Rucking Foot and Ankle Injuries (And How to Prevent Them)

0:00 plantar fasciitis, tendonitis, stress fractures, metatarsalgia, and sprained ankles. These are some of the most common foot and ankle injuries ruckers experience. In this episode, I sit down with John Ritter, a physical therapist who works with hikers, runners, and ruckers to break down what causes each injury, how to recognize the early signs, and what you can do to build the strength and durability needed to keep them from slowing you down. If you want to ruck consistently and avoid setbacks, this episode will give you a clear understanding of how to strengthen your feet and legs to handle the load. You're listening to the Rucker's Edge podcast, a show all about rucking that is designed to help you improve your rucking routine, lose weight, and ultimately gain your strength and energy back. Each episode dives into the science, stories, and strategies behind rucking. You'll learn from top ruckers, coaches, health experts, and performance specialists who break down what it takes to train smarter.

0:53 recover faster, and stay ready for the next challenge. So whether you're new to rucking or an experienced rucker that's already logged hundreds of miles, this is the show for you. I'm your host, Spencer. Thanks for listening in. Before we get going, if this show has helped you in any way, it'd be amazing if you could drop a quick review on whatever app you're using to listen to this podcast right now. It helps me bring new episodes every week, and more importantly, more people looking to improve their fitness will be able to discover the podcast so you can help someone else start or improve their rucking. Thanks so much. John Ritter, welcome to the Rucker's Edge podcast. It's really great to have you here. Thanks for taking the time. Thank you. It's great to be here. So you're a physical therapist that works with hikers, runners, and I learned recently, ruckers. And I'm really happy to have you on the show because I have a lot of questions about frequent injuries that ruckers will come down with after ruck or maybe not even preparing for their ruck. I kind of wanted to start out by asking, through your experience with dealing with hikers and ruckers, why does adding weight to something as simple as just like walking, not necessarily running, but walking and adding weight, what is it about that that changes how our body reacts or responds during that activity?

2:05 Yeah, that's a great question. I think a lot of people underestimate the... amount of force and the impact that their body takes with each step, whether that's running or walking or anything, right? So with walking, generally, we're taking anywhere between two to five times our body weight per step, right? And that's going to be a little bit more going downhill and a little bit less going uphill. If we're running, it's going to be anywhere between five and eight times our body weight. with each impact that we're taking. So it can be pretty significant. Add on, even if you're adding in like 20 % of your body weight, 20, 30 % of your body weight, that adds in additional times of impact per step that you're taking.

2:56 Right. So if so, let's say you're rocking. Right. Generally, when people are are rocking, they're trying to go relatively heavy. Right. I feel like most people are are anywhere within that, like 20 to 50 pound range most of the time. Right. And so that's adding in a significant amount of impact. Per step. Right. And so if you're, if you're used to, and I, I, I like to use analogies with, with other exercises, just because I feel like it's, it's clear that way. But if you're used to deadlifting a hundred pounds, right. And you're, you know, deadlifting a hundred pounds all the time, you feel really comfortable with that. And then one day you go into the gym and you're like, you know what I'm going to do, I'm gonna do 150 pounds today, just for, just for fun. And you start doing 150 pounds. If that jump is too big. for your body to accommodate quickly, then injury will occur, right? So if we do smaller jumps, then normally we can accommodate, we can adapt, and we can be okay, right? But if we make jumps that are too big, too quickly, then our body falls into injury instead of adaptation.

3:59 I feel like this is an issue that we run into, especially with rucking and backpacking and things like that. People are like, well, I can walk. Like I can walk eight miles, right? I enjoy going on an eight mile or a five mile hike or whatever. Let me just add on 30, 40 pounds and I can do that same walk, right? But you have to remember that that weight is compounding an increased amount of force with each step, right? And that force is usually, it's going to be most effective at the hip, knee, foot and ankle, right? Yeah. So did that answer your question? Absolutely did. Absolutely. And I talk about progression often. I have historical ankle issues. And so I knew starting a new activity like rucking, sure, it's not going to be as impactful as running, but there is still going to be impact. And so I started just walking and then adding weight incrementally. Curious to see what your opinion might be. So someone starting out rucking. What sort of progress would you recommend to them in terms of weight? Let's say they have an hour a week. They're going the same distance at the same speed. The only thing they're changing is weight. How much would you add and how frequently?

