Runners are a notoriously difficult "breed" to handle for the physical therapist. In fact, a colleague of mine has an orthopedic surgeon friend who says he would "rather treat heroin addicts than runners." Ouch!
The reason behind this response is that when an injury that requires a rest from pavement pounding rears its ugly head, runners tend not to respond that well to the advice that they should put their feet up for a while. Even when other forms of exercise may be suitable, they often find these alternatives don't fill the void that running has left. I guess that's why they run in the first place.
This is especially true in the build-up to race season when runners are upping their mileage ready for spring marathons and other race distances. It's that time of year again, and I have seen a steady increase in the number of runners booking appointments for either a nagging or a full-blown injury.
After already putting in so much time and energy, it is easy to see why a runner may be reluctant to stop training with the big race looming. We all know (and even the runner knows) that in order to recover from an injury you need to rest from whatever caused it and address any factors that may be placing additional strain on the tissues in question.
But how do PTs get runners to listen to their advice so the injury can be treated as quickly and effectively as possible?
Plan of attack
I find that the key to successfully attaining the oxymoron that is a nonrunning runner has a four-point plan of attack:
1. Explanation: Explain the injury, what causes it, why it needs rest and the treatment you will be providing. People in general are far more likely to do something if they know why they are doing it.
2. Reasoning: It may seem obvious, but it's logical to have a little time off now, rather than a whole lot more time off later when the injury becomes chronic. The longer an injured body part is placed under the stress to which it has responded negatively, the longer the rest period will need to be.
3. Alternatives: Give them other ways they can exercise. Try to come up with ideas and suggestions that are going to be most suitable and appealing to the individual. Some common examples include pool running, cycling, cross training, rowing, etc.
4. Stand firm: Tell them that they should not run until you give them the go-ahead and be clear that you expect this rule to be followed. PT is a partnership between the therapist and patient. You stick to your side of the bargain (providing appropriate treatment and advice), and they should stick to theirs.
This may all sound a little like you are training a dog, and I really don't mean to sound harsh or be offensive toward runners — I am actually a runner myself. I'm not trying to be rude, and I don't believe this applies to every runner out there. But I do find adherence to a rest period to be a common problem among my running clients, which I feel hinders their progress along the path to recovery.
Refocus
Another great tip for distracting injured runners is to give them another focus. The best of all of these is their own rehabilitation. As most of you will know, running injuries are often due to training errors such as:
- Overtraining
- Too many long, slow runs with no variation in speed or terrain
- Too much hill work
- A lack of strengthening/flexibility work
- Ignoring the warning signs of an injury
- Old or inadequate footwear
Rest and physical therapy treatments are half the battle when rehabbing a running injury, and the other half is determining what caused the injury in the first place and correcting the error. In fact, it is usually missing this vital part of treatment that causes an injury to recur once running training resumes.
A physical therapist should be able to perform a movement or gait analysis, as well as performing muscle length and strength tests to determine muscle imbalances that require work through rehabilitation exercises. This can be a focus for the runner, and a comprehensive rehab program may take up to an hour a day (usually more like half an hour) to complete and may also include stretching or other exercises that should be carried out periodically throughout the day.
If the PT is not a running specialist, he/she may also recommend that runners speak to an experienced coach regarding their recent training plans and also their running technique to see if this may need work, to help reduce the risk of the injury recurring.
Return to running
Another problem I tend to encounter with my clients is a difficulty sticking to a gradual return to the running program once I have given them the green light to start training again. This is often especially true if the runner has stuck to your "no running" rule throughout his/her rehab.
Often they have been champing at the bit to get back out there, and the excitement at being able to run — for even a short distance — takes over. The temptation to try just that little bit further can get the better of even the most self-controlled athlete.
Providing a structured and personalized return-to-running program may help as there are then clear boundaries at each stage that should not be passed. Also at this point, don't "discharge" the runner from your care and leave him/her to carry on as before. Keep "check-up" appointments every couple of weeks to make sure they are not pushing too hard, too soon and have had no flare-up of their injury.
Any still necessary hands-on treatment can also be administered and you can check the progress of their rehab exercises. Only "discharge" runners once they are back up to full training and pain-free. You should also instill in them an understanding of why the injury occurred and that they need to persist with the rehabilitation program even once back to full training.
