The Physical Performance Show

Physical Performance Show – Episode 383 Show Notes
In episode 383 of The Physical Performance Show, host Brad Beer sits down with Professor Franco Impellizzeri, one of the most influential and outspoken voices in athlete load management research, for a wide-ranging conversation on why "load management" is an old concept dressed up in new data, why the acute to chronic workload ratio (ACWR) never held up to scrutiny, and why context — not more metrics — is what separates good decision-making from noise.
Show Sponsor:
Pillar Performance continues to lead the way in sports nutrition through micro-nutrition innovation, now expanding into the Performance Health range. One of their newest releases, Collagen Repair, was developed with Gelita Laboratories (Germany) using a clinically trialled collagen peptide (Tendofort) to support tendon and ligament health in conditions like hamstring tendinopathy, Achilles tendonitis, shin splints, and patellofemoral pain.
Head to pillarperformance.shop (or thefeed.com for North American listeners) and use code PHYSICALPERFORMANCE for 15% off your first purchase.
Pogo Physio also offers online Telehealth Consultations for endurance athletes managing bone, tendon, or joint issues — book online at pogophysio.com.au.
 
Professor Franco Impellizzeri's work can be explored here:
https://profiles.uts.edu.au/Franco.Impellizzeri
And...
https://scholar.google.com/citations?user=z35F1WAAAAAJ&hl=en
 
Listen in as we delve into the following:
What "load management" actually means, and why it's a relabelling of concepts coaches have wrestled with since the 1930s–40s
The double-edged sword of the data revolution: from heart rate monitors to today's GPS, wearables, and AI-driven analytics
Commercial and career incentives behind pushing metrics — both from tech companies and researchers
Confirmation bias and why interpreting data without a theoretical framework is "like reading tarot"
The case against the acute to chronic workload ratio (ACWR): its lack of scientific support despite IOC endorsement
A landmark runners' study showing the opposite relationship between ACWR and injury risk — and what that reveals about the field
Why meta-analyses and systematic reviews in load research can be manipulated to "find whatever you like"
The difference between using a metric personally versus promoting it as scientifically validated
Why the most skilled clinicians tend to hold their conclusions with the least certainty
A real-world case study: a soccer training drill "failure" that was actually a video-monitoring blind spot, not a bad drill
The expanding role of data scientists in sport, and why interpretation — not collection — is the real skill gap
Whether AI and machine learning can (or should) replace the sports scientist's judgement
Individualised and personalised training approaches — and why even these are still built on group-level generalisations
Distinguishing signal from noise, and why one "failed" intervention doesn't mean an athlete won't respond next time
Practical advice for coaches and practitioners: accept uncertainty, treat training like a "trial of therapy," and reassess
If he could track only one metric: heart rate (or perceived effort) over power
The push for more honest scientific debate — including a proposed on-air "intellectual sparring" series with dissenting researchers
 
Quotes:
"Understanding the quantity of training for athletes has been a hot topic since training methodology started... managing load is not new." — Professor Franco Impellizzeri
"When you don't have a theoretical framework and an a priori idea strong and supported, it's like reading tarot, to be honest." — Professor Franco Impellizzeri
"There's zero evidence that this metric can either help or can actually reflect some sort of mechanism." — Professor Franco Impellizzeri, on the acute to chronic workload ratio
"Don't take yourself too seriously." — Professor Franco Impellizzeri
 
Timeline:
00:00 – Introduction: host's specialist physio training and the load management "viva" question
01:04 – What is load management? An old concept, relabelled
02:31 – From heart rate monitors to GPS: the rise of training data
06:14 – Commercial interests and the risk of becoming "slaves of data"
08:05 – Why load management matters: the drug-dosing analogy
09:24 – Load management as a decades-old coaching concern
10:23 – Confirmation bias and interpreting data "like reading tarot"
13:17 – Championing methodological rigor in sports science
16:33 – Meta-research, honesty, and acknowledging uncertainty
18:22 – Why the most skilled clinicians express the least certainty
19:18 – Origins of the critique of the acute to chronic workload ratio (ACWR)
20:09 – Takeaways for contemporary practitioners on load management models
21:34 – Why the ACWR lacked scientific and conceptual support
23:02 – Training load, time-at-risk, and reframing injury risk
24:24 – The contradictory runners' study and what it implies
26:43 – Cherry-picking and overfitting in load-injury meta-analyses
28:34 – Taking a stronger public stance on social media
30:34 – Science as a self-correcting process
31:31 – The discipline required to properly read and critique research
33:58 – Why data alone can't tell you what to do
34:24 – Case study: the soccer drill that "failed" — until the video told the real story
36:49 – The role (and limits) of data scientists in sport
38:46 – Could AI replace the sports scientist's job?
