Joe Uhan Launches Stay The Course Column

Stay the CourseGreetings, iRunFar readers! Welcome to the introductory post of what may be a new feature on iRF landscape: Stay the Course. In this column, I hope to explore some concepts of sports medicine and science – and how they can keep us on [and sometimes off] the trail. Before delving in, a little background on your author:

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I got into running for the same reason most boys do any sport: to impress a girl. I’d tried (and failed at) most sports in high school, until I tried running. Our high school squad wasn’t very strong, so I made varsity from the get-go. Although I never parlayed that varsity success into dates, I was in love with all the sport had to offer – freedom to roam, camaraderie of a team, and the battles on track and trail.

One of my best friends was a year younger than me, so after graduation, I found myself returning to his track meets to become his de facto coach: devising race strategy, cheering on every corner, and even developing elaborate race-day nutritional ploys (anyone ever hear of “bicarbonate loading?”). This experience planted the seed that would later sprout into a real coaching career.

Joe UhanA year later, I matriculated to the University of Wisconsin-Eau Claire, a Division-III school in central Wisconsin. There, I had the privilege to be coached by marathon guru, Sean Hartnett. Sean, who would go by nothing else, was the Philosopher Coach. His “Miyagi”-like approach to the sport was reflected even in his attire: subbing the polo shirt, whistle and clipboard for jeans, a plaid blazer, and a plaid hat. His egalitarian philosophy and commitment to team still resonates with his former runners equally strong as his many Sean-isms, such as “Big Mileage pays Big Dividends,” “Race (train, and coach) with The End in mind,” and a single word: “Unus,” meaning one, in Latin. He also taught us more practical lessons, including, “If you raced hard enough, it shouldn’t take more than a couple beers to have fun,” as well as the liberal use of a certain fruit extract as a skin protectant and thermal insulator for the frigid, post-season meets. My time with the Blugolds and Sean – and the collective triumphs and struggles we shared – would prove to be a blueprint for my professional and personal life, and for how I want the running experience to be for others.

After graduating, I was employed as a lab chemist with flexible hours. I took advantage and helped out the track team at my old high school. A low-key, part-time volunteer gig became a true passion. I loved coaching, and threw the bulk of my time, effort and passion into it.

My coaching philosophy was simple: whatever the kids needed, I’d provide it. It didn’t take long to determine their most significant need: quality sports medicine. My personal frustration with conventional treatment for running injuries – rest, pain-meds, or surgery – grew geometrically as a coach. It killed me to see my kids injured, so I found myself poring over the internet looking for the latest, greatest exercise, stretch, tape or brace that would get them running again. Despite my lack of training, I was often successful. As it turned out, getting them better was as rewarding as getting them faster.

Joe UhanI loved coaching enough that I wanted to do it for a living. I got educated; first via USATF Level I and Level II coaching certifications.  That was great, but I wanted more. I enrolled at the University of Minnesota, intent on getting a Master’s Degree in Kinesiology. Having a strong technical background, I passed on biomechanics and physiology and went the other way – sport psychology. I loved it! During this time, I would work in the lab in the morning, take classes midday, and coach in the afternoon. I found myself applying the concepts from class to my athletes, sometimes the very same day.

But anyone who’s coached within the construct of a school system knows full-well the politics of athletics: the program, the athletic department, the school, and the parents/boosters. I realized over time that the coaching profession was too political and volatile (and too poorly compensated) to rely on. About this time, I experienced a persistent knee injury, which ultimately wiped out a tremendous marathon build-up. After two months of pain, I saw a Physical Therapist. A minor but important running cue and some patellar taping abolished my knee pain in a single visit. As I ran on the treadmill in the clinic realized, “I wanna do this for a living!” So on the same day I defended my Master’s Thesis (on “Team Cohesiveness in Interscholastic Cross Country”), I was on the phone with a program director of a Physical Therapy program.

So, just about seven years later from that day, and a decade since I stated coaching, here I am.  What I like to tell patients on their first day – namely my runners – is that “I wear three hats”:

  • Physical Therapist
  • Coach
  • Runner

And while it can be delicate to balance the three, it is when they work together that they are most lethal – for running injuries and on the race course!

What iRunFar and I hope this column to be is a resource not simply for running injuries, but a place to share and discuss important and salient concepts of sports medicine, biomechanics, and general science and how they might apply to us – and how they might ultimately make our time out on the trails and roads more enjoyable.