5:15 This is a great question. And it kind of, it comes down to a principle called progressive overload. The principle of progressive overload is how much can I push past what I was doing before to create adaptation without creating injury. Or with reducing risk of injury. We can never eliminate risk of injury. Like injuries happen walking down the stairs or whatever. So we can never eliminate risk of injury, but we can significantly reduce it. Generally with... When we're adding in weight, if we're doing rucking or backpacking, if we're adding in weight to walking, I think because the duration of the activity is really long, I like to go a little bit more conservative than with traditional lifting, right? So the progressive overload principles generally have been applied to traditional lifting exercises, right? So like deadlifts, squats, things like that. So working out in the gym, lifting weights. The general idea is 10 % progression per week, right? So if you think, okay, I'm deadlifting 100 pounds this week, I can go to 110 pounds next week, right? And then you can kind of progress in that manner. The problem with activities like rucking is there's a lot of different variables that are going on, right? So there's the distance that you're walking, there's the terrain you're walking on, and now you're adding in the addition of... the addition of weight, right? So first

6:48 off, you have to make sure that you're able to walk the distance that you want to walk, right? So let's say I'm doing this trail circuit. It's going to be five miles. I build up to being able to be really comfortable walking that five miles without any additional weight. And then where do I start with additional weight? Like how much can I add on? I think generally a good place to start is probably between 10 and 15 pounds. That's not a lot of weight in most people's minds. They're like, ah, this is like 10, 15 pounds. So that's not going to make a big deal. But if you add in those 10, 15 pounds over the course of five miles, that makes a pretty significant impact, right? Once you can do that, then you can start to incorporate that 10 % per week progression rule, right? So maybe every couple of weeks, you're adding in a couple of pounds. Right. So I'm going to, I started with 10 pounds after a couple of weeks, I'm going to go up to 12 and a half or 13 pounds. Right. And the 10%, it doesn't have to be perfect. You can do a little bit more, you can do a little bit less. Right. But that idea is going to help keep you from progressing too quickly and allow your body time to adapt to the new stimulus. Right. So what you want to do is start conservative, find a weight that you think is going to be, you know, less than you can handle, right? So shoot under rather than shoot over, right? Shoot under to start, make sure you're comfortable with it, and then begin that progressive overload progression.

8:15 Because what happens is what I see a lot of times is people say, okay, I wanted to get into rucking. I knew that I enjoyed hiking, I enjoyed walking, and that was really great. I wanted to make it a little bit more intense, get a better workout in. I'm going to add some weight. I'm going to add in 20, 30 pounds, and then I'm going to go. And what ends up happening is they get stuck at that weight for a really long time, or they end up falling into injury or something like that. So it's better to take a couple of months to build up to 30, 40, 50 pounds. Right. Rather than get stuck at a weight because you started too heavy. Yeah, that makes a lot of sense. Building up that ramp sort of sort of to say and you hit the nail on the head. I think a lot of Rutgers, you know, they might be former athletes that are used to. maybe throwing some weight around and when they get into rocking oh yeah like 20 pounds no problem 25 pounds no problem just throwing it back and then go out for a long rock and they're like wait hold on what's going on what's going on with my ankle what's going on with my knee so yeah i appreciate your insight on that and and that tip for for progressing let's talk about some of the more common injuries that us ruckers come down with and the number one is is blisters.

9:31 Everyone has blisters, but having you on as physical therapist, let's, let's focus on musculoskeletal issues. So from doing my research and my understanding of these different injuries, I kind of grouped them into like different categories. One would be load and impact, perhaps causing some injuries. The other one would. would be soft tissue. And then the last one I have, my favorite, we'll save for last. But let's start with load and impact. I know a lot of records will come down with stretch fractures. And I always struggle with this word, metatarsalgia. Is that how you pronounce that? Metatarsalgia. Yep, you got it. So those sound like the more serious injuries.

10:13 What's happening with the body when those injuries occur? Yeah, yeah. So these these kind of fall into the category of repetitive stress injury, right, where the body is unable to adapt quickly enough to the activity and the stress is placed in a place where it shouldn't be right. The the foot and ankle. is designed to absorb impact with each step right so that's that is the that is the purpose of of the foot and ankle it's it absorbs impact and then helps to store that impact store that energy and help propel you forward right and it does that through a couple of different mechanics i mean i guess if if we have the video on here i'm holding a little foot model here okay so if you can see it great if not that's okay so if you think of the arch of your foot the inside arch of your foot It goes through something called pronation and supination.

