The Run Smarter Podcast

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Stem cells are one of the most talked-about frontiers in medicine—but how much of it actually applies to runners dealing with tendon pain?
In this episode, I’m joined by orthopaedic surgeon and researcher Chukwuweike Gwam to break down the latest evidence on stem cells and tendon healing. We unpack what stem cells actually are, how they work in the body, and whether they live up to the hype when it comes to treating tendinopathy.
We also explore the real-world limitations, risks, and costs—alongside what the future might hold for regenerative medicine in running injuries.
If you’ve ever considered injections, biologics, or wondered if stem cells are “the next big thing”… this episode will bring you up to speed.
About Chukwuweike Gwam MD:
 Orthopaedic surgeon (USA) specialising in hip & knee reconstruction 
 MD (Howard University), PhD in Molecular Medicine (Wake Forest), MBA 
 Research focus: regenerative medicine, stem cells, and translational science 
 Passion for improving healthcare access and bringing lab discoveries into real-world treatment 
Follow him on Instagram:
https://www.instagram.com/chukwuweike_g/
Key Topics & Insights

What Are Stem Cells (In Simple Terms)?
 Think of stem cells as the body’s “repair reserve”
 They help regenerate tissue by:  Creating new cells 
 Regulating inflammation 

 We all have them—but: Quantity decreases with age
Quality declines significantly

Why Do We Heal Slower As We Age?
It’s not just one factor—it’s a combination:
 Reduced stem cell quality and number 
 Slower blood vessel formation 
 Reduced cellular signalling 
 Increased “senescent” (non-functioning) cells 
In other words: your repair system is still there… just less efficient.

Stem Cells & Tendon Healing — The Theory
The idea is simple:
 Harvest stem cells (fat, bone marrow, etc.) 
 Process them 
 Inject them into the injured tendon 
The goal:
 Improve collagen structure 
 Enhance healing response 
 Accelerate recovery 
But here’s the key point…
👉 They are NOT a magic bullet—they’re an adjunct.

What the Research Actually Shows
From their literature review (2015–2025):
 ~1,800 papers screened 
 ~150 relevant studies included 
Findings:
 Improved collagen alignment (under a microscope) 
 Increased tensile strength (in animal models) 
 No consistent improvement in long-term human outcomes 
👉 Especially beyond 6–12 months, results tend to equalise.

The Most Interesting Finding
In rotator cuff studies:
 Stem cells improved early recovery (first ~6 months)
 But no long-term difference compared to standard treatment 
Why?
 Stem cells likely help regulate early inflammation 
 The body eventually “catches up” on its own 
Why Results Are So Inconsistent
This is the biggest limitation:
No standardisation.
 Different sources (fat, bone marrow, skin) 
 Different processing methods 
 Different patient health profiles 
👉 Your stem cells ≠ someone else’s stem cells

Risks & Limitations
 Potential for tumour formation (teratomas) with certain stem cell types 
 High variability in outcomes 
 Mostly animal-based evidence
 Difficult to control how cells behave once injected 
Cost vs Benefit (Reality Check)
 Stem cell injections: ~$3,000–$5,000+ 
 Cortisone: ~$200 
 Rehab: far cheaper, highly effective 
In most cases:
 You’re paying a premium for uncertain benefit.
What About PRP?
 Some benefit for:  Tennis elbow 
 Chronic tendinopathy 

 But:  Highly variable 
 Not clearly superior to rehab 

Again, works best alongside loading—not instead of it.

