Are you a runner with a running-related injury?

TheKettleBellPhysioBlog, Evidence, Pain, The Kettlebell Physio, Uncategorized0 Comments

Diagnosis: over-passionate.

Are you a runner with a running-related injury?

If you are, you should probably listen to this podcast: http://www.allanbesselink.com/…/690-cgh-002-the-injured-run…

Our body is *designed* to adapt; the principle in Exercise Science is referred to as ‘S.A.I.D.’ – Specific Adaptation to an Imposed Demand. Imagine how many kilometers an ultra-marathon runner would have amassed in their lifetime. Any skill requires consistent, persistent repetition. The act of simply getting stronger demands that you lift and progressively increase load. We may all start a new physical challenge with a different baseline, but there’s *always* a baseline level of tissue capacity or function which needs to be increased.

Whatever the activity, we can and will adapt to increase tissue tolerance and capacity, BUT appropriate adaptation requires SMART programming. A *graded* exposure to the stimulus which also provides sufficient recovery to enable adaptation is essential. This usually means rest or relative rest e.g. doing less, doing something different or perhaps doing nothing at all. The art of doing nothing has been written about here: http://thesciencept.com/the-art-of-doing-nothing/

Orthopaedic surgeon Scott Dye wrote about ‘the envelope of function’ which describes the upper limit of a tissue’s capacity to tolerate the load put through it; described well here: http://www.richmondrehab.com.au/…/…/the-envelope-of-function

LOAD > CAPACITY = INJURY
LOAD ≤ CAPACITY = REHAB
CAPACITY >> LOAD = PREVENTION

Chiropractor Andreo Spina talks about this simple concept on his courses https://www.instagram.com/p/BLoi45_hvXH/?hl=en

As illustrated by the envelope of function, where load exceeds the tissue’s capacity to sustain that load, something has to give; if the load significantly exceeds capacity the tissue simply breaks. If the load is insufficient to cause structural failure, it will become symptomatic and pain is typically a fair indication that the tissue isn’t coping and an appropriate diagnosis is needed. Pain can and should in *some* circumstances be ignored, but unless told otherwise by a clinician, listen to your body and assume it’s an appropriate warning until told otherwise. Pushing through pain is usually not a sensible idea.

For the vast majority of active individuals, be they runners or not, a ‘niggle’ with no mechanical trauma is most commonly a sign of inappropriate load management. The work of Tim Gabbett (https://thesportsphysio.wordpress.com/…/whats-beer-got-to-…/) illustrates the importance of understanding the difference between acute and chronic workload and being able to identify increased risk of injury, and Adam Meakins considers the absence of a training diary a red flag in itself – if you’re not monitoring your training load, how do you know if you’ve done too much? I wrote about the ‘Sunburn Principle’ earlier this year: https://www.facebook.com/PRIDEPhysiotherapyandNutrition/photos/a.1630776910520934.1073741828.1551443601787599/1686229288309029/?type=3&theater

The human body has an innate capacity to heal itself and repair. The one thing most likely to get in its way and screw it up is YOU. For many reasons, we (me included) don’t back off and we become our own worst enemy. The single best thing a Physiotherapist can do to help is STOP *you* from doing the things which are aggravating your injury or preventing it from getting better. It really is that simple.

Negative reinforcement is removing something from the equation to have a positive effect – in this instance, reducing running load to provide sufficient recovery and adaptation of the tissue. Almost without fail, tissue will repair and heal well with full resolution of symptoms if only you let the body do what it’s designed to do. Positive and negative reinforcement (http://thesciencept.com/does-positive-mean-what-you-think-…/
) is an important point to consider and too often Physiotherapists give the wrong message by simply adding “feel good” treatments which have zero specific effect on the symptomatic tissue. Here is a perfect example with arguably the most common presentation – back pain: https://www.facebook.com/PRIDEPhysiotherapyandNutrition/posts/1709340992664525

If you have a simple issue of inappropriate load management (too much), what you *don’t* need is to be sucked into an expensive cycle of unhelpful healthcare interventions, or have your injury and symptoms blamed on something about your body – muscle or structural imbalance, weakness, inhibition, tightness, loss of range, instability etc. Most of the time those clinical ‘diagnoses’ are simply bullshit.

As Allan Beselink says, buyer beware!

I have lost count of the number of times this year that I’ve had pain from overload; I’ve certainly had more days with pain than without it (at one point I was unable to lie flat on my back for 3 weeks), but that’s been a conscious choice on my part to continually keep pushing my own envelope. Wanting to continue pushing the PBs is what active people tend to do. Add to that the physiological challenges of not being able to train or potentially missing an important race and the pressure to just push through the pain is what’s holding us back. In these instances, pain is unlikely to just go away if you keep pushing through it. The definition of insanity is repeating the same behaviour again and again but expecting a different result. If you’re a runner with knee pain or Achilles pain, something must change or you may get to a point where you simply can no longer tolerate it, and that really sucks!

Prior to becoming an Exercise Physiologist and Physiotherapist I had pain (and tissue damage) from overuse injuries in both shoulders and one knee. In each episode I experienced pain for more than a year because I continued to just push on – more than three years of pain from three relatively minor injuries…. Who does that!? As it turns out, lots of people do and it’s most frequently entirely avoidable. Frequently it’s ignorance – we don’t know what we don’t know, but if we *do* know better then it’s pretty stupid right?

“over-enthusiastic” is probably a more appropriate clinical diagnosis that “stupid”.

If you’re a runner with a running related injury, load management is typically the first, last, and only thing you need to ‘fix’ in getting back to doing what you love.

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