11:05 Pronation is when the arch drops. Supination is when the arch lifts. So with every single step, that arch is dropping down. It's kind of stretching out and expanding. And then as you're stepping forward, it contracts, it supinates, it gets higher and stiffer, and it allows you to propel yourself forward, right? If you don't have the ability, the strength in the foot and the strength in the, it's called extrinsic muscles of the foot, the muscles that live within the calf and reach down into the foot. If you don't have the strength to control that pronation and supination motion as you're going through walking, especially with added load, what ends up happening is the muscles can't do their job to absorb impact. And that impact is transferred to. bony areas right so for the for instance with with metatarsalgia so that's pain in the ball of your foot super super common in loaded walking activities like rucking the problem there is there's there's a whole bunch of different problems and i'll try to keep it rather concise right a lot of times we're dealing with with stiffer or more restrictive shoes people are hiking in boots or something like that the the pinching in of the toes actually creates a restricted ability of the foot to maintain what's called the anterior arch. So the anterior arch is the arch across the ball of the foot, okay? You should have a little bit of an arch across the ball of the foot. As we pull the toes together, as we squeeze them together, that arch tends to drop, right?

12:30 And so we're getting more pressure on the center part of the ball of the foot versus the big toe and the pinky toe side of the ball of the foot, which is where the pressure should be. And then on top of that, we add in overload. So we're adding in additional weight that is pressing down and the muscles in the foot are having a hard time controlling that impact, right? Now we add in on that, you know, different kinds of shoes with high heel drops. So your heels are propped up, right? I'm going to pull out my little model again. So your heels are propped up and then we have something called a toe spring in most shoes. So your toes are propped up. So all of that weight is going down into this V right at the ball of your foot, right? So there's all of these factors that contribute to the drop of the anterior arch, but the end factor, the factor that's most important is the strength of the foot to be able to create that anterior arch. And if we don't have that ability, we get that increased bony impact on they're called the metatarsal heads. That's where the ball of the foot is. And then we can start creating irritation in those, in those joints. And it feels like you're walking on a rock all the time. right it's a pretty similar principle with things like stress fractures in the foot so a lot of people will get stress fractures on the fifth metatarsal so the outside of the foot it's the same thing if your body isn't able to absorb that impact the foot isn't able to pronate and supinate you're going to lean to the outside of the foot because it's more structurally stable you're relying on the bony structure of the foot And then that bone is going to get overloaded and you can develop

14:01 stress fractures. Same thing in the shin. If I don't have the ability to absorb impact in the foot, that impact is going to get transferred straight into the heel, up the shin, and then we can develop stress fractures in the shin, right? So it's all about those repeated impact injuries are all about the ability to control and absorb impact per step. And if you don't have that ability, that force is going to get transferred into the structural supportive tissue, the bony structures of the body. Cool. All right. Let's end the podcast there. That was an excellent explanation. That's all the value we need. That was really well explained. I appreciate you spending the time and explaining that. It was really, really easy to follow. And it makes a lot of sense based off of the history of my own injuries and the lack of strength and how it led to stress fractures and other issues like that. Are there any... What would the early warning signs be that, you know, someone might be coming down with a stress fracture or mental tarsalgia? When you go on a ruck, when you have that additional weight, when you're going on a long hike or a long walk or something like that. generally you're going to be uncomfortable at some points, right?

15:15 And that's totally fine. You can have little bits of discomfort here and there. As long as they come and go, it's not a big deal, right? Persistent and escalating discomfort is a sign of injury or maladaptive tissue, right? So it's a tissue that is not able to adapt to the stressor. So, so let's say for instance, I'm developed, I'm starting to develop in like a, let's take a stress fracture in the fifth metatarsal. So on the outside of the foot, I'm starting to develop a stress fracture there. How do I know that that's happening? Well, I'm, I'm going on some rocks. I started to feel like a little bit of soreness on the outside of the foot, but it's not that big a deal. And it goes away relatively quickly after the rock. Right. And then I start to notice it more frequently and the intensity of the system of the symptoms start to increase. Right. And then I hit a point where I go on a ruck. It really bothers me during the ruck. And afterwards, that pain has just like plateaued. It's just staying there and it's not going away. That's generally the progression of a stress -related injury or a stress fracture. And if you can see early on, you can say, hey, look, I'm feeling this discomfort.

16:31 It is increasing in frequency. It's increasing in intensity. It's not adapting. It's not getting better. I need to change something before it becomes an issue, right? So that's when you can decrease a little bit of weight or maybe decrease a little bit of distance, something like that, right? So decrease the intensity of the activity and then figure out if there are other things you can do to correct. Whatever compensation is leading to that excess stress, right? Maybe there's some weaknesses in the foot. Maybe there's some weaknesses in the calf. Maybe there's some weaknesses in the hip. Other things that you can work on to take that excess pressure off of where the body is unable to adapt. to that pressure, right? And that's where talking with like a physical therapist or an athletic trainer or something like that can be really helpful because they have the eyes to be able to say, hey, look, we're lacking a little bit of strength here in this department, which is shunting more of that force over here where we don't need it.

