Lucky for me, where I live in the U.S.’s Pacific Northwest is a hotbed for what many will call ‘alternative medicine.’ Especially in my hometown of Eugene, Oregon, there is a plethora of multi-disciplined medical practitioners who offer a wide variety of services that think and practice ‘out of the box’ of conventional medicine.
For simplicity, I will define conventional medicine in two (rather disparaging) principles:
- Over-Specialized and Isolated. Over-specialization has created a segmented, fractured, and narrow approach that focuses only the symptomatic area, disregarding contributions from other parts of the body.
- The Quick Fix. Conventional medicine tends to provide only quick fixes such as tests, pills, and surgery.
The problem with conventional medicine is that it often fails to treat the whole person, consider multiple interacting systems, and deliver sustainable solutions. Even worse, the additive approach of conventional medicine fails to account for ‘second-order effects’ from the treatments, which are delayed-onset but often very powerful negative side effects. We’re talking about anything from braces and orthotics to pills or surgery. In the long run, the side effects often far outweigh the benefits of these quick-fix additives.
The same is true for most sports medicine. Conventional sports-medicine treatment is often both passive and symptoms-based, including:
- Pain and anti-inflammatory medicines;
- Soft-tissue mobility (chiropractic, massage);
- And if those fail, then scans and surgery.
Even rehabilitative-medicine treatment (including my physical-therapy profession) tends to be overly symptom-based. We as a profession mobilize, do ultrasound and electrical stimulation, stretch and strengthen only the painful area, all of this with no accounting for the complete system and how we use it.
These approaches can be effective for acute, isolated problems, but usually fail at more complex and chronic pain and injury. Thus, many frustrated patients as well as healing professionals, frustrated and disillusioned with the empty promises of conventional medicine, turn to alternative approaches.
As both a patient and professional, I have recently turned to alternative medical professionals, including a naturopath, for my own care. During my first session with a naturopath, adorned on her wall I found a poster of the six principles of naturopathic medicine. I was struck by the wisdom of these principles and how well they apply to runners.
Here’s my take on those principles for healthy, sustainable running:
Promote a focus on overall health, wellness, and disease prevention.
Healthy running involves a diverse palate of running distances, speeds, and surfaces. Like nutrition, our bodies can function in the short term on monotony, but for long-term health, a diverse array of efforts promotes strength and efficiency, as well as avoids burnout. (Indeed, training monotony is a major factor in Overtraining Syndrome.)
Stress and Rest Balance
In addition to types of running, balancing volume and intensity versus rest is vital. My favorite saying is, “The best exercise is running well.” What it means is that if we function in an efficient way, we will naturally have ample range of motion and good strength, and even further, we will run fast and feel good. A good, holistic approach to efficient running is to “look fast, feel fast!”
Pain is information that should neither be ignored nor halt us in our tracks. Not all aches and pains we feel while running are relevant or are evidence of tissue damage or impending doom. Rather it’s usually our brains trying to tell us that we need to change something. Objective interpretation of that information, coupled with minor adjustments, are together the key to navigating pain and avoiding bonafide injury.
Identify and Treat the Causes (Tolle Causam)
Identify, address, and remove the underlying causes of disease.
Look to the Stride
How we run plays the biggest role in how we feel and the generation of aches, pains, and injury. A close look at our running stride is the most important aspect of injury treatment and prevention. For example, the vast majority of running injuries are impacted by overstriding, when the foot/leg lands too far in front of the body. This group includes plantar foot pain, lower leg and Achilles pain, hamstring stress, and low-back pain, to name a few. Failure to address running strides is the most significant and ludicrous deficit in sports-medicine treatment of runners. The stride must be addressed early and often!
Equal and Opposite
It’s easy to get sucked into symptom treatment. That sore foot must be iced, heated, massaged, stretched, and strengthened. But what if the stressor is a deficit in the opposite leg? We run with both legs and, quite often, a push-off deficit in one leg creates excessive landing stress on the other. (See below.)
Besides running strides, exercise and life intensity are the most overlooked factors in running injury. Chemical stress breaks down tissue, making it susceptible to compromise. Balancing chemical stress–avoiding too much intensity in our training and also excess stress in our non-running lives–is the key to avoiding tissue breakdown (which is why we paint bridges).
Treat the Whole Person (Tolle Totum)
Treat the patient, not the disease. A naturopathic assessment addresses the nutritional status, lifestyle, family history, physical, mental, emotional, genetic, environmental, and social factors in a person’s life.