Practical Takeaways (For Runners)
 Stem cells are promising—but not ready for prime time (yet)
 They may:  Speed up early recovery 
 Improve tissue quality (in theory) 

 But:  Don’t outperform rehab long-term 
 Are expensive and inconsistent 

The fundamentals still win:
 Progressive loading 
 Smart training 
 Patience 

 📲 Follow Dr. Gwam: https://www.instagram.com/chukwuweike_g/

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On today’s Q&A episode, Brodie tackles a wide range of listener-submitted questions—covering everything from preparing for mountain races without hills, structuring marathon training in your 50s, and the science of hydration, to managing lateral knee pain, deload weeks, and cardiac drift in ultra events.
The common thread is learning how to train smarter by understanding why your body responds the way it does—and how to adjust accordingly.
Key Questions & Insights
Training for Mountain Events (While Living on the Flats)
 Prioritise VO₂ max development (e.g. Norwegian 4x4 or 30:30 intervals) 
 Build strength and power:  Walking lunges, split squats, calf raises 

 Prepare for downhill demands with eccentric quad training (e.g. reverse Nordics) 
 Use incline treadmills and stairs to simulate terrain 
 Key principle: bridge the gap between your environment and race demands 
Marathon Training at 57 (Sub 3:30 Goal)
 Current structure (4 runs + 2 strength days) is solid 
 Ensure 80/20 intensity balance (most running easy) 
 Strength training should include:  Squats, deadlifts, lunges, calf raises 
 Focus on heavier loads (6–8 reps) for performance gains 

 Don’t overlook:  Recovery (sleep, nutrition) 
 Deload weeks every 4–5 weeks 

Hydration & Recovery (The Science)
Hydration plays a critical role in recovery through:
 Nutrient delivery (oxygen, glucose, amino acids via blood plasma) 
 Muscle repair signaling:  Hydrated cells promote protein synthesis 
 Dehydrated cells increase protein breakdown 

 Glycogen replenishment efficiency 
Practical takeaway:
 Measure sweat rate (pre/post run weighing) 
 Replace both fluids and electrolytes, especially in long or hot runs 
Lateral Knee Pain in Runners
Potential causes discussed:
 ITB friction syndrome (load/repetition-based irritation) 
 Patellofemoral pain 
 Other joint-related issues (requires proper diagnosis) 
Key management strategies:
 Stay below pain threshold (0–1/10) 
 Use run-walk strategies to manage load 
 Address contributing factors:  Cadence 
 Step width 
 Downhill running exposure 

 Strength helps, but load management is the priority 
How to Structure a Deload Week
Purpose: allow accumulated fatigue to recover and adaptations to occur
Options for strength training deload:
 Reduce frequency 
 Reduce load (~30%) 
 Reduce range of motion 
 Or a combination 
Key goal:
 Start the next training block feeling fresh, strong, and ready to progress
Cardiac Drift in Long Runs & Ultras
What it is:
 Gradual rise in heart rate despite constant effort 
Main contributors:
 Dehydration 
 Heat stress 
 Glycogen depletion 
 Neuromuscular fatigue 
Strategies to delay drift:
 Start conservatively (70–75% HR max) 
 Prioritise hydration and electrolytes 
 Maintain carbohydrate intake (60–90g/hr) 
 Manage heat (cooling strategies, pacing adjustments) 
Key Takeaways
 Train the physiology required, even if you can’t replicate the exact environment 
 Recovery (hydration, sleep, nutrition) is just as important as training 
 Pain management = load management first, not just strengthening 
 Deload weeks are essential for long-term progression 
 Cardiac drift is inevitable, but you can delay and manage it

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Returning to running after injury isn’t as simple as waiting until you’re pain-free and heading back out the door.
In this episode, I sit down with Eric Hegedus to break down a structured, evidence-informed approach to returning to running—based on his clinical commentary and years of working with injured runners.
We dive into how to bridge the gap between rehab and performance, why so many runners get re-injured, and how to use simple tools like TRIMP to guide your training decisions.
If you’ve ever felt unsure about when to run, how much to do, or whether you’re progressing too quickly… this episode gives you a clear framework to follow.