17:27 So let's see if we can correct some of that. The most important thing is recognition of that progressing pain response and changing something so that it doesn't continue to progress to a significant injury. Yeah, that's an excellent idea you had about reaching out to a professional, a physical therapist and helping to identify what could be changed because, you know, you can cycle through hundreds of different changes that you can make through your rucking to figure out what's going on where someone that's been trained to identify it really quickly can just save you months, if not years, of trying to correct it on your own. So appreciate that. Let's move on to a few other. injuries that i think can be kind of grouped into the same category these are plantar fasciitis and tendonitis they also seem to be pretty common amongst ruckers so similar question to before like what what's going on in the body that's that's causing these yeah luckily the explanation is is pretty similar right it's it's about overloading specific tissue right so let's take plantar fasciitis for example i'd say probably like 80 % of the people that I work with are dealing with plantar fascia pain.

18:37 And so that's just something that I see all the time. It's something that I work with all the time. The main issue with plantar fascia pain, I like to think, I like to describe it this way. And I feel like this gives a pretty clear picture of what's going on. I talked earlier about the pronation supination of the foot, right? How the pronation is where the arch drops down. It's where the... The foot is adapting to the surface that you're stepping on. You're absorbing impact. And then the supination is where the arch lifts. It becomes stiffer, stronger, and that's how you push off, right? You propel yourself forward. The mechanisms, the muscles that control that motion in the foot, you can think of them as like springs, right? So the springs stretch as the arch collapses. The springs contract as the arch lifts. And that's how we absorb impact with the foot. The plantar fascia is more like a rope.

19:27 than a spring. So the plantar fascia is attached at the heel. So the front of the heel bone, and then reaches out and is attached into the feet or into the toes across the, across the arch of the foot. If the springs of the foot, if the muscles of the foot can't do their job or they fatigue too quickly, what happens is the arch drops faster or more uncontrolled. It can't absorb the impact very well. And so what ends up happening is that arch essentially drops and hangs on that rope of the plantar fascia, right? So that plantar fascia is taking on all of that extra force as we're stepping down and it's pulling at where it's attached to the heel bone. That constant pulling can create adaptations like a heel spur or things like that. That's not necessarily the cause of the pain. That's just an adaptation to the excess stress that the foot is experiencing.

20:23 What ends up happening is that plantar fascia, because of that constant overload, the plantar fascia starts to degrade. The plantar fascia and connective tissue in general It's not it doesn't have a lot of blood flow. And so it has a hard time adapting and healing if it is overstressed. And so things to work on one is removing that excess stress by building up the strength in the feet and the calf. Right. So actually being able to absorb impact. And then the other thing is doing things like and this is going to sound silly, but it plays a huge role in any kind of foot rehab. But like. So consistent use of toe spacers, right? Making sure that we have good mobility in the foot, doing small, simple exercises throughout the day, like toe yoga or toe lifts, like alternating your lifting of your toes, scrunching your toes, working on arch lifts and things like that can help improve blood flow to the feet, which is going to improve healing times, right?

21:17 So if you're dealing with some sort of injury, adding those things into your routine is going to be super, super helpful. Great. So that's a little bit about plantar fascia, plantar fasciitis. And now when we're dealing with other kind of tendinopathies, right? So we'll talk about, you know, peroneal tendinopathy, which is that pain kind of along the outside of the ankle, behind the ankle or posterior tibial tendon dysfunction, right? Which is that inside of the ankle pain going down into the foot or even Achilles tendinopathies or Achilles tendonitis. These tendon irritations happen because of persistent, again, persistent overload, right? So either there is too much stress on one side of the ankle, right? There's too much stress on one set of the tendons, which is causing them to become irritated. Or there's just a general overload. issue, right? Where you're either doing too much or you've progressed too quickly and the body is not able to adapt to the situation, which creates persistent irritation of the tendon that isn't able to adapt, right?

