Episode 19: Interview with Rachel Macri, DPT
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Welcome to Chasing Life Podcast, where we talk about fitness, running, career, and life tips to inspire you to live your best life. I'm your host, Sarah Kane, and I hope you enjoy today's episode.

Hello and welcome to another episode of Chasing Live. I'm Sarah and today's guest is one of my longest and best friends. We've been best friends since freshman year in high school and she is a physical therapist. Her name is Rachel Macri. She's been a physical therapist for over 10 years. She was a collegiate softball player and is a personal trainer at her husband's gym. She lives in Syracuse with her husband and two cats and so I'm so excited to interview her today and I hope that you will find

her information valuable. And so we're going to get started. So Rachel, can you give us three to five tips or exercises for runners to help reduce injuries? I'd be glad to, Sarah. And thank you for having me on your podcast.

All right, probably one of the most important things I recommend for runners is to cross train. Make sure you're giving your body different kinds of stresses that it can adapt to. One thing in particular you want to make sure you're working on is lateral strength. Running is a sagittal plane motion, which for the most part means that your arms and your legs are moving forward and backward, forward and backward.

And so unless you cross train with lateral or sideways movements, runners do tend to get weak in those abductor muscles that we have. So your gluteus medius is a big one. So I recommend cross training. Make sure you're lifting some weights. Make sure you're challenging your body with different directions. Trail running is great for that because it's not a straight line and you have to be aware of obstacles that might be in your path.

I also recommend highly that people make sure they have strong feet and ankles. And not only do you want your feet and ankles to be strong, but you want them to be enduring. If you think about what running is, it is single leg hopping. You're hopping from one leg to the other, which means you should probably be able to balance well on each of your legs. One of the tests we use to see if a runner is ready to return to running after an injury is the single limb heel raise test.

So standing on one leg, seeing how many heel raises you can do before you fatigue out. And a good number to shoot for is anywhere from 20 to 30 repetitions in one set with minimal fatigue.

And again, we use that as a marker to see if people are ready to go back to running after an injury. Another tip I have, I'm sure many runners have heard this, probably don't do it enough, myself included, is stretch. You need to stretch out your muscles when you're done running, especially after your longer runs when you're putting in

five to 10 to 15 miles. Those muscles are going to be tight. You need to make sure they're nice and limber when you're done stretching. Another tip I have is to make sure you're ramping up your mileage appropriately. I'm sure people have heard the 10% rule where you're ramping up your mileage 10% over each week. Your body adapts to stress. So if you give your body the appropriate stress, it'll react positively. If you

If you give your body inappropriate stress, which could be too little or too much, it's going to react inappropriately or negatively. That can result in injuries. Or on the other side of that, if you're not giving your body enough chances to adapt to stress, you're not going to see any progress. And the final tip I have for runners is to make sure you're getting enough sleep. Sleep, sleep, sleep. That is when your body repairs itself.

and allows you to go out that next day and hit your runs hard. Thank you, Rachel. That was very helpful information. And I know you and I have had many conversations about my running. And one of the biggest things that we talk about is my balance work and also focusing on my ankle strength and my foot strength, especially because I have flatter feet and I tend to pronate.

So that's something that has been really helpful to learn from you. So thank you for sharing that with. Absolutely. A huge problem. We see that in runners quite frequently, you know, flat feet, weak posterior tibialis, those ankles ever. And if you think about the effects of that further up the chain, it puts more stress on the knees, puts more stress on the hips, the low back, but an ankle strength, super important. Since you've been a PT for so long, what made you decide to pursue the physical therapy field?

Well that's an easy one Sarah. I got hurt a lot when I was a kid. I was very active. I had two surgeries at the age of 20. I had shoulder surgery and knee surgery so I got to see the patient side of physical therapy and I'd always been interested in the human body. It is pretty remarkable what we're able to do with it. The fact that we can heal is crazy and amazing to me.