40:42 – Advice for coaches and practitioners: accept uncertainty
42:09 – Individualised approaches are still a form of generalisation
44:31 – Separating signal from noise — and why not to give up early
46:56 – If only one metric: heart rate over power
48:21 – One piece of advice: "don't take yourself too seriously"
48:51 – This week's physical challenge: swimming without pain
50:16 – What's next: meta-research projects and replication studies
51:43 – A proposal for public scientific debate, and Ian Shrier's work on consensus
56:32 – Why genuine debate is hard to find in science communication today
57:59 – Episode close
THE TEAM:
Join The Physical Performance Show LEARNINGS membership through weekly podcasts here: https://www.patreon.com/TPPShow
Our goal is to get you back to your Physical Best. Find out more about Telehealth Consultations and book online at pogophysio.com.au.
Your Host:
🏃 Brad Beer - Instagram & X @Bradbeer and YouTube @PogophysioAu
The Physical Performance Show can be found at:
Facebook: facebook.com/thephysicalperformanceshowpodcast
X: @tppshow1
Instagram: @physicalperformanceshow

Physical Performance Show – Episode 382 Show Notes
In this episode of The Physical Performance Show, host Brad Beer sits down with Pogo Physio's Tim Studley for Part 2 of their two-part mini-series on shin pain and tibial bone stress injuries. Having covered diagnosis and differentiation between MTSS and tibial bone stress injuries in Part 1, this episode shifts focus to management — mechanics, return-to-run programming, strength and conditioning, footwear, and terrain considerations for runners recovering from (or trying to prevent) tibial bone stress injury.
Show Sponsor:
Pillar Performance continues to lead the way in sports nutrition through micro-nutrition innovation, now expanding into the Performance Health range. One of their newest releases, Collagen Repair, was developed with Gelita Laboratories (Germany) using a clinically trialled collagen peptide (Tendofort) to support tendon and ligament health in conditions like hamstring tendinopathy, Achilles tendonitis, shin splints, and patellofemoral pain.
Head to pillarperformance.shop (or thefeed.com for North American listeners) and use code PHYSICALPERFORMANCE for 15% off your first purchase.
Pogo Physio also offers online Telehealth Consultations for endurance athletes managing bone, tendon, or joint issues — book online at pogophysio.com.au.