22:25 So changing activity level slightly and then getting in the right kind of exercise, the right kind of progressive loading to the tendon is what's going to help it to go through the healing process that it's trying to go through but can't because it keeps getting overstressed and once that tendon can go through the healing process it can get stronger and then it can adapt to the activity that you're doing right so it's all about it's all about load management and then understanding why this particular area is being overstressed. And I go into all kinds of different stuff. Usually issues at the feet are related to issues at the hip. Usually Achilles tendinopathies are related to hamstring weakness and hip extension weakness. So there's a whole bunch of different things at play here. I would say the biggest thing when you're dealing with any kind of stress -related injury, whether that's a bony stress -related injury or a tendon overload injury, is get working on it. As soon as possible, because it's probably just going to get worse.

23:31 And the sooner you start working on it, the faster you'll be able to correct it and the less impact it will have on your activity long term. I'm curious with plantar fasciitis and tendinitis. Will those present during the activity or is that sort of like a delayed? You're going to see that tomorrow morning situation. That's a really good question. And this is a little bit different. per person, right? But generally connective tissue issues and tendon issues will follow a specific pattern, right? Usually these issues will be worse at the beginning of activity, right? So when you first start your rock, you're like, oh my gosh, my foot is killing me or my ankle's killing me. My Achilles is killing me. And then give it, you know, 15, 20 minutes or so into the activity, things are going to start to feel pretty good. You're like, oh, actually it's not that bad, right? Things are feeling pretty good.

24:22 That's just because the tissue is warming up. It's heating up. It's becoming more pliable, more stretchy. And so it's not as sensitive, right? So then you can go through the rest of your activity feeling pretty good. unless you hit that specific threshold where the pain will start to ramp up again, right? So I'm sure you've experienced where you start out on the hike, you start out on the ruck, you're not feeling great. Like, ah, things are feeling tight. Things are feeling uncomfortable. Then things start to feel pretty good. You're like, okay, things are feeling all right. And then if you're doing a particularly big day or particularly heavy day, sometimes those symptoms can start to settle back in and you're going to start to feel it towards the end again. So sometimes you'll feel it towards the end, sometimes you won't. And then comes the post -activity irritation or pain.

25:04 And this is pretty different person to person, usually because of the point that they're at in their healing process, right? If something is really chronic, you've been dealing with this issue for a super, super, super long time. usually that's going to mean it's more delayed, right? So you're going to be maybe feeling it the next morning or the next day, sometimes even 48 hours after is where it really, the extra pain really starts to set in. If it's a newer injury, it's usually going to settle in a few hours after the activity and it's going to be, you know, maybe a little bit more sharp, a little bit more present, right? And then still maybe take a couple of days to peter off, right? So the general pattern that you're going to see is pain at the beginning of activity, As it warms up, it feels better.

25:49 And then as you cool down, it gets worse again. And then it maybe takes a day or two to feel better. If you're seeing that pattern and it's not muscle soreness, then you need to get it checked out and get working on it. Yeah. You mentioned something before about how you have observed Achilles tendonitis can be impacted by a weak hamstring. Yeah. Go ahead. No, I'm just curious about that. Can you explain that more? And can you talk about maybe, you know, any potential impact from a tendonitis? Was it like, do you call it peroneal tendonitis? Is that the one on the outside? Yeah, peroneal tendonitis on the outside. So what would that one be tied to if like ankles tied to a weak hamstring, I guess? I don't know if any of these questions make sense. Yeah, yeah, definitely makes sense.

26:39 There's always, there are always localized stress responses and then like we call you know distal or or surrounding stress responses right so In order to propel yourself forward when you're rucking or to push uphill or do a big climb or something like that, there's a whole bunch of muscles that have to work together to help you do that. Your glute muscles are going to help with hip extension, which helps to push the leg back behind you and propel you forward. Your hamstrings are doing the same thing. They help a lot with hip extension where you're pressing the leg back. We think of hamstrings as doing just leg curls, but they do a lot more than that. Your hamstrings are propelling you forward and helping to propel you uphill. And then your calf is doing the same thing. So your calf going down into your Achilles tendon is helping to propel you forward. So all of these muscles are doing that straightforward propulsion, right? And we can think of that as like a percentage distribution almost, right? And we want it to be relatively equalized, right? We want the hip to be doing a lot of work. We want the hamstring to be doing a lot of work. We want the calf to be doing a lot of work. let's say my hamstrings are super, super weak. I just don't really train the hamstrings that much. And for whatever reason, my body has decided that it's more efficient and more effective to just over -utilize or over -recruit my calf muscles and not really use my hamstring too much, right? So the body's going to lean into that.

