Today on the doc on the run podcast we’re talking with Patrick about how to stay on track when you see a doctor or physical therapist and make sure that they focus on your running goals.
Dr. Segler: We’re talking with Patrick who is a guy that actually connected me on Twitter. Patrick has a really interesting story. He’s been to physical therapy and the main reason I want to have him on the podcast today is that he actually had this experience and he posted about on Twitter, he said, “This podcast is awesome. Had a recent experience with physical therapy that centered around continuation on my running goals instead of fixed and done, huge impact.” And so I wanted to have Patrick, I just connected with him and say “Hey man, can you come on the podcast and just talk about your experience with physical therapy and help people understand how they can better get their physical therapist and doctors and all of us medical practitioners to be more on track with their goals and not just focused on the injury.”
Patrick welcome to the show! Thanks for coming on today.
Patrick: Oh yes hi!
Dr. Segler: I don’t know a whole lot about your story, but maybe just could you just tell us a little bit about what it is that happened like you were in physical therapy. Right?
Patrick: Yeah I was.
Dr. Segler: So what did you have to do? What happened? How was it that you were able to go to the physical therapist and how did you talk to them and present your story in a way that was compelling enough for them to take you seriously and not just treat your injury, but instead sort of treat you as a whole person to direct all of your therapy toward achieving your goal of continuing to run.
Patrick: I actually kind of went directly to physical therapy and I, unfortunately, I opted to kind of avoid as much as possible. I was encouraged by my brother who has a pretty serious cyclist to go to a place that did just that. They went straight into physical therapy. I’m not sure whether or not I needed a doctor’s referral or not in order to start that process.
Dr. Segler: Yes. I mean, sometimes when we go to physical therapy you have to have this specific order from a doctor to do this very specific things. But sometimes you can get straight into the process. So when you went to them, how were the physical therapists when you first talked to them? Did they sort of focus on your injury or did they ask you more about what are your specific goals in terms of what activities you want to do? How did they approach you?
Patrick: A little bit of both. I kind of approached on seeking the medical attention I wanted. I let them know like “Hey I’m a runner, I’m in the middle of marathon training, I’d like to continue training and my left hip hurts essentially.”
Dr. Segler: Okay.
Patrick: Then they went from there and they did a really great job. I think their medical business practice was kind of catered towards that so I was pretty fortunate in that regards. But my first injury that I had probably 8 years ago maybe, an attempt from my first marathon, I was kind of referred to an orthopedic surgeon by our neighbors, and this is when I was like 19 maybe 20 years old and I told them I walked in there and I told him basically what was going on and instantly right when I told him trying to train for my first marathon, he instantly rolled his eyes.
Even walking into that front lobby I was, I felt so much out of place, it was full of 80 maybe 90-year-old people literally falling apart who kind of needed that kind of service. So I new kind of reflecting that really I just kind of need some physical therapy and some guidance to kind of strengthen some of the muscles probably around whatever injury I have, based on just the readings and try to self educate myself as best as possible.
Dr. Segler: Okay so that’s an important point. So you basically went into this. You sort of went into your whole process of beginning therapy seeking treatment as a completely educated patient who had done some research to try to figure out like well such as training for marathon and your intent on doing that race and you want to continue to maintain your fitness and all that. You knew you had to do something different than the normal thing than you would normally get a physical therapy which as you said this one other setting it’s like a bunch of people who were old and falling apart.
And you’re a different person, completely different goals, completely different intentions. So that was like step one, right? As you pretty educated yourself on the process of physical therapy, of recovery, of regaining and your strength in overcoming this injury, right? So how did you even start that? I mean how did you go about that process? Did you just search for hip pain? Or what did you search for initially?
Patrick: Oh man, that’s a good question. I’m not really sure if I have any specific answer to that, just kind of my general interest in running. I spend my free time watching YouTube videos and reading online and I’m currently reading Lore of Running, the book. And just kind of understood in kind of read about general kind of, I guess joint injuries and how hips tend to be a common, I guess injury.
Dr. Segler: Yeah so that’s the thing is there’s a lot of information available now, right? I put lots of information out but I’m just one person and they are lots of doctors have lots of different attitudes and opinions and there’s a lot of information that I think is most helpful actually in books like you’re talking about that are not written by physicians necessarily.
They’re written by runners, and runners many times have what I think is truthfully a much better understanding of the runner’s body than most physicians do. So I know that I will for sure or one of my classmates is going to probably approach me on some conference and tell me that I’m nuts for saying that.
But I think it’s true! As physicians were sort of trained out of that approach where you think that we would be of course intent of recognizing your specific athletic goals. But it’s not.
