Champion's story

One great thing about my current job is that I often get to combine my passion for physical therapy with my passion for running. I frequently have the opportunity to help local runners recover from injuries. Recently, I have helped a few of the faster runners in the community manage injuries. This has great for a few different reasons. Of course, it is great to help these people just like it is satisfying to help all the other clients I work with. It has also been fun to observe how these elite runners deal with injury. In many ways, to me, these are defining moments.

First off, what I have noticed is that the champions shift gears quickly. This happens in a couple different ways. First, they listen to what their bodies are telling them. If they feel tired or sick, they do not push past this. They listen. Second, when they experience pain, they listen very closely. The quick shift with respect to pain occurs with the mode of training they choose. If the pain prevents them from running, they do not dwell on it. Instead they go directly to the next best mode of training. This might be riding a bike if an injured tendon can't take ground reaction stresses. It might be switching to pool running if dealing with a stress fracture. Point is that there is no feeling sorry for themselves. There is a goal, and most recognize that dealing with injury is just part of the game.

One thing I love too is that these runners value and respect their inner circle of advisors. They listen to themselves, their coaches, and their PT's! If they need to shut it down, they do. In the long run, they are back to training more quickly for it.

The title of this entry comes from Jerry Lynch, who is a sports psychologist. He has published many books which I have thoroughly enjoyed. He is a former competitive runner himself so he frequently comments about advising runners. One concept he touches on is the Champion's story. He notes that the best runners will set goals, and then write the 'story' to achieve them. The 'story' can be how they train, rest, eat, and of course, deal with injury. Good stuff. Check it out.

Side Note: The photo at the top is of "Ocho". This past season Bill Potts and I raced numerous times. At the Capon Valley 50k, we raced a 'pinkie' run, our term for a fun run where we run together thoughout the entire race. It was a great race. We ran steady to an 8th place finish. The awards table for top ten finishers had many quirky handmade crafts. I chose Ocho for my award. He sits in the bedroom as a reminder of my champion story: train hard, run smart, and have fun! Thanks Bill.....

Managing time off from injury

Dealing with an injury is always a challenge. Many runners that I see in the clinic struggle with injury. Their focus often settles on what they can't do: run. My role as a PT often encourages injured athletes to change their focus onto what they CAN do intead. There are plenty of options out there for the injured. In most instances, the focus should be on relative rest versus complete rest. Obviously if the athlete is dealing with 7+/10 pain, then complete rest is the answer. Most nagging running injuries tend to be in the 0-3/10 pain range. At this level, it is ok to keep running as long as ther is no obvious impairment of ruuning form. It is in the middle ground, the 4-6/10 pain range, that the cross training and relative rest is key. I like to think of it as the pushing buttons range. The reason being that most runners just want to run. They usually do not want to fool with much else. That is except for the champion runners who recognize the value of mixing it up when they can't run at the level they want.

As I mentioned above, there are numerous different modes of exercise for the injured runner.
At the top of the list is pool running. This form of exercises most closely follows the actual form of running. In deep water, an athlete can go through the motions of running without having to deal with the ground reaction forces that typically are pounding on the legs. It is a great first choice to take a load off. It requires the use of a buoyancy belt and not a whole lot else. I typically cup my hands into small paddles so I can actually move back and forth in the pool. I suggest that the runner focuses on the movement of their legs so they can try to mimick their on-ground form. Many studeis suggest that pool running can maintain fitness for up to 6 weeks. If you think about this in terms of common running injuries, think stress fractures, it works out quite well. A runner can maintain fitness and in 6 weeks be nearly healed.
A progression from deep water pool running would be running in shallow water. It requires water shoes so you do not tear up the soles of your feet. The buoyancy effect unweights most of the body weight but now the runner enjoys the benefits of weightbearing, albeit usually only 25% of bodyweight. Running against the resistance of the water causes the runner to forward lean whihc encourages a mid foot strike. Needless to say, these running form priciples are key for on-ground running.