28:09 It's going to use the calf muscles more, which means that there's more stress at the Achilles tendon because the hamstring or the glutes aren't doing their job. And so it makes it more likely for that Achilles to develop an overload issue. And it's the same thing with the hamstring tendinopathies. All of the time, I'll see people who are dealing with hamstring tendinopathies. It's like, all right, let's see how many single leg calf raises you can do. And they can do like 12. And so it's all about work distribution. And the better we can get everything working, the more we can distribute that force that's being applied while we're doing our rucking and the less likely we are to overload any specific tissue. Gotcha. Bet. That makes a lot of sense, strictly from my own background of having some tendonitis issues and just having weak legs in general. And that's something that I've been working on a lot in the past couple of months to strengthen my legs. Now, I wanted to talk about the last one, sprained ankles.

29:09 I know a lot of people use boots to kind of help provide some stability or some structure there. But sprained ankles, are they related to bad luck? Or are there things that make someone more likely prone to rolling an ankle? Yeah, yeah. Sometimes it's bad luck, right? Any injury is going to have some sort of luck component to it, right? You can't always avoid injury forever. So at some point, if you're spending time on your feet, especially on uneven terrain, like on a trail or something like that, at some point, you're probably going to sprain your ankle. The problem with sprained ankles is that they generally lead to persistent spraining of ankles because most people don't rehab them correctly. So what ends up happening, there are a few things that will predispose someone to ankle sprains, weak feet and ankles in general. So like poor ability to absorb impact or poor control, poor balance.

30:07 Those things are all contributing to the likelihood of an ankle sprain. are tend to be more likely to have an ankle sprain because with a higher arch, your weight tends to be towards the outside of your foot, which will make it easier for you to have an inversion ankle sprain weakness in the peroneal muscles. We talked about those peroneal muscles, the muscles that go down that outside of the leg and the outside of the ankle. Yeah. If for whatever reason, those muscles are weaker and they have a harder time controlling the ankle, more likely to have an ankle sprain. But what happens with the ankle sprain is post injury. A lot of things happen. Right. And I'll try to go through these briefly. You end up with limited ankle range of motion. Right. So the ankle stiffens post injury. Right. Which leads to it makes it harder to strengthen the ankle. And then on top of that, we have some sort of damage or injury to tendons around the ankle post ankle sprain, which will. create what's called an inhibition effect right so if the body knows that there's an injury to a specific tendon it will try to not use it as much which will lead to more weakness down the road and then the other thing is a lack of proprioception now proprioception is the ability to know where you are in space and understand where your joints are right like if i close my eyes and extend my arm i know where my hand is because of proprioception and it's just signals coming in from different tissues that tell me where where that is What happens with ankle sprains is the ligaments of our ankle get overstretched.

31:36 Okay. And so that signal that we get from like where our ankle is changes post ankle sprain. So you have to move your ankle farther now before you're receiving that input that your ankle is being stretched because those tissues have been overstretched, which means you're more likely to overstretch and get into a position that's going to cause a sprain than you were previously if you don't retrain that proprioception. So there's a whole bunch of different things that lead into ankle sprains. And most of the time, if you have an ankle sprain, it will lead to repeated ankle sprains. If you don't rehab the ankle well, and just because you've had a ton of ankle sprains in the past doesn't mean you can't rehab that ankle and get it feeling better and stronger and improve the proprioception and reduce your risk of ankle sprains down the line.

32:31 More with John in just a moment, including the top three workouts he recommends Rutgers do to prevent these injuries from occurring. But first, I want to take a quick break and say thanks for listening to the podcast. If you know someone that is suffering from one of these injuries or someone that is new to rucking, please text this episode to them. It could help them avoid injury or recover a little faster. Also, sharing this episode would help the show grow and help more people improve their health and lives. Okay, back to it. It sounds like the recurring theme here for these multiple injuries is weakness in your foot or your legs. In your opinion, I mean, and I realize each situation, each person, you know, it's kind of specific on what they can do to minimize these injuries. But if you could list out like three most beneficial workouts that you can do to strengthen your foot as a rucker, what would you suggest? There are so many things to dive into with this. I mean, this is my job. I love throwing out these exercises and things, but I do have... A couple of guiding principles that I think are really important and then also specific exercises that I think are really helpful. The main thing that you want to think about when it comes to rucking is something called single leg stability. The ability of the hip and the foot to control rotation in the leg and absorb impact. So there's a great test that you can do for this. It's called a single leg step down. So if you stand on one leg, and you

34:03 can either do this on a box or just like on the ground or something like that, and you do a single leg quarter squat, if you can keep your knee forward and keep it from hugging into the other knee, and you can keep your arch lifted and keep your arch from collapsing down, then that's a good test for single leg stability. Now, what happens if you do that test and your knees are hugging in together and you feel like you can't separate your knees and you keep falling over, right? What can you do to help improve that single leg stability? And there's a couple of things. One, you have to get crazy strong feet and calves.