We are basically taught to look for a specific problem and then fix that problem. Which usually translates to make it look better on X-rays or increase in the measurable range of motion of it or something like that based on these parameters that are sometimes archaic. And you as a patient, as a runner, as an athlete, your whole sort of sense of self and everything attached to your athletic achievement is completely, is not even secondary, it’s just somewhere way down the list.
I really think you have to be able to go in and redirect those conversations many times. So if you have a friend like a running buddy who is suffering from some kind of injury, where would you tell them to start? It’s okay your knee hurts, so what is that? Is that arthritis? Is it like Iliotibial band syndrome? Is it Patellofemoral syndrome? It could be a whole range of things but just as somebody who’s been through this process like if you had a friend who had an injury and they wanted to run and they’re worried that it’s going to mess up their training, where would you tell them to start?
Patrick: Well being not a medical expert, just a runner. I would tell them probably go to an orthopedic doctor and get into physical therapy. Specifically, hopefully somebody that’s like maybe advertising themselves that’s sports medicine orthopedics where they kind of understand that and my second round of physical therapy that I went to for my recent hip injury that’s what I did. I went to a place that’s kind of like a dual, like in the building upstairs is all the orthopedic doctors and downstairs is where all the physical therapy happens.
Dr. Segler: Okay.
Patrick: I didn’t anticipate going up to the orthopedics. I had intended just to kind of get my doctors script kind of transferred to go right in the PT, with the understanding that they were all kind of sports oriented, right? That they would have an innate sense that kind of that’s what their practice is about is continuation of someone’s running goals.
But the orthopedic doctors upstairs like one of the guys was an Ironman, so I was like, that guy probably gets it if I had to go back and really get evaluated in case I needed shots or get cut open or something that’s probably in my best interest. So that’s what I would advice.
Dr. Segler: Yes, so that’s a good point. You have to find somebody that understands you. I won’t bore you with the whole story here, but basically one of my relatives had an issue where basically he had a blockage in his Carotid Artery. A significant Carotid blockage and I was having a discussion, I said “you really might want to think about changing your diet” and he had a really horrible diet.
He was eating hotdog a lot like literally for many years, every day Monday through Friday for lunch he would go to this place and have a hotdog and I said, “You really have to think about that.” He said, “Well I talked to my cardiologist and my cardiologist said it’s okay for have a hotdog at lunch if I eat a healthy breakfast and I have a salad with dinner” and I know who his cardiologist was and the guy weighs like 400 pounds, and I said “Look I know that he’s a cardiologist and he’s an expert for sure in this area, but you cannot, no matter what his credentials are, you cannot take dietary advice from a fat guy.”
When you’re an athlete, if you see somebody who’s a runner, who’s an Ironman triathlete, who has some athletic activity even if it isn’t that. If they have something that they really do if they’re a cyclist and they really do it consistently, they’ve been doing it for a long time, they will understand your desire to continue that activity. And I don’t think that’s true of other doctors who are not athletes.
I do not think that they understand where we are coming from. As you talked like before about this person basically kind of rolling their eyes at you when you tell them you’re training for a marathon. Yeah, I think it’s silly, and I lecture to these doctors, they think it’s silly. They think its “Well that’s just crazy. That’s why you have this problem in the first place you should quit doing that, you should quit running” and that doesn’t make any sense to me.
You don’t go to the doctor to have the doctor tell you quit doing something. But that is a fairly standard approach so that sounds like you were able to find somebody who’s really going to be on your team if you needed them to be. Was that a coincidence or do that doctor was an Ironman triathlete before you got there?
Patrick: No, I searched in my health care providers, my insurance search engine to see who is in there and I am just searching like terms like sports medicine and everything and I kind of found them and I read their biographies. I kind of sought that out.
Dr. Segler: Yeah so that’s interesting, that’s a good idea. Most people would know to do that. Sometimes people search the website. Some people just look in the actual booklet that the insurance company sent to them that has a list of the providers that are in the network, and they’ll pick somebody at a nearby facility, basically just based on proximity.
That’s the thing is if you do that, you don’t really know what you’re getting into. If you can search online and search their individual profiles and see. Do they have something that discusses them being an athlete? That would be really helpful but when you get there, one thing you can do of course is see like does this look like my people or not and if it looks like the same group, that you would see an athlete checking for your marathon, well that’s great.