A Systems Approach
Holistic treatment of runners takes a whole-systems approach. Because running is a whole-body motion, how each segment moves impacts every other part of the body. As such, each runner should be evaluated from head to toe. Dysfunction (range-of-motion loss and/or weakness) with trunk extension and rotation as well as hip, knee, and ankle mobility can all contribute to a failure point elsewhere in the system. Indeed, motion loss at the hips and pelvis is a crucial issue in lower-leg pain, and without treating those restrictions, we cannot expect that lower-leg pain to go away.
Find the Lynchpin
When taking a systems approach, it is far more likely that there exists one solution to 10 problems, rather than 10 different solutions. Conventional medicine loves segmental treatment, and runners often consult the foot specialist for foot pain, while seeing a separate doctor for hip pain. Far more often than not, 10 issues fall under one umbrella–and it’s usually mechanical or chemical stressors. Moreover, the equal-and-opposite reciprocality of running (Uhan’s Second Law of Running Injury) makes it clear that yes, that right-foot pain is related to your left-hamstring pain. Treat the system and you fix it all.
The Efficiency Rule
As I tell my runner clients, there is tremendous upside to sustainable injury treatment. Running injuries are a misuse of energy. For various reasons, energy that should be used for forward propulsion is being absorbed by the body’s tissues. Reorienting that energy away from tissue-absorbing aches and pains will create more speed. As such, anything that sustainably relieves pain will make you faster. The converse is also true. It’s easy to relieve pain. All it requires is a change to the system. For example, shin pain can be quickly relieved by crawling on one’s hands and knees. But if that change does not (in a very short period) make you faster, it is unlikely the sustainable (and correct) solution.
Doctor as Teacher (Docere)
Educate and support patients on their personal-health management. Empower patients to take responsibility for their own health.
Learn about Your Body
Injuries are an opportunity to learn about one’s body: its history, habits, and sensitivities. Running injuries are rarely an act of God. Other than falls, most injuries are a result of how we run. Thus, injury setbacks and challenges should be used as a tool for learning about running efficiency, training balance, or one’s own individual habits and sensitive areas. A skilled and holistic practitioner should help guide you through this learning process. Passive treatment ultimately leads to a repeat of history.
The Healing Power of Nature (Vis Medicatrix Naturae)
Recognize the body’s inherent ability to heal itself.
Get out of the Way of Healing
Among my favorite and most humbling quotes I use in the clinic is by Voltaire, “The art of medicine consists of amusing the patient while nature cures the disease.” To me, that means two things. First, it means that the body will heal itself if we will let it. As such, there aren’t too many things we can do to speed up healing, but many things we can do to slow it down. Secondly, it may seem trivial that a doctor ‘amuse’ or otherwise distract a patient, rather than skillfully treat. But a chief part of that amusement are things like pain education and management, and–like a pacer in a long ultramarathon–providing guidance and reassurance that they’re on the right path.
Surrender without Giving Up
Injuries often occur when we fail to heed the messages of stress and our tissues become damaged. Once that happens, real tissue healing must occur and that healing process can be long and painful. Failure to surrender can slow or prevent healing time. Over-cross-training is a huge part of this, often adding difficult-to-measure mechanical and chemical stress. I ask my patients (only half-jokingly), “Do you want to become a professional elliptical rider?” If the answer is no, then you’re far better off doing nothing. Very often, runners will try every treatment method out there except rest. Indeed, I believe the most powerful benefit of surgery is that it forces a runner to completely and finally rest!
First*, Do No Harm (Primum Non Nocere)
Choose the simplest, most-uninvasive, and least-toxic treatments necessary for each patient.
This is a philosophical principle that states that the simplest explanation (or treatment) with the least complexity and number of assumptions is most likely the correct one. Start simple first. Rest before doing surgery, injections, or adding complexity to the system. Then cover the bases of mechanical and chemical stress. The vast majority of problems will alleviate with this approach. (This approach usually fails, and surgery is required, only after a runner has ignored or otherwise trained through a problem for many months or years.)
‘Via Negativa,’ Beware of Side- and Second-Order Effects
Recognize that adding anything into a system, such as drugs, braces, or surgery, can introduce side effects and latent influences. Surgery is notorious for creating core-stability weakness, significant (and sometimes severe) scar-tissue mobility restriction, and compensatory movement patterns. The concept of Via Negativa is addition by subtraction. The best treatment removes negative influences without the introduction of new variables. Taking away complexity is always a net win.
* And last.
This naturopathic approach should give runners real food for thought for approaching running and whole-life health and wellness. This holistic, multi-dimensional approach–a standard to which I try to practice–will not only provide the most robust solution to running injuries, but also ensure our running and our lifestyle are truly healthy and sustainable.
Call for Comments (from Meghan)
- What elements of naturopathy, when applied to running health, do you generally practice in your daily life and running?
- Which elements do you give up on or avoid practicing, even if you know they might be good for you?