Call for Comments (from Bryon)

  • Do you have any questions for Joe on his background?
  • Anything sports science issues you’d be excited to have him write about?
Joe Uhan

is a physical therapist, coach, and ultrarunner in Eugene, Oregon. He is a Minnesota native and has been a competitive runner for over 20 years. He has a Master’s Degree in Kinesiology, a Doctorate in Physical Therapy, and is a USATF Level II Certified Coach. Joe ran his first ultra at Autumn Leaves 50 Mile in October 2010, was 4th place at the 2015 USATF 100K Trail Championships (and 3rd in 2012), second at the 2014 Waldo 100K, and finished M9 at the 2012 Western States 100. Joe owns and operates Uhan Performance Physiotherapy in Eugene, Oregon, and offers online coaching and running analysis at uhanperformance.com.

There are 24 comments

  1. Mike B.

    Welcome Joe. Physical therapy can be such great tool. For 6 months I was having problems on and off with my left hip flexor and then a friend suggested a PT here in Golden, CO. After one visit the pain was gone and she had improved my form. I cant read enough about form and mechanics (if you know any must read books please let us all know). I look forward to your articles.

  2. KenZ

    Awesome! Am looking forward to some good, well based, and useful sports injury articles. If there's one thing I've learned over the last year, there is a world of difference between a PT and a _good_ PT (the same goes for every profession of course, but I mistakenly thought that PTs who said they knew how to deal with ITB issues actually knew what the heck they were doing).

    Am just getting over what I at least consider to be the world's worst IT band case over the course of a year. Couldn't run 2 minutes. Couldn't go down stairs for weeks. Saw a good regular doctor, then a PT for a few months. Nothing. Got 6 sessions of myofascial release from probably the most reputable place I've heard of. No luck. Did three continuous months (religiously) of the exercises for ITB issues from Running Times (http://runningtimes.com/Article.aspx?ArticleID=3528). No luck. Had three sessions, and a guided cortisone shot with/by Doc Michael Fredericson (yes, the guy that authored most of the early papers linking ITB issues with weak hips). The shot helped for a month, then I was back at stage one. Saw another PT. No luck. Saw a chiropractor. No luck. 6 more sessions of myofascial release, 10 sessions of Active Release Technique (might have helped a little, but no magic) and then… found a good PT. Like, one that actually treated me as a unique case, and didn't try to just apply the basic IT band fixes from the books. Maybe it was that, maybe it was time, but FINALLY after a 4 month buildup (starting from 2 min of running again) and more exercises from the PT targeting _my_ issues, and it looks like I'll have a running season again.

    I launch into this exhaustive explanation because a) I definitely feel sorry for myself! and b) I look forward to both the injury recovery AND the injury prevention information you can bring to the table. Read as: ITB sucked hard, please help me avoid ever getting PF and all the other stuff that is hopefully preventable!

  3. Susan Welz

    Found a better way to help people and that makes life worth living. So impressed with your enthusiasm that I just had to write. Stay Focused! Stay people Minded! I wish you further success.

  4. OOJ

    Thanks for the post!

    Later this week, we'll delve into our first injury post that addresses the fundamental elements of injury. ITB is a prime example of a multi-faceted issue that involves both "tissues" and "forces" — and why both issues need to be addressed to fully recover. Stay tuned!

  5. Caleb

    Really excited about the new column! I'm really skeptical about a lot of things because much of it seems contradictory. Hoping that you can provide some good information.

    1. Jake Rydman

      I can vouch that Joe knows his stuff. I thought I had "perfect mechanics", but Joe has helped me improve my bio-mechanics even more and I've become more efficient out on the trail. I'm biased bc Joe's a friend of mine, but i honestly think we're all in for a treat. And thanks Bryon too, good call on having this column!

      1. Caleb

        awesome! Can't wait to learn new things. I'm dealing with PF in my left foot right now, so i'm a little more interested in this stuff now!

  6. dogrunner

    hi Joe – I'm looking forward to your column. Should be interesting. Bryon is definitely developing iRunFar into a great resource.

    To echo KenZ – my experience with PT has been really mixed. PT to treat symptoms vs PT to fix underlying causes. I used to have a lot of ITB problems, then a major calf injury (from mtn biking). Went to a series of PTs who all wanted to employ fancy gadgets (ionto, stim, drugs – ok that was an MD), but with no benefit to chronic problems (did help with acute inflammation though). Then, after a year of limited ability to run, ONE session for my calf with a PT who somehow immediately diagnosed the root problem (a "permanent" spasm) and fixed it right away(and seemed like it took very little action on her part). She also gave me some strengthening exercises to reduce risk of future problems. I mentioned I also had recurring ITB problems and she told me how to manage that too. Then we wondered what to do with the other 5 sessions that insurance would cover (more strengthening work). So PT has helped me a lot, or, was only of limited use. I'd love to hear your thoughts on a game plan from injury to total recovery – is there a general recipe? There are so many flavors of PT how is the consumer to know what to do?