34:44 Now, there's a whole bunch of different ways to do this, but barefoot calf raises are a great place to start. right so the reason why you want to be barefoot is if you're in shoes shoes have what's called a rocker in them i talked about that toe spring earlier shoes have a rocker which and some arch support which kind of takes away a lot of the work that needs to be done from the foot and so doing the barefoot you incorporate the foot a little bit more so barefoot calf raises this is going to sound crazy i promise this is true if you are an active adult you should be able to do at least 25 to 30 single leg calf raises in one go, right? At least, right? And if you're sitting around at like 12 or 15, that is something you need to work on because that is going to lead to stress injuries later on, right? So getting super strong calves, crazy important. The other thing that I would suggest is like back squats, things like that. Those are awesome. Those are great exercises to do.

35:48 But if you're going to be doing a single leg activity like rucking, you're strengthening. First off, strengthening is it's it's not a good thing. It is a necessary thing. If you do not strength train, you will not be rucking for very long. Right. Like you have to do strength training. And what you should do is bias your strength training towards single leg. exercises, right? So like a Bulgarian split squat, it's where you have your back leg up on a bench or a chair and you're doing a lunge, right? Incredible exercise to help build up, strengthen the glutes, help to strengthen the quads and the hamstrings. Excellent exercise. Any kind of single leg step down. So you put your foot on a box, right? And you're just trying to drop down and touch your other foot to the floor and then come back up, right?

36:38 So any kind of single leg exercise where you have to incorporate a little bit of balance right and you're focusing on on that that one leg at a time is going to be hugely beneficial to helping to strengthen all of the things that will usually lead to injury down the line right there's something called a kickstand deadlift right so if you think i don't know really how to explain that if you're standing on one leg but you put your toes down with the back leg You hold a really heavy weight in one or both hands. You touch the weight to the ground and you come back up. It's called a kickstand deadlift. So I'm not fully on one leg. I've got a little bit of balance assist with the back leg. That is an excellent exercise.

37:21 Single leg deadlifts, also huge, super, super helpful, but they're a little bit more advanced, a little bit more challenging, right? So that's where you're just standing on one leg, holding some weight, bending forward, touching that weight to the ground and coming back up. So if I had to choose like three exercises, I would say barefoot calf raises, Bulgarian split squats for just quads and glutes, just getting super heavy. And then a single leg deadlift for balance work and glute med or like that outside the side glute muscles, right? Development. I would say that those, those would be like my three go -to exercises that I'm just going to get crazy strong in that will help to prevent injury and also just make me a beast in rocking. Awesome. Yeah. Thanks so much for sharing that. I'm going to start adding a few of those into what I'm currently doing. I've been doing a lot of towel scrunches recently. That's been helping me out. I feel like I'm definitely getting some strength there.

38:20 You mentioned the word barefoot. I've mentioned to you previously that I embarrassingly. OK, so when I get back from a rock, man, my feet are screaming. So I immediately just jump into my. UFOs recovery slides. And then I'll wear them the next day and the next day. I wear them just all the time at the house. And I have a feeling that you don't like hearing people say that. Maybe you don't like it, but you have a preference for people to walk around barefoot, it seems. Am I wrong with that? I definitely have a preference. I'm very biased. I've worn exclusively minimalist shoes for over a decade now, right? I'm not saying that everybody needs to do that, right? You definitely don't. But I like to use this analogy because I feel like it makes it a little bit clearer imagine that you're training for deadlifts right so you're training deadlifts and you're you're trying to build up your ability to lift heavier and heavier and heavier and always and forever and never without you are exercising with wrist straps on right which means you've got you've got straps on your wrist they're going around the bar most of the that means that most of the weight is taken off your hands but your hands don't have to do very much work and that is the only way that you train forever and then you get to a competition and they're like they're like hey what what like what weight are you going for to lift and you're like oh i've built up my my strength my legs are super strong now i'm gonna go for like 400 pounds four or five hundred pounds for this deadlift and they say oh by the way