Listen in as we delve into the following:
Biomechanical vs. biological risk factors, and why running intensity matters more than mileage for bone
Cadence, overstriding, and how a heel-strike pattern increases tibial loading
Foot pressure distribution, lateralised loading, and how footwear/orthotics can help
A case study: how cadence cueing, orthotics, heel raises, and calf strengthening resolved recurrent tibial bone stress injury
Managing anterior tibial cortex injuries: why they're high-risk, slow to heal, and often need surgery
Moving from time-based to symptom-led (optimal load) management for posterior-medial tibial bone stress injuries
The five evidence-based criteria for returning to running after a tibial bone stress injury
Why a 10% increase in pace can cut a bone's fatigue threshold by 50%
Structuring intensity and volume in a return-to-run program to avoid a "double whammy" of risk
Strength and conditioning phases: contralateral leg work, weight-bearing progressions, and pre-running plyometrics
Clinical strength benchmarks for calf raises, leg press, hamstring curls, and hip abduction
Footwear considerations: heel wedges, rocker-bottom shoes, and the debate around carbon plates
Surface and terrain: why stiffer surfaces and flat terrain are preferred during return-to-run
Treadmill running and its effect on distal loading
What's next: an upcoming Q&A episode, and future instalments covering the femur, sacrum, tarsal bones, and calcaneus
Quotes
"Muscle loads bone." — Brad Beer
"That runner doesn't need to be strong. They need to be uber strong." — Brad Beer, quoting tendon researcher Ebonie Rio
"A 10% increase in pace reduces the fatigue threshold of a bone by 50%." — Brad Beer
Timeline
00:00 – Introduction & sponsor: Pillar Performance
02:26 – Running mechanics and tibial bone stress injury risk
03:18 – Cadence, overstriding, and heel-strike patterns
05:43 – Foot pressure distribution and medial tibial bending
07:39 – Case study: footwear, orthotics, and cadence cueing
08:37 – Overview of bone stress injury management complexity
09:35 – Anterior tibial cortex injuries: high risk, slow healing, surgery
11:30 – Shift from time-based to symptom-led management
14:49 – Balancing speed of return with recurrence risk
15:48 – Five evidence-based return-to-run criteria (Sheeran & Reid, 2024)
18:11 – Why intensity is a greater risk factor than volume
20:35 – Strength and conditioning: matching capacity to running demands
22:29 – Three-phase strength progression: pre-, during-, and post-weight bearing
24:52 – Clinical strength benchmarks for return to running
26:16 – Return-to-run walking milestones and symptom monitoring
27:16 – Pain tolerance guidelines: the "any pain, stop" rule for bone
27:45 – Footwear considerations: heel wedges, rocker-bottom shoes, carbon plates
28:42 – Surface and terrain considerations
29:40 – Treadmill running and distal loading effects
30:39 – What's next: Q&A episode and future bone stress injury series
33:01 – Episode close & sponsor mentions
THE TEAM:
Join The Physical Performance Show LEARNINGS membership through weekly podcasts here: https://www.patreon.com/TPPShow
Our goal is to get you back to your Physical Best. Find out more about Telehealth Consultations and book online at pogophysio.com.au.
Your Hosts:
🏃 Brad Beer - Instagram & X @Bradbeer and YouTube @PogophysioAu
🏃‍♂️‍➡️ Timothy Studley - Instagram @timothy_physio
The Physical Performance Show can be found at:
Facebook: facebook.com/thephysicalperformanceshowpodcast
X: @tppshow1
Instagram: @physicalperformanceshow

In episode 381 of The Physical Performance Show, host Brad Beer — sports and exercise physiotherapist — sits down with Pogo physiotherapist Tim Studley for the first instalment of a two-part mini-series on shin pain and tibial bone stress injuries, following on from their earlier three-part bone stress injury series.
This episode is essential listening for runners, coaches, and clinicians alike, unpacking how to tell the difference between medial tibial stress syndrome (MTSS/shin splints) and a true tibial bone stress injury — two conditions that can feel identical but require completely different management. Brad and Tim walk through the physiology of bone loading, the palpation tests that separate a "safe to keep running" diagnosis from one requiring an MRI, and the loading tests used to stress-test the tibia safely in clinic.
Show Sponsor:
Pillar Performance continues to lead the way in sports nutrition through micro-nutrition innovation, now expanding into the Performance Health range. One of their newest releases, Collagen Repair, was developed with Gelita Laboratories (Germany) using a clinically trialled collagen peptide (Tendofort) to support tendon and ligament health in conditions like hamstring tendinopathy, Achilles tendonitis, shin splints, and patellofemoral pain.
Head to pillarperformance.shop (or thefeed.com for North American listeners) and use code PHYSICALPERFORMANCE for 15% off your first purchase.
Pogo Physio also offers online Telehealth Consultations for endurance athletes managing bone, tendon, or joint issues — book online at https://pogophysio.com.au.