Another option for injured runners is the use of an ellitical machine. There are many makes and models out there. One in particular I like is made by Cybex. The machine has a large foot platform and optional hand use to work the arms. The fluid motion of the machine cycle very closely mimicks running. Resistance can be added for increasing the intensity of the work. It is a great machine that i now use as an adjunct to my normal training even when not injured. I can use it in place of a recovery run. I can the work for my legs without the pounding. I can then proceed directly to my core/lifting routine without a hitch.

Using an exercise bike is another option for injured runners. It hardly mimicks running but think of it as just priming the engine. You are getting a hearlt rate response which get the cardiovascular system active. With runners who are not able to weightbear, I frequently start with use of the bike.

One question I often get from clients is "how do I know if I can still run my target race after this injury?". Advance Marathoning by Pfitzinger provides a useful guide. It breaks down the number of days missed because of injury compared to number of days to target race.

<10 days missed: resume schedule if race is 8weeks or more away, AND if it is less than 8 weeks off

10-20 days missed: resume schedule if race is 8 weeks or more off. REVISE goal if less than 8 weeks off

>20 days missed: Revise goal if race is 8 weeks or more off, AND revise goal if race is less than 8 weeks off.

Nothing too fancy there but it provides a framework to get started on regarding whether you can keep targeting a race or if you should realistically chose another one. Hope it helps......

Time to heal

One of my favoirte places to run is the C+O canal towpath. The painting on the left was done by a local artist of the canal. I love it and was excited to share. Enjoy!

To continue the thought on my recent leg injury, in hindsight one of the key mistakes I made, which you can learn from, was that I disregarded the basics of time required to heal. I let the runner side of me trump the clinician side. What I mean is that when you suffer an injury, there is a certain amount of time that needs to pass before the body can reasonably heal itself. This same concept applies to other areas of rehab. For example, it takes a certain amount of time before a weakened muscle can get stronger, no matter how much effort you put into it.
With my recent leg strain, I tried to rush back too quickly. I barely gave the muscle 24 hrs to heal which is simply too short. I iced, wrapped, and elevated the bugger. It felt better so I tried to get right back to it. As a clinician, I know that there are stages of soft tissue healing whihc were not being respected. The phases of healing are: 1) Inflammatory 2) Reparative and 3) Remodeling. The length of these phases will be different depending on what part has been injured. For example, an injured tendon might take a month to cycle through the reparative phase versus 2.5 weeks for a muscle.

With my injury, an injured muscle, the inflammatory phase happens quickly which is why the initial repsonse is key. As mentioned previously, ice and compression can help tremendously in this stage. I often encourage people to shy away from advil and the like. The reason for this is that inflammation is the first step of healing so we do not want to impede it from occuring. The healing occurs in a stepwise fashion so to block the step which initiates the other steps is not recommended.

New muscle fibers can appear in 18 days from the injury. By day 21 the muscle fiber is able to generate tensile force. So, when you think about the above information, you must consider where you are in the healing process. If you are one week post injury, realise that the muscle simply has not had enough time to heal to the point where it can be asked to perform. Consequently, a runner needs to focus not on running but rather the crosstraining to maintain the current base of fitness. 3 weeks into it is a distinctly different place as far as the healing goes. It is more appropriate to start thinking about actually getting back into the basics of running.

Each person heals differently based on age, sex, medical history etc. Use the above info to stimulate thoughts on managing injury. Obviously, when injured it is best to have a health care provider advising you on an indiviual basis. Happy trails.....

Grasshopper

I knew it had to happen. As a clinician, the statistics on running injuries are pretty ugly. Even still, I have been injury free for years. Of course, there is the little stuff that you can train through like a sore achilles. I had not been forced to stop running since I had torn my meniscus 3 or 4 years ago. All this changed a couple weeks ago.

At the end of a typical loop leaving from the gym, I suddenly had crazy sharp pain in my right calf. Basically, continuing to run was simply not an option. I walked a half mile back to work sort of scratching my head about what was going on. My focus was on what had been different in my training. My experience in the clinic tells me that most injuries occur in a transitional period: increases in miles, intensity, or frequency are typical culprits. The strange thing was that I was not in such a period. I had gently returned to running after the Grindstone 100. I thought about my shoes, which that day were my Newtons. I am new to Newtons but they had really treated me well to date. It was not as if the shoe was new to me. Then I thought about the recent training. I had just done a 19 miler with Team Jackass at a steady clip, marathon pace plus 20 seconds. I felt good most of the way. Thinking back another couple weeks I recalled an ankle sprain on the same leg while on the Rock Creek trails. It was a good sprain, the type where you feel the bones clunk. It hurt, but not horribly. I iced immediately and took a break from running for a few days. Without swelling or pain I took back to running. In hindsight, this might have been my first mistake. The best I could do as far as my leg strain goes was that I was compensating for the twisted ankle which caused me to overtax the muscles of my lower leg.