But if it looks like your grandmother’s bridge club, maybe you’re on the wrong spot. But it is a fair assessment I think when you go in and you see even if it says sports medicine doctor because I know a guy that’s a sports medicine doctor and he was sports medicine like fellowship trained after he did his orthopedic residency. But now he basically does total hip replacements on old people. That’s like 95% of his practice. He has the right credentials for someone like us. But he doesn’t currently do that, he’s not really doing sports medicine. He’s just doing replacing parts on old people, is what he’s really doing and so he’s probably now fairly far removed from the mindset of being able to keep somebody like you running and training for a marathon.
Dr. Segler: What’s the event that you’re training for now?
Patrick: Right now I am kind of in off-season. I have no set training schedule, just pretty low mileage to couple of miles a day. I’m trying to run in the mornings. I’m in Dallas, so it’s going to get pretty hot pretty soon. Last summer was the first summer I kind of trained consistently through that. So mornings are kind of the only option. Just this week I started running in the mornings but my last race was the Woodlands marathon. I think that was early March. That was my second marathon.
Dr. Segler: Cool! How did it go?
Patrick: It went really well I ran at 2:58. So I should be Boston qualified fingers crossed. That was my goal and I had told my therapist in December, I was shooting for a Spring Boston qualifier.
Dr. Segler: Wow! That’s fantastic. Okay so your second marathon you basically qualified for Boston, ran under 3 hours, which puts you in like the top like what 100th of 1% of all runners to run under 3 hours, right? I mean you’re like in this really elite category now, truthfully.
Patrick: Oh wow I didn’t know that.
Dr. Segler: Oh Yeah that’s very very vey, I mean you remember Lance Armstrong, it was a huge thing. I don’t know if you ever saw this but it was a big deal when he was running this race. He had like six pacers when he was trying to run under 3 hours, and he barely made it. So that tells you something I mean Lance Armstrong, all the political stuff aside everything else, there’s no question the guy’s pretty phenomenal athlete.
Somebody that can win the Tour-de-France so many times and then really have to work that hard to run under 3 hours and he afterwards said it was tough deal, that it was not easy to run under 3 hours. That’s a huge accomplishment. So this was all even after you’ve had an injury. You’ve had some issues, still qualified for Boston and clocked this phenomenal time. What do you attribute that to? What was it that you did that got you out of the sort of injury mindset in back to the “I’m going to run and qualify for Boston” mindset? What kept you focus on the goal?
Patrick: I don’t know I guess just consistent running every day, training and with an emphasis on strength training through the kind of exercises that my therapist have given me in the past.
Dr. Segler: Okay, good point. That’s a great thing to talk about. One of the things I frequently talk about is that if you get injured no matter what it is, it’s always one part. It’s not you’re sick all over. You have whatever it is, your plantar fascia is injured, you have a stress fracture in one specific metatarsal, your hip hurts, you have an issue like an irritation of the bursa in your shoulder, whatever. You get one issue. It’s one thing, it’s not all of you.
When you run, the entire machine is keeping you moving, right? You’re doing a lot of strength training, you’re doing a lot of other stuff, you’re doing things that most runners don’t normally do even though all of us know somewhere in the back of our minds we know that doing strength training, doing core training, really working on your glutes and hamstrings. Working all these things that support you better, make you stronger, help you maintain form that’s efficient longer is all beneficial. But when you get an injury and your physical therapist tells you really have to do these things to get over this injury, suddenly you’re really motivated to do all those things, right?
Patrick: Right exactly, yes! It’s way easier when someone else gives you a specific list of like, do these this many times or for this amount of seconds, these specific exercises.
Dr. Segler: Right, okay so you got this list from your physical therapist. But now given all the other things that you’ve read in your spare time and all articles you’ve looked at online, all of the information you’ve gone. How many times have you read some article about how to run faster, how to get stronger, how to improve your time. Have you been suggested or told in a subtle way by these articles that you should probably do the things that your physical therapist gave you to do? A lot I would get, right?
Patrick: Yes think so.
Dr. Segler: Right so people are writing about all the time, but most of us are not doing it. We’re just not because runners, right? Like it’s fun to run. It’s really fun to do clam shells or planks or whatever most people don’t really enjoy doing those things. But when we get injured, sometimes I think it can be a blessing in disguise because you go do those things and you get a lot stronger and even though you’re not actually running this much because you’re recovering from an injury, when you do start running again your overall fitness is so much improved that you can suddenly have like a bump in your athletic performance.
I think, it’s really interesting that that happened. So big question is, are you still doing all of those things? All the things your physical therapist gave you to recover from the injury, are you still doing them? Are you incorporating them into your workout routine now?