Listen in as we delve into the following:
The prevalence of tibial bone stress injuries and why the shin is the most common bone stress site in runners
Why bone stress injuries occur: workload errors, loading frequency vs. magnitude, and individualised risk factors
The continuum from "happy bone" to stress reaction to frank stress fracture
Why pain magnitude doesn't reliably predict injury severity
The heterogeneity of bone innervation and why the periosteum is key to understanding pain
Differentiating MTSS from tibial bone stress injury — and why the management is entirely different
The 10cm palpation rule: a clinical prediction rule for when to suspect bone vs. soft tissue
Why the anterior (front) shin is a higher-risk, non-union-prone injury site
The loading-test ladder: double leg calf raise → single leg calf raise → single leg hop → side-to-side hop → forward hop
The role of muscle-bone synergy: how calf strength and girth influence tibial bone stress risk
Recovery timelines by injury grade, and why MRI matters for prognosis and athlete buy-in
A real case study: a triathlete's navicular injury, deconditioning, and return to tibial bone stress injuries
Quotes
"You can go from hero to zero really quickly with bone." 
"Higher levels of pain don't necessarily mean a worse injury." 
"Muscle loads bone." 
Timeline
00:00 – Introduction & sponsor: Pillar Performance
02:15 – Introduction to Tim and Brad's conversation
02:27 – Prevalence of tibial bone stress injuries
03:56 – Why bone stress injuries occur: workload and biomechanics
05:22 – Symptom patterns: bone stress injury vs. other shin pain
07:42 – Heterogeneity of bone innervation and pain variability
10:10 – Why pain severity doesn't predict injury severity
11:07 – MTSS vs. bone stress injury: two schools of thought
12:06 – Brad's clinical experience and personal injury history
13:59 – Cardinal signs and symptom progression in MTSS
15:23 – The three-legged stool: history, physical exam, imaging
16:19 – The 10cm palpation rule explained
19:43 – Applying the rule in practice
20:42 – Anterior shin pain: a higher-risk presentation
21:39 – Loading tests: from calf raises to forward hopping
24:07 – Individualising the loading-test progression
26:03 – Does the 10cm rule apply anteriorly?
26:55 – History as the biggest predictor of reinjury
27:53 – MRI, prognosis, and grading via the Fredericksons scale
29:15 – Reading hesitancy and movement quality in loading tests
31:10 – Why bone stress injuries aren't purely about vertical impact
33:03 – Calf girth and bone stress risk correlation
34:56 – Case study: a triathlete's navicular injury and recovery
35:58 – Episode close & sponsor mentions
THE TEAM:
Join The Physical Performance Show LEARNINGS membership through weekly podcasts here: https://www.patreon.com/TPPShow
Our goal is to get you back to your Physical Best. Find out more about Telehealth Consultations and book online at pogophysio.com.au.
Your Hosts:
🏃 Brad Beer - Instagram & X @Bradbeer and YouTube @PogophysioAu
🏃‍♂️‍➡️ Timothy Studley - Instagram @timothy_physio
The Physical Performance Show can be found at:
Facebook: facebook.com/thephysicalperformanceshowpodcast
X: @tppshow1
Instagram: @physicalperformanceshow

In episode 380 of The Physical Performance Show, host Brad Beer and Pogo Physio physiotherapist Tim Studley conclude their three-part expert series on bone stress injuries by focusing on what happens after diagnosis. From imaging and prognosis to rehabilitation, return to running, and long-term prevention, this episode provides a practical roadmap for athletes, coaches, and clinicians managing these complex injuries.
Brad explains why identifying the underlying causes of a bone stress injury is just as important as healing the bone itself. The discussion covers deloading, progressive reloading, strength and conditioning, bone-building exercise, and the simple but powerful strategies that can dramatically reduce the risk of recurrence.
Show Sponsor:
PILLAR Performance is leading a new frontier in sports nutrition through micronutrition innovation. Their new Collagen Repair formula, developed in collaboration with Gelita Laboratories, is designed to support tendon and ligament health while promoting collagen synthesis to help athletes stay healthy and perform at their best.
