Today on the Doc On The Run Podcast I’m really excited to have Marla on the show to talk about her experience with recovering from a running injury. Marla has I think a really great perspective on everything involved and trying to navigate the whole medical system and actually recover, not just using the standard approach which is usually offered to us when we get injured, but really trying to step back and look at all these different components of recovery from an injury and then try to really change what she was doing, assess what she was doing and make changes as she went throughout the course of recovery to try to really get the best improvement as quickly as possible. Running injuries can be really difficult for lots of reasons and one of the reasons I think they seem to be so difficult is that the standard of approach in medicine is to first tell you to “stop running”. That’s what most doctors want to say is “Well running is stressful so you should stop running if you have a stress related injury”.
But when that approach alone doesn’t work, usually the doctor will offer you something like an expensive or an invasive procedure like a corticosteroid injection or surgical procedure or something else to try to get you to heal. Sometimes those approaches are necessary but sometimes they are also counterproductive. Sometimes the standard medical approach, or the “standard of care” as we like to call it, can send you spiraling down this path of frustration and despair and it becomes more and more difficult to actually get yourself out of that spiral.
Dr. Segler: One reason I wanted to bring Marla on the show was that she really seemed to exemplify the investigative approach and creativity that’s really needed for a runner to get past an injury.
So Marla, thanks for coming on the show! Maybe you could just begin by sharing a little bit about your athletic background, your running history just so everybody can get an idea of what sort of running, what makes you happiest.
Marla: Well I’m one of those people who essentially came out of the womb wanting to run. I ran my first race when I was four. I have an older sister. My parents weren’t necessarily big runners but my older sister was a runner and I just loved it immediately. So I ran my first 10K by that time I was seven. I ran track and cross-country in high school but my main sport was actually soccer. I actually don’t even necessarily think of myself as a runner in the sense of I wasn’t kind of competitive in high school and for track and cross-country but I did it more because I just love the sport.
Some people ask me what my passion is. I liken myself to a dog in the morning. When I wake up I’m excited to go running. There’s a whole population out there who thinks I’m “crazy” or ask me how I get the motivation and to me that’s not even a question. If I had more time in the day, I would run more and so I’ve picked up a habit pretty much of running about six miles every morning before I work. Weekends, I would “treat myself” to eight to ten miles. I just run pretty much in steady pace. I’m not fast, I’m not slow. Some days are faster than others, some days aren’t.
I would just say that I actually didn’t really do the research on what sort of proteins or diets or whatever we should have because I actually didn’t have any performance goals. I wasn’t trying to PR on anything. I tended to not to attend any races because I found it more difficult to drive myself to a location when I could just run out to the door in front of my house. I would say that it’s my passion, it’s been my therapy, it’s what I’ve used for the good times and the bad times in my life and it’s just my favorite thing to do ever. I was pretty much injury-free.
Dr. Segler: If you could, share what initially happened and what set off this whole chain of things that really disrupted you’re running so significantly.
Marla: So basically I’m thirty seven right now, healthy otherwise. I started having a little pain in my foot, kind of in the back heel area. I’m not really sure what it is, I have done my Google research and it didn’t look like what was plantar fasciitis. But then again some people define that differently, I don’t know. But I didn’t have that first step pain or any of that. It just kind of hurt at the back of heel and it was probably on a scale of one to ten on the pain level around three, it was just annoying. It didn’t really stop my running but it was just annoying me.
Finally after about three months of persistent pain, I go to my podiatrist. At this point I don’t really have a team of professionals that can help me even know who to go to, to probably assess the damage or injury or what was nagging me. So of course the first thing I do was I go to this person and I go in and based on what I understand of the medical system of how it tends to work for most people is that you go in and they have about fifteen minutes to see you and in this fifteen minutes that I’m in I express this pain. I’m told immediately that I have plantar fasciitis and it can be quickly solved with the cortisone shot.
So, I’m like “great, I can run pain-free, fantastic!” This is the best thing I’ve ever heard, I’ll just take a quick cortisone shot and I will be on my way and maybe run back to the office. So I got all ready and she takes out the needle and everything and the second the needle is administered I screamed at the top of my lungs. I’ve never felt something like this in my entire life. My pain immediately goes to eleven and it was a shriek of pain. Apparently I still don’t know exactly what happened but my take is that she somehow punctured the nerve sheath or something because it wasn’t any pain I have ever felt. I have never had nerve pain and now I know what nerve pain is and it was just as an electrocution that felt like I had bolt of lightning that went out of my top of my skull.