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In this month’s Latest Running Research episode, Brodie breaks down three fascinating studies that challenge common beliefs and refine how runners should approach performance and injury prevention. First, a randomized controlled trial on ketone supplementation reveals that while ketones significantly improve cognitive function—helping with reaction time and mental clarity—they do not improve running performance, efficiency, or fuel utilization. Despite feeling better during efforts, runners didn’t run faster, and some even experienced gastrointestinal issues, raising questions about their real-world value for endurance athletes. 
Next, Brodie explores a meta-analysis comparing high-intensity interval training (HIIT) vs moderate continuous running (MICT). The key takeaway: HIIT is more effective at improving running economy (efficiency at submax speeds), particularly at moderate intensities, while steady running is better for improving VO₂ max (your aerobic engine). This reinforces the idea that both training styles serve different physiological purposes—and combining them strategically is the smartest approach for performance gains.
Finally, a newly released review challenges one of the most common rehab narratives: that weak glutes cause poor running mechanics. Across 19 studies, there was no consistent link between hip strength and running biomechanics, and even strengthening programs failed to meaningfully change running form. Instead, Brodie reframes strength training as a way to increase load capacity, not “fix” technique—highlighting the importance of gait retraining and smart load management over blindly strengthening muscles.
🎯 Key Takeaways
 Ketones may sharpen your brain—but won’t make you run faster
 HIIT improves efficiency, steady running builds aerobic capacity → you need both
 Stronger glutes ≠ better running form → focus on capacity, not just mechanics
 Fatigue, load, and training errors remain the biggest drivers of injury risk

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Episode Summary
In this Q&A episode, Brodie answers listener-submitted questions covering everything from transitioning to zero drop shoes to fixing ITB pain, understanding Zone 2 training accuracy, and safely introducing sprint work.
Along the way, he breaks down common misconceptions, highlights what actually matters, and provides practical, step-by-step strategies you can apply straight away.
If you’ve ever felt confused by conflicting advice or stuck in an injury cycle, this episode will help you cut through the noise and run smarter.
🧠 Questions Covered
How do you safely transition to zero drop / minimalist shoes (especially with a neuroma)?
What are the best exercises for ITB syndrome—and are exercises even the priority?
Do you need a VO2 max test to truly train in Zone 2?
What’s the safest way to introduce sprint training?
Why do your calves (soleus) feel like they’re burning early in runs—and what can you do about it?
🔑 Key Takeaways
Zero Drop Transition
Transition gradually—this is non-negotiable
Start with walking / strength work before running
Introduce running in small doses (5–10 minutes per run)
Build volume slowly (~10% per week)
Monitor for warning signs: calf tightness, foot pain, Achilles stiffness
ITB Pain (What Actually Matters)
The cause is usually load + mechanics, not just weakness
Common triggers:Downhill running
Narrow or crossover step width
Cambered surfaces

First line of treatment:Modify training load and mechanics

Strength work (secondary but helpful):Step-downs
Crab walks
Hip hikes
Single-leg control work

Zone 2 Training (Do You Need Lab Testing?)
VO2 max testing = gold standard, but not essential
Most runners can rely on:Effort (RPE)
Conversation test

True Zone 2 should feel:Sustainable for long durations
Minimal fatigue buildup
“Could do it all over again” effort

Introducing Sprint Training
Start with strides, not all-out sprints
Structure:Gradual acceleration (15 sec)
Short peak speed (8–10 sec)
Full recovery (1–2 min)

Progression:Start with 4 reps at ~75% effort
Build to 6–8 reps at ~90–95% effort

Keep it controlled and progress gradually
Burning Calves (Soleus Overload vs Something Else)
The soleus handles very high loads during running
Common overload factors:High intensity or hills
Minimalist footwear
Rapid training increases

But… consider another possibility:

👉 Compartment syndrome
Clues it might not be “just tight calves”:
Burning sensation early in runs
Bilateral symptoms
Long-standing issue despite rehab
Forced to stop rather than push through
Helpful strategies:
Longer, more gradual warm-ups
Walk/run approach
Avoid sudden intensity spikes
Let symptoms settle before continuing