For 15% off your first order, visit pillarperformance.shop (or thefeed.com for North American listeners) and use the discount code PHYSICALPERFORMANCE (one word, capitals) at checkout.
In this episode, you'll hear
Why MRI remains the gold standard for diagnosing bone stress injuries and guiding treatment
When a clinical diagnosis may be sufficient—and why imaging usually provides better certainty and prognosis
The three-step rehabilitation framework: identify risk factors, deload appropriately, then progressively reload
Why treating the underlying cause is essential to preventing repeat bone stress injuries
How rehabilitation differs depending on injury severity and high-risk versus low-risk bone sites
Practical principles for returning to running, including restoring volume before introducing intensity
Why the opposite limb also requires strength and bone loading during rehabilitation
The role of strength training, plyometrics and osteogenic exercise in rebuilding bone capacity
Why bone responds best to short, novel loading sessions rather than long continuous exercise
The concept that "bone cells get bored easily" and how to optimise bone adaptation
Why multidirectional movement remains important long after returning to sport
The impact of childhood sport participation and bone geometry on lifelong injury risk
Brad's personal journey with osteoporosis and what it taught him about endurance athlete health
Three practical strategies every endurance athlete can implement to reduce bone stress injury risk
Why recovery—not just training—is where adaptation actually occurs
Quotes / takeaways
"Treat the cause—not just the injury."
"Restore volume before you restore intensity."
"Bone cells get bored easily."
"It's not the training you adapt to—it's the recovery from the training."
"Eat more than you think you need."
Partners / links mentioned
Show Sponsor: PILLAR Performance — 15% off your first order using code PHYSICALPERFORMANCE at checkout.
North America: thefeed.com
Timeline
00:00 – Introduction, sponsor and final episode of the Bone Stress Injury mini-series
02:27 – Clinical testing for femoral neck bone stress injuries
03:26 – Clinical diagnosis versus MRI: when imaging is essential
05:14 – Why MRI improves prognosis and return-to-sport planning
07:03 – The three-step rehabilitation framework: risk factors, deload, reload
08:58 – Deloading strategies for high-risk bone stress injuries
09:50 – Progressive tissue loading and returning to running
10:46 – Why training volume should return before intensity
11:45 – Reloading the unaffected limb during rehabilitation
12:44 – Strength training, muscle function and long-term bone health
14:30 – Why bone cells "get bored" and how osteogenic exercise works
15:56 – Novel loading strategies, multidirectional movement and chaos hopping
17:23 – Childhood sport participation and building stronger bones
19:14 – Brad's personal experience with osteoporosis as an endurance athlete
21:40 – Three practical strategies to reduce bone stress injury risk
24:29 – Skeletal deload weeks and cross-training alternatives
25:27 – Recovery as the key driver of adaptation
26:26 – Final advice for athletes and clinicians
27:49 – Brad's top performance tip: "Eat more than you think you need"
28:18 – Listener challenge: fuel immediately before and after every training session this week
28:56 – Episode close and conclusion of the Bone Stress Injury mini-series
THE TEAM:
Join The Physical Performance Show LEARNINGS membership through weekly podcasts here:
https://www.patreon.com/TPPShow
Our goal is to get you back to your Physical Best. Find out more about Telehealth Consultations and book online.
Your Host:
🏃 Brad Beer – Instagram & X @Bradbeer and YouTube @PogophysioAu
The Physical Performance Show can be found at:
Facebook: facebook.com/thephysicalperformanceshowpodcast
X: @tppshow1
Instagram: @physicalperformanceshow

In episode 379 of The Physical Performance Show, host Brad Beer and Pogo Physio physiotherapist Tim Studley continue their three-part expert series on bone stress injuries by shifting the focus from training errors to the biological factors that determine whether an athlete's skeleton can tolerate training demands.
This episode explores the critical role of energy availability, bone health, recovery, and risk stratification in both preventing and diagnosing bone stress injuries. Brad shares practical screening strategies developed over two decades of clinical practice, explaining why identifying the underlying cause—not just treating the injury—is essential for long-term athletic performance and injury prevention.
