Six Principles Of Naturopathic Running Health

Stay the CourseLucky 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:

  1. 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.
  2. 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:

Prevention (Praevenic)

Promote a focus on overall health, wellness, and disease prevention.

Diversified Training

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 Management

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.)

Chemical Stress

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.

Occam’s Razor

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?
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 6 comments

  1. Meghan Hicks

    Hi all, I hope you’ll take the time to read the whole article to see that it’s about considering one’s running and life health in a holistic manner. Indeed, some ideas in naturopathy are unsubstantiated by research, but the conceptual idea of approaching one’s health from an all-systems position–what this article primarily pulls from naturopathy–is both fascinating and worthy.

    1. Jon

      Meghan, I love iRunFar and I have a great deal of respect for Uhan’s education and experience. I read the article twice thoroughly and it’s replete with grandiose claims with no mention of evidence to back up them up.

      “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.”

      Am I wrong in asking to see the data? To see any kind of testing, experimentation, or patient history? At least a link to a study that could possibly be used to support it? It is of course possible for a runner to be injured in one place, compensate in his or her stride, and get an injury in another place. But to assign frequency or cause and effect is a huge leap beyond that and should be backed with actual evidence.

      “…The body will heal itself if we will let it.”

      Frankly, this is the type of dangerous, generalized claim that faith healers use to convince people to not see doctors for their cancer. Yes, our bodies can often heal themselves with proper rest. But there are plenty of injuries that merit trained medical involvement and to tell people otherwise is recklessly irresponsible.

      I’m glad that the author didn’t get too far into naturopathy. But let’s be clear here: naturopathy is not just full of claims “unsupported by research”, it is in many cases going against evidence-based medicine. If preventing and treating running injuries should indeed be more holistic in its approach, then let’s not bog it down with naturopathy and all the baggage that comes with it.

  2. sickdog

    I second Barry and Jon’s comments. As an animal health care provider, and long-term Oregonian, I have multiple clients that are naturopaths. There overall lack of knowledge of anatomy, physiology and pharmacology is alarming. Although you cannot condemn an entire profession based on several individuals, the ideas often promoted by the profession (homeopathy, “traditional Chinese medicine”, acupuncture, etc.) lack evidence to support their use. Combine this lack of knowledge, with the overall complex factors involved with sports injury and recovery (for god’s sake, we can’t even determine if compression socks are useful!), there is ample potential for financial gain for the practitioner without real benefit to the patient.

  3. Matt

    Thanks to Dr. Uhan for laying out his point of view and for writing this column. I respect that this perspective is based on extensive clinical practice but agree with the comments above.

    Conventional medicine may well be overspecialized and focused on quick fixes, but a scientific approach to medicine and public health are also what has increased life expectancy at birth in Western Europe and North America from ~40 in 1800 to ~80 today. A naturopathic version of history — without antibiotics, vaccines, or the scientific link between smoking and cancer — would be nastier, shorter and less filled with running as a leisure activity.

    None of this means that any of the points Dr. Uhan makes are wrong, but starting with an attack on conventional medicine and continuing without presenting evidence make them harder to believe. The complexity of running-related injuries and recovery techniques are an argument for a more scientific approach, not a less rigorous one.

Post Your Thoughts