    1. OOJ

      Thanks for the comment!

      Every health care practitioner is different – even in the same profession or licensure (or even clinc!).

      There's no one "perfect" way — as the Bhuddists say, "Many Paths to the Summit" — and no one approach will work for everyone. However, there some fundamental elements of injury that should always be given a close eye.

      I tell all my athletes during exam: "There's the clinical you and the athlete you". Meaning: you must examine and treat the clinical issues (inflammation, ROM, strength etc), but perhaps more importantly look at the motor control — how you're moving your body — on the run and everywhere else.

      These fundamental concepts will be discussed very shortly!

  7. Kristin Z.

    Excellent Joe! Maybe one other "housekeeping" mini post could be what PT's can do in practice… there are definitely misconceptions as to what we can/cannot do (grade V mobs, diagnose, other forms of rx), etc. As with anything, there are awesome PT's (chiros, MD's, ATC's, MT's) and there are less so… you, i'm fairly certain, can show where the "high bar" is set. Congrats!

    Kristin, OR

  8. David T.

    I would like you to address a few things:

    1. Minimalist vs. traditional vs. Hokas – What are the benefits and draw backs of each and who should consider using which type of shoes?

    2. Basic treatments and prevention of common ailments (ITB syndrome, planter fasciitis, etc.)

    3. Any innovations in training

    Look forward to your columns! Great addition Bryon!

    David T.

    1. OOJ

      Thanks for the suggestion!

      To reiterate what I commented above: later this week I'll have a post about injury factors. The real question is, why was your 5th met broken? Why not the 1st? or the 3rd?

      We'll address that in a big-picture format next post! Stay tuned! :) In the mean time, UltraRunning has a nice article on stress fracture management in their March 2012 issue (as well as their October 2011 issue) by Tom Whipple.

  9. Ben Nephew

    Hi Joe,

    Do you have any idea why there is such a lack of carefully controlled studies on potential treatments in sports medicine vs. most other types of medicine? Given the size of the running population, getting large enough sample sizes shouldn't be much of a problem. There is definitely some great work out there on running physiology, but most of the studies testing different treatments seem to be more descriptive than hypothesis-based. One of the first things I found when looking up hamstring injuries:

    http://ajs.sagepub.com/content/28/3/297.short

    http://bjsm.bmj.com/content/46/2/103.abstract

    I wish I could get studies published without control groups!

    Ben

    1. OOJ

      Ben-

      I'm not an authority on research, BUT here's what I *think* is the issue: too many variables.

      In order to have gold-standard (RCT) research, you would somehow have to control for "everything", including running mechanics — which is extremely difficult. That's why most studies are "pain vs no pain" (VAS or functional scales) and strength measures — not return to running, running volume, or competition — all the things we runners care about in a running-based study where *how* we run plays a huge role.

      Then there's your control group: you could control run volume, but what about biomechanical integrity within a control? Again, very, very difficult.

      Sheesh, even to get an inclusion criteria for a one injury is tough. Lateral knee pain: there's ITB, SI joint referral, lateral collateral ligament, lateral meniscus, PFP, fracture, bone tumor. To effective screen all — your study numbers would take a hit…and your clinical applicability would, as well…

      Gotta keep trying, though…

      1. Ben Nephew

        The thing is that there are similar challenges for most other diseases. Instead of running mechanics, you may have variations in metabolism. I went to a conference on depression, which is another type of injury with many variables. While there is need for improved treatments, there are current treatments that have gone through RCT and work. The most interesting comment at the meeting was a comparison between childhood cancer and depression research. Childhood cancer was virtual death sentence 50-60 yrs. ago, but the survival rates are now incredibly high for many types of cancer. The key to the the development of new cancer treatments was tremendous national and international effort by researchers to communicate and initiate large clinical trials. I think sports medicine could benefit from a similar development.

        Your example of lateral knee pain underscores the issue with diagnosis. When you hear about professional runners having issues with getting an injury diagnosed, that's a bit worrisome. I think that MRI has a great deal of potential for improving diagnoses, but sometimes it seems as though MRI's are used more for 2D images than 3D images.

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