Second mistake for grasshopper was trying to get back to running too soon. I felt the sharp pain on a Thursday, and tried to run two days later. It was such an amateur mistake. I am embarrassed that the PT in me did not smack down the runner in me. It is a testament to the passion of running in us. So I tried to run too soon and made it significantly worse. I felt a pop in the muscle as I gimped back to the car with my buddy Mike Yuengling. The posterior tibialis was in complete rebellion/ shut down mode. I was done for a few weeks at least.

There are a variety of lessons to be learned here. I should know better how to manage these things because I do it every day. Learn from the clinician Doctor G, not the runner Bobby G!

One quick lesson, with more to follow, relates to listening to your body. I frequently help athletes recover from injury. I ask them to rate their pain on a 0 to 10 scale.

If the pain is in the 0 to 3 range, I am ok with resuming normal activity. For a runner, I ask that if the pain is causing them to limp then all bets are off. Otherwise they can gently try to run.

If the pain is in the 4 to 6 range, it is most appropriate to switch gears to cross training. For a runner, as with most other athletes, I like the stationary bike, elliptical, or the pool. Depending on the injury, one might be better than the other. You want to cross train until the pain drops back into the 0-3 range.

If the pain is in the 7 to 10 range, it is time to just shut it down. Focus on letting things calm down. Go back to the basics: ice, compression, elevation, and relative rest. Do this until the pain subsides so you can begin to gently train again.

A key element with the above recommendations is that the athlete is honest with how they assess their pain. No cheating in other words. It is an accurate assessment of the pain. If your pain is a 5/10 but you really want to meet your training buddies for a run then it does not become a 3/10. Recovery from an injury should be about changing training such that you can stay active and heal at the same time. More to follow on that.....

Ryan Hall

We had a great time over the weekend with the Pacers crew(www.runpacers.com) at a benefit for Ryan and Sara Hall's foundation (http://www.thestepsfoundation.org/). I had fun chewing the fat with Ryan about a variety of topics. You quickly realize that he and his wife are just ordinary people who just happen to be darn fast runners. Ryan is a big supporter of the importance of cross/strength training. This is something that I emphasize with many of the runners I work with so having him on my side is great. It was a thrill to be a part of the event.

I mentioned to Ryan that I would see him in Boston next year. Somehow I think my corral will be a bit further back than his.........

hit the FUN button

You gotta love this time of year for training. The temperatures are cool, the air crisp, and the recent snow adds a certain beauty to the DC landscape. For me, this time of year is a transitional one. I am winding down one season and looking forward to another one. With a focus marathon training program, each workout should have a goal. For example, the goal of the long run is to build endurance by raising aerobic metabolism. The tempo runs are slotted for developing a runner's anaerobic threshold. Following a structured program for multiple races can leaving feeling drained. As a result, it is important to really focus on taking some down time this time of year. Enjoy the freedom of not having a goal for each run or workout. Go for a hike with family, run around playing games, or try a spin class. All of these examples will allow you to be active, maintaining fitness, without the drain of hitting a target pace or distance. Have fun with your down time. Doing so will ready you for the next training cycle. It is better to start next season mentally fresh than still sluggish from too much work when rest is needed.
This time of year I love to get out on the trails in Rock Creek Park. It is a beautiful area with challenging terrain. The uneven terrain gives the balance system a bit of work, and the hills certainly help maintain all the glute strength from the cross training. My gait is constantly changing on the trail which helps reduce the stress load on my muscles and tendons. This time of year is a great time to allow the body to rest and heal. Bottomline is there are times to just have fun. For me, the time is now. Pull on those goofy socks and run just for the love of it. Think about how much fun Boston will be in April.......