Happy one-year anniversary of Stay the Course! It’s been an honor and privilege to pen this column for the past year. Like a hard race, it is a challenge and assessment to take one’s professional knowledge, beliefs and values and open it to critique.
It’s also allowed me a valued opportunity to offer unique perspectives on issues and problems plaguing runners. Readers of StC might notice that there has been very little conventional sports medicine content in the columns. Why? Because frequently:
A. Runners already know a lot about conventional sports medicine approaches, yet they’re still in pain.
B. The key to sustainable improvement is to find and treat the cause, not the symptoms.
Having a platform to disseminate these alternative concepts has been rewarding for me, and I hope, for the readers, as well.
Treating runners is challenging. To relieve their pain, temporarily, is one thing; but to create sustainable improvement, is much tougher. Almost always, it requires analyzing and changing mechanics.
If you get ten PTs together in a room and asked them how the felt about changing someone’s running mechanics, at least eight of them would sooner sit in a dental chair, or be on the business end of an endoscope.
Why? Changing someone’s mechanics is difficult, and it is scary! Most of us aren’t comfortable doing it. But so it is for the doctor on the other end of that endoscope. However, daunting and difficult are not reasons to avoid what, for most runners, is what they need most.
I still remember the first runner whose mechanics I aggressively changed. It was intimidating, challenging, and at times frustrating. But in those initial experiences, you trial and error, and error some more. But you learn. And then you learn that, when you can create a sustainable, efficient change, pain evaporates.
Then it becomes fun. And deeply rewarding.
Based on those learning experiences, I’ve since developed some fundamental Rules that guide me – as a therapist, coach, and runner – with running injuries. They’ve served as guiding principles for not only sustainable pain-relief, but healthy, sustainable running:
Uhan’s Laws of Running Injuries
1. Every running injury invariably changes the way you run (The Pain/Brain Law).
Pain changes the brain. Clinically, we see this across the board with any serious injury: a fall, a surgery, a fracture. It changes how you move. It’s not simply due to fear (though it can be). It is a primitive fight-or-flight response: the brain will automatically find “alternative movement strategies” to keep you moving. Period. It’s a basic survival instinct. If something hurts – or is damaged – the brain will find another way for you to escape.
Too often, especially with running injuries, that new strategy becomes the “new normal.” Compensation becomes reality. The brain adopts it as normal. And most of us cannot tell that we’re different, as the brain blends this new strategy into your “normal movement” pattern.
It’s like we have an Excel spreadsheet for every movement pattern we do. For example, there’s a file called Run.xls in our brain. When we have pain, it’s as if one of the Board of Directors opens the file, changes one (or a hundred) functions, and hits save. Your brain still thinks it’s Run.xls. But it’s different.
And you move different. Less efficiently. Often pathologically, causing anything from aches and pains to further – and usually different – injury.
How do we combat this?
- Take pain seriously. Never run through an injury unless it’s mid-race, or within days of a race. Even then, rest as much as you can.
- Rest. Allow tissues to heal maximally.
- Beware of “program overwrites.” Do Not Limp or Compensate! Ever! Even if running normally is more painful, compensating will foul up “Run.xls,” and you might never get the original back.
- Keep a back-up copy of Run.xls. Know your normal! Keep periodic video of your good stride. Perform running drills consistently that will reinforce your most efficient running mechanics, so if and when you do become injured, you truly remember how to do it.
2. For every injury action, there is an equal, and opposite reaction (Uhan’s Second Law of Motion)
When I’m first working with an injured runner, I often channel my inner psychic:
- For the runner with left foot pain, “Did you ever hurt your right knee a long time ago?”
- For the person with right hip pain, “How many times have you sprained that left ankle?”
It’s not mysticism. In the course of a thorough exam, you’ll find issues on the opposite side – or end – of the body corresponding with the current injury. It’s part compensation, but it more about how running works. Running is reciprocal: push creates pull, short makes long, rotation makes counter-rotation. It’s how we propel. That said, any running injury will affect the opposing action to whatever is painful.
This concept is important to not only cover the bases with injury rehab, but also to find the true cause of a given injury. For example, many runners with unilateral hip pain (the driving, flexing phase) will have a history of foot, ankle or knee pain on the opposite leg (the extending, push-off leg). Another example is plantar foot pain: many runners will have a history of ankle, knee or hip pain affecting the push-off of the opposite side. A weak push off one side makes for a sloppy, painful landing on the other. Effectively treating both the flexing and opposite, push off leg is vital to ensure a complete recovery.
Lastly, my favorite:
3. A runner’s mechanics, without energy input, will devolve to greater and greater disorder until it reaches equilibrium – and they stop running. (Uhan’s Law of Running Thermodynamics)
My college coach used to say, “Injuries have a memory.” I used to think that pertained to the tissue somehow “remembering” it was hurt. This is sometimes true (with collagen fiber). But with the brain, it is nearly always true. It serves the brain well, in a survival sense, to remember pain. And with each injury, there is opportunity to compensate, however minor. Injuries – aches, pains, and stiffness – can cause brain and tissue changes, which in turn can cause run mechanics to gradually become more inefficient. Inefficiency causes greater stiffness, aches, pains, causing greater inefficiency…and a downward spiral forms.
Ultimately, this process results in more severe aches and pains, or injury, forcing a runner to severely curtain their running volume, or stop, entirely. Game over. Happy retirement. Talk to any “retired” runner; there are few, if any, who do so voluntarily. Instead, it is because of pain, stiffness, or misery that stole the fun, speed and distance from their running.
Maintaining efficiency – and pain relief, sustainable running, and enjoyment – takes consistent energy and regular attention to stride integrity. Without it, you risk becoming another early retirement case.
- Take the time to do active stretching, before and after the run. Stiffness is progressive, like a room with wall closing in. Stop the progression with consistent range of motion. Consider periodic massage or weekly yoga classes – anything to maintain normal functional range of motion and strength.
- Run speedwork regularly. The consistent performers with longevity in the sport all run speedwork. Speedwork, augmented with drills, maintains full range of motion and maximal stride efficiency. Without efficiency, you cannot run fast. Routine fast running, even in short volumes and relatively low intensity – keeps those walls from closing in.
- Be mindful of your run mechanics. Know how you run, and be mindful of when something feels off.
- Ask for help! We all run with others. And we all know how each other run. Yet seldom do we ask for input or reminders about form. Golfers do this, why don’t we? Running with mindful, helpful friends is like running with a coach every day.
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I hope these concepts, and the articles from the past year, are helpful for you, keeping you on the trail, doing what you love. My entrance into medicine was motivated by my love of the sport, and my desire to see everyone be able to participate to their fullest potential. I wish for that for all of you in the next year and beyond.
Thanks for the support, and see you out on the trail!