Show Sponsor:
PILLAR Performance is leading a new frontier in sports nutrition through micronutrition innovation. Their new Collagen Repair formula, developed in collaboration with Gelita Laboratories, is designed to support tendon and ligament health while promoting collagen synthesis to help athletes stay healthy and perform at their best.
For 15% off your first order, visit pillarperformance.shop (or thefeed.com for North American listeners) and use the discount code PHYSICALPERFORMANCE (one word, capitals) at checkout.
In this episode, you'll hear
Why biological factors may contribute more to bone stress injuries than training load alone
The long-term consequences of early sport specialisation and why multi-sport participation builds a stronger skeleton
Medical conditions and medications that can compromise bone health and increase injury risk
Why low energy availability (RED-S) is one of the biggest contributors to bone stress injuries
Practical screening questions clinicians should ask to identify athletes who may be under-fuelling
The relationship between training volume, mood, gastrointestinal symptoms, sleep, life stress and bone health
Female-specific indicators including menstrual irregularities and amenorrhoea
Male-specific indicators including reduced libido and changes in morning erectile function
Why blood tests, iron status, vitamin D and hormone profiles provide valuable clues to athlete health
The importance of working with sports dietitians to optimise energy availability and performance
Common locations of bone stress injuries throughout the lower limb and pelvis
How injury location can provide clues to whether biomechanics or under-fuelling is the primary driver
Understanding high-risk versus low-risk bone stress injury sites and why blood supply matters
Practical assessment strategies including observation, palpation and functional loading tests
When hop testing is appropriate—and when it should be avoided
Clinical pearls for distinguishing bone stress injuries from other common running injuries
Quotes / takeaways
"Training loads the skeleton—but biology determines whether the skeleton can cope."
"Eat more than you think you need."
"The biggest driver of bone stress injuries is often invisible."
"Above the knee, think fuelling. Below the knee, think biomechanics."
"Treat the cause—not just the bone."
Partners / links mentioned
Show Sponsor: PILLAR Performance — 15% off your first order using code PHYSICALPERFORMANCE at checkout.
North America: thefeed.com
Timeline
00:00 – Introduction, sponsor and recap of the Bone Stress Injury mini-series
02:27 – Why biological risk factors deserve greater attention than ever before
03:51 – Early sport specialisation and athletic history as risk factors
04:50 – Medical conditions, medications and bone health
05:45 – Sleep, stress and the biological contributors to bone stress injuries
07:08 – Understanding low energy availability (RED-S)
08:32 – Practical screening questions for under-fuelling
09:02 – Female athlete indicators: menstrual health and amenorrhoea
10:29 – Male athlete indicators: libido and morning erectile function
11:51 – Blood tests, iron studies, vitamin D and hormone profiles
13:18 – Why even small daily energy deficits accumulate over time
14:16 – Working with sports dietitians and estimating energy requirements
15:40 – Brad's number one recommendation: "Eat more than you think you need"
16:08 – Common sites of bone stress injuries throughout the body
18:00 – Using injury location to distinguish biomechanics from under-fuelling
18:48 – High-risk versus low-risk bone stress injury locations
21:12 – The most commonly missed bone stress injuries in runners
22:37 – Clinical examination: observation, palpation and localisation of symptoms
24:19 – Differentiating shin splints from bone stress injuries through palpation
25:14 – Functional loading tests and when hop testing is appropriate
26:31 – Hop testing, femoral neck injuries and clinical safety considerations
27:24 – Differential diagnosis and key assessment principles
28:25 – Episode wrap-up and preview of Part 3
THE TEAM:
Join The Physical Performance Show LEARNINGS membership through weekly podcasts here:
https://www.patreon.com/TPPShow
Our goal is to get you back to your Physical Best. Find out more about Telehealth Consultations and book online.
Your Host:
🏃 Brad Beer – Instagram & X @Bradbeer and YouTube @PogophysioAu
The Physical Performance Show can be found at:
Facebook: facebook.com/thephysicalperformanceshowpodcast
X: @tppshow1
Instagram: @physicalperformanceshow