Doc On The Run Podcast: Communication Is The Key

Communication is the key

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Today on the Doc On The Run podcast we’re talking about how communication can help prevent running injuries and help running injuries heal faster.

Before I get started I just wanted thank you for listening to the Doc On The Run podcast. The amount of positive feedback from runners who found these episodes helpful is just unbelievable. I’m really grateful for you listening. I just have one quick favor. If you would, please go to iTunes and just rate the podcast. I’d really appreciate it!

What we have here, is failure to communicate.

Your running injury didn’t start the day you called a doctor for help.

Your running injury started weeks or months before you told anybody about it.

But I would be willing to bet that you knew it was there. Deep down inside, you knew something was wrong. Maybe you didn’t want to see it. Maybe you didn’t want to feel it. Maybe you didn’t want to acknowledge it. But I’ll bet you had some subtle clue trouble was brewing.

The first sign of a running injury is some sort of unusual tension, muscle tightness, achy stiffness, or even some odd sensation like the feeling of your sock bunched up in your shoe or the collar of your sock is just a little bit tight around your ankle.

Granted those all may be very subtle sensations. But they are the early warning signs.

The problem with running injuries is that they are easy to ignore. A little tightness here or little achiness there is nothing compared to the pain you feel in those final few miles of a marathon.

The problem with runners is that they are used to ignoring pain. One of the most important elements of training for endurance sports is learning how to endure. After all, enduring is the name of the game. You have to learn how to keep running when your quads tell you to quit. You learn to ignore the burn, tune out the noise and keep going. You have to learn how to suffer.

It is just not surprising that runners ignore the early sensations they can signify the start of a running injury.

When running injuries are ignored, they don’t go away. If you ignore a case of tendinitis, you keep running and try to ignore your plantar fasciitis, you think that neuroma is going to magically disappear, you are wrong.

Running injuries don’t heal if you keep doing the same thing.

If you applied enough stress to a particular tissue when you’re running that it became injured, it takes a lot less stress to keep it injured.

Let’s take a common example. You been increasing your mileage for months. You’ve been getting stronger. You’re feeling fit. Your muscles have built up strength and your tendons and ligaments have followed right along. The bones however have not quite been building strength at the same pace. Then finally, on a hard 20 mile run you develop the beginnings of a metatarsal stress fracture.

Maybe you really just have a metatarsal stress reaction or stress response. It’s behaving like a stress fracture but it’s not actually cracked or broken. Obviously if you do the same 20 mile run every day, it’s going to get worse.

But what does it take for it to get better?

Maybe only running 10 miles would be low enough stress that the bone can actually start to repair itself. Maybe the distance is 5 miles. But you know for sure that you’re going to have to run less, or at least do something else to change the way the force is applied to the foot if you’re going to heal that achy metatarsal bone. You can’t keep doing the same thing and expect a different result.

You certainly can’t assume that you could continue running the same distances with the same intensity and expect any injured tissue to repair itself. You have to remove enough stress to allow that particular anatomic structure to heal.

That doesn’t necessarily mean you have to stop running. That doesn’t mean you have to lay on the couch for six weeks. That doesn’t mean you have to lose all of your fitness.

But you have to communicate at the very first sign of trouble.

If you’ve been fortunate enough to run for years without an injury, you’re lucky. Either that or you’re doing a lot of things right. Or, maybe your coach is doing a lot of things right.

And even if you’ve never been injured, if you have a coach, the chances are really good that your coach has had lots of athletes who have become injured.

You may not really know how to recognize the warning signs and early indications of an impending overuse injury. But your coach does.

Don’t ever forget that your coach has the cumulative experience of many lifetimes of running. Your coach sees runners get injured, looks back at the training program and then figures out what went wrong. Your coach understands those subtle changes that can precede an injury.

So if you’re communicating with your coach on a regular basis it is possible that your coach will notice something you might miss. Your coach might be able to help you avert disaster.

Your coach isn’t the only one on your team who might be able to notice the subtle changes that show up before an actual injury blows up.

I would be willing to bet the overwhelming majority of runners who are heading for an overuse injury, but might be unaware of it, would have the preceding tightness discovered, and perhaps resolved if they were just getting regular massages.

Your massage therapist communicates with you by feeling asymmetry. Your massage therapist notices lumps and knots in your muscles. Your massage therapist notices unusual areas of tightness. Your massage therapist puts her hands on you and can actually feel how you feel. Your coach communicates with you by hearing how you feel during your workouts.