So it just was a good fit for me. You know, we get to work at restoring people's ability to get back to whatever function they were at prior to injury.

Can you tell us some highs and lows of the career field that you've experienced? Sure, I'm going to start with the lows because I like to end on a high point. So I think the worst part about my job is obviously patient deaths. Now it's not something fun to talk about. You'll obviously see it more in the acute care setting or long-term care setting where people are more acutely or more chronically sick.

That's the least fun part about my job when you have a good rapport with a patient, they end up passing away.

Some other lows include other serious conditions or illnesses that really aren't expected to get better. You know, maybe they're not going to be fatal for that particular patient, but quality of life expects not to improve a whole heck of a lot. That's tough to work with. Now the highs though far outweigh the lows. So just being able to get people feeling better, functioning better, that's the best part of my job. You get to see people really progress and improve with

with whatever injury, illness, condition they've been dealt. Thank you. That sounds like it can have some really fulfilling aspects. Can you go into a little bit more of what a physical therapy session entails? You've experienced that as a patient, but also as a therapist. That's true.

The first session is when your physical therapist is going to evaluate what it is that you do need. So that's when we're doing all of our tests and measurements. And that's when we get the most subjective history from our patients, figure out what the problem is.

what it's preventing you from doing and what your goals are for PT. And really it's the patients that drive those goals. If I make up goals for you, Sarah, and you don't care about the goals I set up, chances are you're not going to work very hard towards my goals. So it's important for us as therapists to listen to our patients and figure out what their goals for therapy are. So that's really the first session, figure out what the goals are.

And then from there on, it's doing the work that needs to be done to meet those goals, whether it's stretching, strengthening, combination of both, or just retraining somebody's brain in order to get to a better, healthier movement pattern. - Thank you. I have experienced a couple of physical therapy sessions. Unfortunately, because you live an hour away, I can't have you as my therapist.

But I have had to go to physical therapy for a tight hip flexor issue, as well as a tight hamstring. I always found it worthwhile to spend that time learning how to really fully function or how to stretch properly, especially my hip flexor. It was after my first hip flexor session that I realized that I wasn't stretching after I was running. And as a result of that, I learned how to treat my body right and take that time to stretch more. And that let I know that I have problem areas in my

my hip flexor because I sit all day at my desk and then my hamstring think was more of a fluke thing, but I spend a lot of time trying to stretch my hamstring, especially after my long runs.

because runners typically have tighter hamstrings. So I have learned a lot from my physical therapy sessions as well. That's right. I mean, your body really is a series of mechanical links, just like a machine. You have to make sure all of those parts are running smoothly and operating at their maximum function. Meeting with a physical therapist is a great way to learn how your body mechanics are, and you can learn how to improve your mechanics as well. Yeah, we're fairly good at picking out people's faults.

So you've had a lot of years of physical therapy and you've met a lot of patients. Can you share with us one of your most interesting cases? I had a tough time answering this question, Sarah, because I've had so many crazy interesting cases. I couldn't narrow it down to one.

I narrowed it down to three. All right, so one of the craziest things I saw was this gentleman who came into the hospital with a condition called pyoderma gangrenosum. I had never seen it before and I haven't seen it since. It's an autoimmune condition where people develop these crazy sores. They end up turning into painful blisters.

And in some cases, you can see tissue death within those wounds. So the example I saw in the hospital, this guy had a blister open up on his foot after he dropped something benign on it. Maybe he dropped screwdriver, I forget what the object was, but it didn't puncture his skin. All it did was it tapped his foot and then he ended up developing the sore and

It progressed to the point where he had lost all of the muscles in the top of the foot, but he still had the tendons attached. And you could see right through his skin, he still had function of those superficial tendons, but he had nothing underneath it. And again, I haven't seen it since, but that was pretty nuts. Were you able to help improve his condition? How do you... Medically, that was up to the doctors.

