The Monday Memo
January 13, 2020 PITT DPT STUDENTS
Death, Taxes, and Distance Runners Training Through Injury
I’ll start with a simple question that most runners get on a daily basis: “why do you run so much?” A good question nonetheless, but one where the answer truly never satisfies, nor is it one size fits all. Understanding this point is the key to treating the stereotypical distance runner.
I played basketball, soccer, and swam competitively all throughout my childhood, but gave it all up to focus on running track and cross country to earn a college scholarship at Pitt. To me, it was a sport first and foremost, a means to an end that would hopefully evolve into a lifestyle or a hobby that would stick with me through my adult life. To others, running can be an escape, a way to de-stress and retain focus and clarity. It is a form of community; it encourages healthy social interaction for many, and welcomes any individual no matter the experience or ability level. Exercise, weight loss, and various other health benefits also draw people in, but to understand the athlete, you must first ask the question: “why do you run so much?” Without the answer to this question, without understanding the motivation behind the athlete, you cannot understand and appreciate the method to our madness.
Many of us have experienced this exact scenario: runner comes in after initiating a program, they express concern over something they clearly feel is important enough to dedicate their time to looking into, and when you provide your analysis and utter the words “I think you should think about taking some time off,” you’ve lost them. I’d like to play a little unpopular devil’s advocate, as someone who has been told to take time off, and as someone who tells others to take time off. After the dust settles, instead of placing the blame on the runner for not following our recommendation, what if it is our fault for having the conversation the wrong way? Einstein said that insanity is doing the same thing over and over and expecting a different result, so knowing the chances of success with this particular conversation, why do we still try to shut a runner down six weeks before the marathon?
I don’t have an answer, because the approach will not be a “one size fits all.” When it is definitive that an injury is too severe to run on, and it is evident to the therapist but not the patient, it is our responsibility to not allow that patient to be put in a situation where they could do potentially irreparable damage. When on the fence about shutting them down completely, I firmly believe airing on the side of caution can be as detrimental as running on a muscle strain or tendonitis. Physically they may feel better in a week or so if they take the therapist’s advice, but does that athlete want to come back when they have another set back only weeks from competition? Learn about your athlete and what motivates them, determine how you can help them achieve their goal/motivation, and develop a plan that works for you and the patient.
Just like all your patients, start with the goal, “I want to run the marathon.” If they are running because this race is the opportunity to run with their family member or for a cause they are passionate about, asking them to stop running may be the worse news they have heard in months. If they are trying to qualify for a bigger race or meet a certain time, they have invested countless hours into training and will probably not allow knee pain to keep them from achieving their goal until they are literally unable to walk. In my experience, knowing that my PT wants me to run my race, and understanding they are tailoring our sessions with the goal of getting me to the race, opens doors that can get forever shut simply by immediately suggesting time off.
I am not saying we should allow all our injured runners to run, I simply wanted to provide some perspective as to what the conversation might be like from the other side of the table. Running is a sport that involves a lot of pain and sustained discomfort, so it should come as no surprise that running through injury is very much a part of the sport. In my time at Pitt, I have had two navicular stress fractures, one femoral neck stress fracture, two hamstring strains, a quad strain, a partially ruptured Achilles Tendon, a torn labrum and FAI that required surgery, a concussion, back spasms, and just about every lower extremity tendonitis under the sun. I plan on going out for a 6 mile run later this afternoon, and I fractured my twelfth rib only three weeks ago. Why do I run so much? I run so much, simply because the work isn’t finished yet. I have the same level of dedication as the runner on your treatment table later today. I may be one of the more extreme cases, but just like the majority of your patients who are runners, every running injury I have ever had has come with the goal of getting right back on the horse.
-Joshua Trzeciak, SPT