39:51 you can't use wrist straps like how much weight do you think you're gonna be able to lift Because you've never trained your hands. You've never trained that grip strength, right? Now, sure, you will have developed some strength even with using the wrist straps, right? But it is not going to be enough to do what the rest of your body can do, right? Yeah. We have to look at footwear the same as we look at any other kind of assistive device, right? If you're going to do a huge hike or a huge rock, then getting some supportive shoes that are going to help to protect your feet, take off a little bit of weight from your feet. That's great. That's not a bad thing, right? But if you exclusively train in highly supportive footwear, and you never go anywhere without orthotics, and you've got your custom orthotics that you wear in every pair of shoes, your feet will become dependent on those assistive devices. They will get weaker and weaker and weaker. And this has been shown in endless research studies where the persistent use of orthotics leads to weakness in the foot and weakness in the foot. contributes to all of these issues that we've been talking about right so i'm not saying that you can't use those things but you have to have some part of your training that is either in less supportive shoes or in no shoes right doing specifically doing strength training in like flatter shoes or even barefoot if you can is going to be huge in helping to prevent injuries and issues. Again, you don't have to

41:22 ruck in minimal issues. You don't have to ruck barefoot or anything like that, but you have to train your feet like you train everything else or your feet are a hundred percent going to be your limiting factor and what are going to be what stops you from being able to ruck at some point. That's fantastic. Wow. And I feel like we should probably maybe warn the listener if they do plan to start working out barefoot, maybe transition into that. Don't go, don't go. Yes. Yeah, for sure. For sure. If you're interested in transitioning to footwear that is a little bit more minimalist or something like that, reach out. I can give you some pointers or something like that, but making sure that you, it's the same principle that I, that I talked about earlier, right? You can't go from a hundred pound deadlift to 150 or 200 pound deadlift in, in a day. It has to be a progressive overload principle, same as everything else. Good deal. So we talked about strengthening. What about stretching? Any particular stretches that you recommend, Rutgers? Yeah, mobility in general is, I think, super important.

42:25 You'll talk to some strength trainers and things that have very low opinions on mobility. I think that mobility in general is super important. I would focus on the mobility of the hips. So internal, external rotation of the hips, doing some seated 90 -90s where you're dropping your knees down to each side. Getting your hips super mobile is going to be huge in the long term for helping reduce injury and reduce pain in the future, helping to prevent the offloading of stress to places like your low back and things like that. So hip mobility, I would say, is the biggest thing to focus on. And then the other one that people don't think about very much is going to be toe mobility, right? Specifically at the big toe. The big toe often gets really, really stiff. But the ability to extend the big toe for the big toe to come up is essential for normal gait. Like you just have to be able to do that in order to walk normally. And especially if you're going up or down. steep inclines so being able to do a being able to sit on your heels with your toes extended right so have the balls of your feet on the ground and be like in a kneeling position and being able to sit back on your heels great stretch for the foot great stretch for the calves and then in general working on hip mobility i think is is really important awesome good deal john appreciate that I want to ask you about your services. You primarily

43:57 are focused on helping people with foot and ankle issues. So do I have that correct? No, you're right. So my my my niche, right, my main focus is generally foot and ankle. The communities that I work with are generally trail athletes, right? So trail runners, hikers, backpackers, ruckers, people who like to spend time outdoors. generally those people are dealing with foot and ankle issues. So that's kind of the, that's my main focus, but I treat everything. I like to help people stay outdoors. I like to help people stay active. I'm primarily a virtual, right? So wherever you are in the world, I can help out if you need. And yeah, the best place to get in contact with me is Instagram. That's the easiest place. So it's John Ritter, DPT.

44:41 on Instagram, just reach out to me. I'm happy to help. Even if you just have a quick question, I'm happy to provide a little bit of help. The way that my services work is I always offer a free consultation, a free initial consultation. So we hop on, we talk about what's going on, what you need. And then I help develop a plan for you going forward on whatever you need to get you back to whatever specific activity you're trying to get back to. Good deal. And I'll post a link in the show notes for people interested in reaching out to you on Instagram so they can easily find it. But John, that's all the questions I have for you. I'm super appreciative of you jumping on here and sharing your wealth of knowledge and being so generous with your time. Thanks, man. Yeah, it's been great. I always love an opportunity to ramble about things I'm passionate about. So I appreciate you sticking in there with me. Thanks again, John. Yeah, absolutely.

45:30 Thank you. All right, that wraps up my conversation with John Ritter. If you are interested in the services John offers or just want to reach out to him on social media, you can find him on Instagram at JohnRitterDPT. If you want to reach out to me, head on over to TheRutgersEdge .com or on Instagram at TheRutgersEdgePod. If you enjoyed today's episode, make sure to follow or subscribe to the show in your favorite podcast app so you're notified of new episodes. Okay, that's it for today. Thanks again for listening to this episode of The Rutgers Edge.