoseand i bet you'll notice. and you can kind, try and think like when it's hot and humidam i getting this more? is it happening i'm cold, cause cold cramping tends to be strength.the hot humid cramping tends to be sodium. >> male audience member #7: ok thanks. >>jordan metzl: alright? sure. >> male #8: hi, this is a follow up on thepotassium. i notice that a lot of people, a lot of my friends who play sports basketball,football they started drinking a lot of coconut water, coconut juice and i just want hearyour take on that? and then more generally, after you do like the functional training,the plyometric jumps, the burpees whatever,
what's your best thing to take in terms ofrecovery aside from eating right after? like amino acids, protein etcetera. >>jordan metzl: alright two good questions.so first with the coconut water craze. i mean i think coconut water is great it's basicallyisotonic so it's kinda not high sodium, it's kinda neutral. i think eating is fine, coconutwater is fine if you like and you're gonna take it. it's probably a little more nutrientrich than obviously water which has essentially none. but it's not like a magic formula. sopeople are always looking, oh i need this, it's not a this. just food is fine, too. butif you like that there's no down side. and if you're gonna take it, it tastes good, noproblems. it's a little expensive but no big
deal. in terms of post-injury, post-workout foods,fuels. i really don’t like the kinda powders and all that. i know there is a whole bigindustry of these synthetic powders but i just think anything that has like a half-lifeof six years on the shelf is probably not a good idea. and so i think just natural,natural occurring foods. i mean get stuff that's on the perimeter of the supermarket.anything that's in the middle that doesn’t expire until 2016, you know, stay away fromi think in general. and it doesn't matter, it's totally you know much like the guy askedabout biking, it's whatever you will take is fine for me. that it can be scrambled eggs,it can be you know yogurt, blueberries and
granola. whatever it is that you like, doit. and there's no magic answer to that, basically naturally occurring food i think is the best.some combination of carbs and protein, scrambled eggs is great. anything you'll do is great.alright, no magic answer. >> male #9: hi i'm trying to get back intoa more aggressive athletic routine and a bunch of chronic injuries are sort of resurfacing.do you recommend from a medical standpoint, establishing a baseline whether it is tryingto figure out whether it’s a meniscus or a ligament or you know, whatever the jointsare. i mean, is a baseline something to seek medical help with to then figure out if it'sgetting better or worse? >>jordan metzl: that's a good question, imean the answer to that is that i would start
doing stuff and start building some strengthand see if there's a one pinpoint thing that's the exact thing every time. if just kind ofeverything hurts cause you're doing more, that tends to be kind of functional exceptif there's one thing that's actively limiting your ability to be active then i would getthat thing checked out. but i'm sure you have a meniscus tear, i'm sure you do- >> male #9: yeah. >>jordan metzl: -just because many peopledo. so and if we get an mri it'll show up and what happens is people get surgery allthe time because they have a meniscus tear on their mri and they're no better and they'vehad a piece of their meniscus taken out and
they're actually worse off. and so you knowi think the key is to start doing some of the stuff i'm talking about, see how it goes,see what happens to that pain. if there's one particular thing that's problematic, thenwe can look at that further. >> male audience member #9: ok >>jordan metzl: alright? >> male #10: hey jordan, thanks for comingin. >>jordan metzl: no prob. >> male #10: i try to bike at least everyday to work to and fro and i have lower back pains. what do you suggest doing? stretchingbefore or after or both?
>>jordan metzl: good question. so you know,how far are you biking and where are you coming from? >> male #10: i do about six or eight mileseach way. >>jordan metzl: oh nice, and you're comingfrom where abouts? >> male #10: brooklyn. >>jordan metzl: so coming over the bridgeand stuff. so you know number one is back pain from biking can be a couple things. numberone if you're doing serious biking like this guy maybe, bike racing or stuff, bike fitis very undervalued for you know, making your bike comfortable. if it's kinda commuter bikingand you're going back and forth which is a
great way to get around and i think gettingaround new york on bike is, i'm really excited for the bike sharing program which is gonnastart in july here. which is gonna be, anyway you guys probably know about this stuff butit's gonna be terrific. >> male #10: great. >>jordan metzl: and i think that, you knowi have a whole bunch of stuff in the book on what's called core strengthening, isometricplanks. to build up what are the core muscles around your middle. and most often bikersdon't do enough middle strengthening and so you kinda end up like an oreo. you kinda havethis soft inside so you gotta start strengthening the middle. those core muscles support youwhen you're sitting on your bike seat and
it makes that pain go away. so start someof the core blaster exercises i have, some of the core strengthening and you can do itat home. try you know a few times a week and i bet your back feels a ton better from that. >> male audience member #10: ok, quick question.post long bike, chocolate milk or coconut juice?>>jordan metzl: take one of each. i mean, chocolate milk's got - >> male #10: that's a bad combination. >>jordan metzl: yeah it probably is. i personally,chocolate milk is probably better cause it's a got a little more fat content and a littlemore carb content. so i think maybe during
long ride coconut water and post long ridei'd go with chocolate milk. >> male audience member #10: ok, thanks. >>jordan metzl: sure. last question. >> male #11: hi, i don't remember if the bookaddresses this in detail, i read it a while ago. any tips for running heat? because summeris much nastier here in new york rather than california. >>jordan metzl: yeah, so you know runningin new york city in the heat is a real issue. i mean, california is lucky in that sensebut you know, the biggest problem i see if you're running in the heat is acclimatization.so i have many fewer problems with people
running in the heat in august than i do injune when we get a hot day when it's been kinda cool. so the body takes about a weekto ten days to acclimatize to heat. and so when it gradually builds up over time, likeit is now here, you know, you need a little more hydration, you probably need a littlemore salt. you need to kind of pre-hydrate. you have some of these more common musclecramping issues. but in general your body gets to, it acclimatizes to heat over time.the problem is if you're up here and you say listen i'm gonna go for a getaway to miamiand it's kinda 45 here and it's 80 there, and you get off the plane and go for a 10mile run. those are the people that end up with a lot of kinda of more significant. ifyou go run the miami half marathon, that weekend
i always see people the next couple days withbad muscle tears because they've just been running in the cool and they're not acclimatized.so heat tends to be the problem with acclimatization and then you know, some of the sodium andsome of the dehydration stuff as well. >> male #11: thanks. >>jordan metzl: alright, so i just wanna sayin conclusion thank you guys so much, a pleasure to be here. i know i was competing againstjustin beiber on friday, but you learned some good stuff here. so i really appreciate beinghere, thanks a lot. bye-bye.
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