Interestingly enough, they were planning on amputating his foot. That was why he was in the hospital. You know, his wound wasn't getting better with outpatient care and they were going to amputate it. They hadn't yet diagnosed this condition. Then one of the doctors said, "Huh, you know, I remember learning about this very rare condition. It's actually autoimmune. And if he has this and we amputate his foot, it's just going to crawl up his leg. It's going to get worse and worse and worse."

and they ended up doing this biopsy and sure enough he had this rare condition so the medical treatment was a hyperbaric chamber. I don't know how that patient ended up doing. My job was to go and teach him how to use crutches so he was offloading that leg. He did fine with me but that was a pretty wild case. Another condition I remember seeing, this was in the outpatient setting, and really I wasn't treating this girl for this condition. She was coming to me for something else.

but she had a condition called Potts syndrome, POTS. And the way she got it was interesting. She was surfing in California and she crashed with a big wave and ended up kind of snapping her neck back. She's lucky she didn't break her neck, but what she did do was injure her vagus nerve and she ended up with this Potts condition. Basically, whenever she stands up, her blood pressure can't raise up high enough

So she used to pass out every time she stood up. Also, your heart starts beating really, really fast when your blood pressure isn't raising up as if your heart rate is essentially trying to raise in order to get the blood pressure up.

So this poor girl at 19 years old had to have a port placed and every week or every two weeks she has to infuse herself with saline in order to keep her blood pressure at a normal level. And I have one more really cool case that I saw. Let's hear it. This has a little bit of relevance to your life, Sarah. Your younger brother had that chest cave in. That's a condition known as pectus excavatum.

In really severe cases of this, that breastbone is so depressed that kids have a hard time breathing and it can literally squish their heart and their lungs. So again, I've only seen this one time in the hospital. There's a procedure called the NUS procedure. And what they do is they insert this rounded kind of a bar. So imagine like a crowbar, but a little bit rounder. They

make an incision on the kid's rib cage, they insert this bar and then they flip the bar up so that the chest is now convex instead of concave.

And that bar stays in these kids' chests for two years before they take it out. Oh my gosh. That's pretty wild. They're literally using metal plates to like force these rim cages open. That's pretty cool. Wow. Yeah. Science is cool. I always love hearing all of your PT stories. You have the best stories and patients. The resilience of the human body and people in general is amazing. It really is. So I'm going to throw two curveball questions to you. These ones I didn't prepare her for. So this one's a

This one's a fun one, so you should like this one. What are you obsessed with right now? PT-wise? PT, life, TV shows, anything. Right now...

I have been obsessing over a bathroom remodel that my husband and I are starting to plan. We've hated our guest bathroom since the day we moved in. We've been in there for four years. I'm really excited. It's all mechanical stuff, which is right on my alley. So I'm really excited to learn. We've never done this before. Thank God my father lives a few miles away and is going to be able to help us with it because we're

On our own, we'll probably have a huge gaping hole in the floor in about a week. That's what I'm obsessed with my personal life, PT life. I've been really into the foot and the ankle over the past few years after myself experiencing plantar fasciitis and Achilles tendinosis. That really was what prompted me into looking more at the foot and ankle. It really is a crazy structure or set of structures in there.

It's been interesting to learn more about the foot and ankle and its role and impact higher up on that mechanical chain. Can we go off that topic quickly? Since those are really common running related injuries, do you have any advice or tips or anything that you learned through your experience that you can share with us? Go to a PT.

Do what they tell you to do. That's the short answer. Longer answer, if you're trying to avoid going to a professional, get your problem checked out. Make sure you are stretching consistently.

Make sure you have really, really good balance and endurance in those foot and ankle muscles. And don't be afraid to change your running pattern. We find a lot of heel strikers, right? And more and more research is coming out that says it's probably not the most natural way to run. Our ancestors probably ran more on their forefoots because they didn't have shoes. They didn't have an inch or two inches of padding underneath their heels. They were in their stocking feet.