Patrick: Oh yes absolutely! Probably not as much as I should, I probably just do like you said, just want to run so I’ll probably do just as much as I can to get by like as soon as the hip starts to creep in or something around that area or like the knee which is my first injury several years ago. I’m like “Okay now is the time to start doing this again and hit those exercises.” So yes I definitely do that.
Dr. Segler: Do you think the whole experience of having an injury while you’re in the process of training, do you think that that’s made you more aware? Do you sense subtle changes now that maybe before you would have ignored?
Patrick: Yes absolutely!
Dr. Segler: What do you feel? For those that have not been injured yet, what do you start to feel when something’s coming in? Because you don’t just feel like a sudden sharp pain like somebody hit you with a hammer. It always builds, right?
Patrick: Right! Yes. Well actually my first injury where I went to the orthopedic surgeon. He diagnosed me with just the Patellofemoral syndrome in the left knee and that was pretty all sudden. I was just like playing with my dog after like what was my first long run ever, it was like 12 miles and that was pretty sudden.
But most often I feel like it kind of creeps up and my first sign was when I started hitting my strength training exercises is when I feel just extreme heaviness and soreness from my toes all the way up to my core or my hips. The entire legs are just heavy and sore from outside all the way down to the almost the inner bone I guess that makes sense. Just like you said an entire engine but maybe the entire engine in a leg is just feels exhausted. I know that’s kind of my time, okay I should probably start doing some strength and preventative stuff.
Dr. Segler: So that’s the strategy, right? You feel something, you know something’s off and before you just instead of waiting for to just blow up. then you basically start doing this preemptive stuff. You started this strength training. Do you do other stuff? I mean do you like modifying your nutrition? Do you try to sleep more? What else do you do to try to make sure that calms down quickly?
Patrick: I try as best as possible to recover as quickly as possible after I run. So I do kind of what I’ve read and heard is that you should consume some carbs and proteins like right after your workout just to get glycogen back and start to repair process. Sometimes if I’m doing like a Sunday long run in a high mileage week or I’m pushing pace pretty hard, doing a lot of tempo runs, I’m trying to ice pack. Does that answer your question?
Dr. Segler: Yeah, it does! That’s the thing so I think that those things are big. I even tell doctors that I lecture, I just tell them I said “Look, overtraining injury is not too much training. It’s too little recovering is what it is.” Because it’s true, I mean I’ve talked to people of all the time. I did the Virtual Doctor Visit a couple of days ago with the guy that’s training for a 100 mile trail race in the Dolomites.
Most people would say running 100 miles on a trail is too far. But it’s not for an ultra marathoner or it’s just not. It’s not a long way. Some people say riding a bike a 100 miles is too far but we know I was for years and years and I was in heavy Ironman training for like 10 years and I did that every week. That was my Wednesday ride was a hundred miles. So it’s not too much.
But if you do those things too frequently back-to-back and you don’t do the right stuff. If you don’t replace a glycogen and I’m diligent about that. I mean with long bike rides, long runs, everything. If I drive to do those runs or rides, I actually make my recovery smoothie right before I leave the house, put it on ice and I actually have it there so that within fifteen minutes of finishing my ride or run, it’s in and I don’t miss that.
I have it every time. I have to make sure that I get the nutrients back in because if you wait until an hour or two later, you missed the window. You just can’t afford to do that and you have to really protect your sleep on those days where you work out hard. I think that’s the thing is that we get busy at work. We get busy with projects in school, we get pretty busy with all kinds of different things. And then it’s like a little not enough sleep, maybe you miss your recovery drink, maybe you didn’t hydrate enough and those little things start to add up and accumulate into an overtraining injury and if you had been recovering properly, maybe that injury wouldn’t crop up in the first place. It seems crucial at that time but it’s very difficult to undo once you get an actual overtraining injuries. I think that’s really important, that’s really helpful.
Patrick: Yes, so before I bump up my mileage too. If I feel like week’s coming up I’m like “Okay I’m going to bump X amount of miles next week”, if I don’t have the kind of allotted time to incorporate that recovery like you said, sleeping and like stretching and that strength training. Sometimes I just don’t do the increase in volume or intensity because knowing that the time investment is almost like exponential. The harder you train, it’s like you have to have an equal amount or more of recovery with that. That’s a huge portion of my injury prevention building forward for me personally.
Dr. Segler: Yes that’s a good strategy. What are you training for now? Anything that you have like well not that you’re actively training your off-seasons or anything you’ve signed up for that you’re really like geared up for or you’re just waiting for Boston?