Your coach listens for signs of trouble. Decreased motivation. Difficulty sleeping, changes in appetite. Inability to stay on pace during key workouts.

All of those are signs of impending trouble. Your coach has been listening to athletes in training for years. Your coach has been identifying patterns of success for years. That is what your coach does.

You aren’t paying your coach to write out a training plan. You’re paying your coach to keep you as close to your potential for injury as possible without actually getting injured. You are paying for access to experience when you hire a coach.

Your coach is adept at recognizing disruptive patterns which could signify an impending injury. But your coach can only recognize those patterns through communication.

The more information your coach has, the better.

Think about this from another perspective. When we think about therapy, specifically psychotherapy, the only information the psychiatrist or psychologist has as a tool is communication. A study published in 1999 in the Journal of the American Psychoanalytic Association looked at the role of treatment duration, frequency of sessions and the therapeutic relationship. The authors reported that there were gains with both greater frequency of sessions as well as longer duration of therapy in the development of a positive relationship with the therapist and the success of the therapy.

Of course that makes sense. If you go to see a psychiatrist because you have anxiety or depression, the therapist has to figure out why you developed anxiety or depression. You can’t get a blood test or an x-ray to uncover the root cause of the problem.

Instead, the therapist has to communicate with you. The therapist has to learn about you. The therapist has to figure out all of the factors in your past, your upbringing, your relationships, your struggles at work, factors surrounding your self-image and other personality traits.

Once your therapist has a picture of all these different factors more communication between you and the therapist is needed to determine what sort of interplay has resulted in the development of anxiety or depression. It takes a lot of talking to get to that point.

Of course, the more frequent the visits, the more thorough and honest the communication, the longer the history, the easier it becomes for the therapist to recognize patterns of behavior that might be associated with some sort of discord. That may explain why increased frequency of therapy and longer duration of therapy may be more helpful.

If your coach reviews all of your training logs, you are providing a lot of information to your coach. If you are talking to your coach on a daily basis about how you actually felt during each workout, that’s even more useful information. If you sit down on a regular basis and discuss your progression and try to figure out whether or not you are still on track, your coach has even more information about you, your progress and your potential to develop trouble.

The more information your doctor has, the better.

Over and over I have runners tell me that they are shocked I was able to arrive at the correct diagnosis during a phone call or through a web camera during a virtual doctor visit. Many times these runners actually get upset that their previous doctors were not able to come up with the correct diagnosis.

But do not be confused about this. It’s not because I am somehow clairvoyant or magical. Yes I think about running injuries more than most doctors. But the truth of the matter is the reason I seem to be able to hone in on the correct diagnosis in runners is that most of the time I simply have more information than the previous doctors.

Maybe I ask the questions a little differently. Maybe I ask some questions other doctors wouldn’t. But more often than not, when a runner calls me for a phone consultation or a virtual doctor visit via Webcam they have already seen a number of doctors. They aren’t getting better. But they have already tried lots of different treatments that didn’t work.

All of the failed treatments provide additional information that I can use to arrive at the correct diagnosis.

So in some respects, all of these runners who call me for help are communicating better with me than they did with their previous physicians.

That brings up a couple of key points here:

1. Keep track of everything you try to make your injury feel better. The information you can give your doctor about which treatments help and which treatments made no difference at all can definitely help your doctor arrive at the correct diagnosis faster.

2. Communicate more with your coach, your massage therapist and your running buddies. If anything feels “off,” let somebody know. The chances are good you already have people on your own team who can recognize those weird sensations, decreases in energy, sleep disturbances or unusual muscle tightness as some predecessor to injury.

The earlier you seek treatment for any over-training injury, the faster it will get better. The amount of time it takes to heal an over-training injury increases exponentially with its severity. So don’t wait.

3. Trust your gut. If something doesn’t feel right, then it probably isn’t right. Don’t just keep running if something feels too tight or too stiff. Don’t ignore those odd ongoing little aches and pains. Any pain in one specific spot that lasts for more than three days should be checked out. And if you get checked out and it doesn’t seem like your doctor is listening to you, get a second opinion from a running injury expert.

Again I want to thank you for tuning into the podcast and remind you there’ll be a huge favor for me to be really grateful if you would, please go to iTunes and just rate the Doc On The Run podcast.


Freedman N, Hoffenberg JD, Vorus N, Frosch A. The effectiveness of psychoanalytic psychotherapy: the role of treatment duration, frequency of sessions, and the therapeutic relationship. J Am Psychoanal Assoc. 1999;47(3):741-72.