I guess that'd be another thing I'm obsessed with. I run in a zero drop shoe. I no longer run in a shoe that has a heel to a ratio. And it's funny to me now, I'm so accustomed to a zero drop shoe when I wear a normal shoe and it feels like I'm in high heels, even though the difference might be a millimeter or two, you can feel it. Do you feel that the zero drop helped reduce your Achilles tendonitis? Is that one of the reasons why you went to a zero drop shoe?

It is one of the reasons. Now, at the time when I was in acute pain, I would not have tolerated that zero drop show. So I had to wait for my acute pain to go away. I had to work a lot on stretching and strengthening. I worked on my ankles and my feet for a good year and a half. The tendinosis pain took about a year at the Achilles to go away. And that's pretty typical of a tendinosis. And again, that's different from a tendinitis pain.

A tendinosis can take longer to heal. It often takes longer to heal. You just have to be patient with it. I was running that whole time, even with pain. I actually felt better after it was warmed up and I was in the middle of my runs. But to answer your question, yes, that is one reason. Once that acute pain went away, I went to a zero drop shoe and I can't wear anything else now. That's interesting. Thank you for sharing that. I think that tip will be very helpful. Any other things that you're obsessed with right now?

Just my cats at home, that's not new. Tell us about your cats. They're adorable. We have Nutsy and Winnie. Nutsy's about seven or eight now. Winnie's just over one and she terrorizes the older cat.

They're so cute. They're fun to come home to after a long day at work. That's for sure. Yes, pets are great. Cats or dogs, they are fun to have as companions. I know I couldn't have gotten through this pandemic without having a pet as company. Rachel, my last question is, what does chasing life mean to you? To me, chasing life means pursuing whatever it is brings you joy. I like that. Thank you.

Do you have anything you want to ask me or anything else you want to share with our listeners? What have been your three inspirations to run and what do you think you get out of it? Oh, that's a really good question. My top three inspirations to run. Well, when I first started running, it was a competition I set for myself.

And so I feel like that was my initial inspiration of setting a goal for myself. I first set a goal of running

a 5k in under 25 minutes, not realizing how challenging that would be. It took me almost seven years to achieve that goal. Then I set another goal for myself, which was to run my first half marathon. And that's when I learned the power of discipline and following a training plan and pursuing goals. And I felt more fulfilled there.

by having these goals that I set for myself that wasn't as a result of anyone telling me what to do, but this was something that I did purely for me, even if no one else understood it. Even if people kept asking me, well, why do you run? Isn't it boring?

I don't get why you're running so much. And it's like, that's not for you to get, that's for me to get. And I also found that running was something that I could control. When I first started running over 10 years ago, I was going through a job change. I was going through a breakup and I just felt like things were not going well, but what I could focus on was, okay, I can run four miles today.

I could put one foot in front of the other and I can do that for myself. And so even if I had a bad day at work, I had that run to look forward to. And that was something at the end of the day that I could say, well, I did that for me. And so those were the three inspirations I had, I think, to start running and have continued. And then each year I try to set new goals for myself because I

That's what's helped me to continue to grow. My current goal is to run a Boston marathon qualifying time. I'm dealing with a little bit of an ankle issue that Rachel will be so kind after we get done with this interview to take a look at for me. I did feed her with pizza before we started.

Hopefully, once I kind of get that figured out, then I can get back to running and start chasing that goal. And that's the cool thing about running, right? Because there are always goals that you can work towards. You meet one goal, easy. You can come up with another one, whether it's time or distance. There's always something that you can improve upon if you want to.

And also choose to be more recreational runner if you want to as well. Absolutely. That was a good question. All right. Well, thank you, Rachel. I really enjoyed our conversation. And the best part is we got to do this in person. So I got to have a visit with you and even Bradbury with pizza. Hopefully you found some tips helpful. Thank you for having me.

Thank you for listening. If you enjoyed today's episode, please be sure to subscribe and leave a review. I would love to hear from you. Even better, take a screenshot and tag me in your Instagram stories at SarahChasingLife.