Patrick: I’m just kind of waiting for Boston now which is pretty long ways away, so I’ll probably try to sign up or find a good marathon or half in the fall when the weather’s pretty nice. Maybe like November or maybe as late as December but come January, February I don’t want to do anything too close.
Dr. Segler: Oh because you going to get ready for April, right?
Patrick: Yes.
Dr. Segler: Okay so with Boston, what is your goal? Somewhat I’m interested in this because running in the Woodlands and what was that February or March?
Patrick: Yeah that was early March. March 3rd or something.
Dr. Segler: Some pretty predictable weather, right? Like March is going to be good, not too hot in the Woodlands. It’s flat, it’s good course, right? So you have lots of advantages there. Boston is highly unpredictable, right? It literally snowed, it’s rained. It starts in middle of the day. It doesn’t start first thing in the morning. It can be super hot. It can be really windy. There’s like this whole range of possibilities with Boston that you cannot prepare for. And it is not an easy course right? Boston is definitely not the fastest course on the planet. So given that, I’m interested to know like what is your goal for Boston?
Patrick: Oh I don’t know. Running the same time I guess as the Woodlands would be nice, I ran around 3 hours.
Dr. Segler: That would be awesome! Nice, that’d be fantastic!
Patrick: Yes, because my first race was the San Diego rock and roll last year May. I think it was May or early June. Yes early June, and that was a pretty hilly course. There’s a big hill at the end, so that took me off guard. I probably definitely have to do some hill and elevation work, that there’s not much here in Dallas. It’s pretty flat just like Houston.
Dr. Segler: Okay, well any other tips for all the people listening when they get injured, they want to get back on track. They’re dreaming of doing the sub three-hour marathon like you. What’s the one piece of advice you should tell them?
Patrick: Run consistently and healthy. Always be on the safe side I guess. Never do more than you think your legs or whatever joints may not be good for you, allow you to do.
Dr. Segler: Yes so listen, right? You got to listen to your body. You really got to pay attention. Yes I guess it’s the success is in the details when you’re really trying to get back at it. All right Patrick well, hey listen I really appreciate you doing the call the day. I mean I think this is a really big thing when you get injured, you’re going to physical therapy, you really want to try to figure out how to make sure your care is really centered around your continuation of your running goals and not just like as you said on Twitter, not just the fixed and done kind of thing.
Patrick: Right.
Dr. Segler: You really have to be proactive. You have to remember that anytime you’re seeking advice from any health care professional whether it’s a doctor, a surgeon, a physical therapist, anybody, you have to make sure that they’re focused on your goals right? Like not fixing the problem, getting you to the finish line is the deal. And if you don’t really push that on them they may just do their usual routine which is try to get you back to normal.
You have to remember the most of the time they define normal as the middle of whatever group they see. So if you look at the waiting room and it looks like your grandma’s bridge group, you don’t want to be in the middle that group. So if that’s the case then that’s where you’re going through your care. It’s okay, it’s not that the doctors isn’t qualified, it’s just that it’s not something doctors are thinking about. They’re just thinking about getting you to the point where you can walk around the kitchen. So you have to be really proactive when you go see any healthcare professional and go in, prepared to talk about your goals first and foremost and then talk about what hurts and how that’s disrupting your goals.
Patrick: Yes absolutely!
Dr. Segler: All right, well Patrick, hey man, thanks for doing the call. I really do appreciate you coming on to be on the podcast and talk about your experience and again man congrats on qualifying for Boston and running under 3 hours is pretty awesome and let us know how it goes. So I want to hear from you after Boston and see if you get another sub-three at Boston, that’d be pretty amazing.
Patrick: Awesome! Yes thank you absolutely very much. I appreciated it. Thanks for the call. I’m happy to share my experiences and hope everyone out there has just as good experience.
Dr. Segler: Yes I think it’s really going to be helpful. Thanks so much for doing it.
Patrick: Alright thank you. Bye!
Dr. Segler: Alright Patrick, bye!
If you have a question that you would like answered as a future addition of the Doc On The Run Podcast, send it to me PodcastQuestion@docontherun.com. And then make sure you join me for the next edition of the Doc On The Run Podcast!
p style=”text-align: justify;”>Dr. Christopher Segler is a podiatrist and ankle surgeon who has won an award for his research on diagnosing subtle fractures involving the ankle that are often initially thought to be only ankle sprains. He believes that it is important to see the very best ankle sprain doctor in San Francisco that you can find. Fortunately, San Francisco has many of the best ankle sprain specialists in the United States practicing right here in the Bay Area. He offers house calls for those with ankle injuries who have a tough time getting to a podiatry office. You can reach him directly at (415) 308-0833.
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