I tried to put my foot down and couldn’t. I’m already still a little bit numbed up and it was just so excruciating that I literally had to walk out of the office on crutches. She kept telling me “Oh sometimes cortisone shots take a little while for them to settle in and work”. I knew immediately that was not the case. And so there you go long story made short I’ve basically I’m now in crutches for three months. I can’t do anything like if you just barely, I took a feather over the points where the pain was. I felt like somebody knocked the wind out of me and another electric bolt went through my head. I had to end up going to a pain doctor who wanted, who did give me actually a pain nerve block that was temporary to kind of help reset my nervous system because apparently I had been hijacked by my nervous system and then he wanted to give me a series of opioids as well which I just refused to do just knowing and having done my own research and knowing my own tolerance for anything, I just refused that.
At this point in time I think “I need to find a different answer”. So this is when I found you Chris. I started to do a lot of research on nerve pain and the psychology of pain and just the psychology of recovery and how to feel empowered and how to get over an obstacle. Because as someone who loves to run because I’m so intertwined with running it was literally I started having identity crisis. I was known as “Marla the runner”. That’s what I did, that’s how my day started. Luckily my job has nothing to do with running so luckily I had that part of my identity. So I can only imagine if you’re a professional athlete, what you must go through if that’s really how you get paid. But for me even recreationally that was who I was to my friend, to my family, to myself and so this is when the struggle began. So here we are.
Dr. Segler: You bring up several good points. The first thing that you mention was that you have done some research and although you had heel pain which is very very common among everybody not just runners. Heel pain accounts for about forty percent of all visits to podiatrists in the United States. Of that, the overwhelming majority for sure is plantar fasciitis. In most doctor’s offices they do what I did when I had a standard office. We go through the schedule in the morning and I said “Okay, Marla’s coming in today at ten and she has heel pain”. Basically I would assume that heel pain is caused by plantar fasciitis until we’ve actually looked at you to prove it’s something else.
It’s sort of the default diagnosis whenever you have heel pain, and yet you have some research when you said like your symptoms didn’t necessarily fit perfectly with plantar fasciitis. It seemed off to you. You didn’t have the sort of classic pain where you get up and wake up, step out of bed, have that sudden jolt of pain that then goes away. So your symptoms really weren’t classic plantar fasciitis. You were already kind of suspicious of that diagnosis, it sounds like before you even went there. But then based on your story it certainly doesn’t seem like it was just plantar fasciitis. Then this one injection that you had sort of set off your nerve. That can happen. That’s one of the risks of having injection is that you could get actual nerve damage or you could get sort of sprung into this whole chronic pain chain of events where you’re nerve like you said kind of hijacked your system. The nerve basically starts making noise. It’s interpreted as pain and you get stuck in a cycle of pain because it just gets locked up. And then you have to do something also invasive, go to a chronic pain doctor who then does something else invasive like a nerve block to try to shut the nerve off and let it quiet and sort of reset, like you said.
But the first thing is that you really didn’t feel like your symptoms were really consistent of plantar fasciitis. Lots of times when I do second opinions for runners whether it’s in person or on Skype or on the phone, it’s incredible to me how many times they will say “I don’t think I have this, I think I may have something else”. They may not know what the something else is, but they’re already pretty sure. I listen to their story. It doesn’t sound like they have the condition they’ve been diagnosed with and so you have to really service your own advocate. You really just say “Okay, look I know you think I have plantar fasciitis but everybody doesn’t have plantar fasciitis and it could be something else right?” Sometimes have to get the doctor slow down and listen to you and that’s very difficult to do because our system is really kind of counter to that.
You find yourself sort of stuck in this whole process, where you’ve already been to the podiatrist and then you have to go see your chronic pain doctor and then you start running into lots of different doctors and the whole medical process just kind of consumes you so what happened. How did you find yourself really bogged down by that process after you had this injection started hobbling you around on crutches? How did that unfold?
Marla: Well one thing I’m going to say and by the way to the audience out there, Chris is not paying me for this. But I honestly after I saw you, I read your book that is on Amazon about heel pain and I wish I’d started there because I think I would have not been where I am now because that was a great book to help. I think I just had a little bit of an overused injury because I wasn’t changing my pace or my gait. I just was kind of thing moving around at the same rate all the time and not doing any sort of different movements and I think that we could start really really well to start there even having started with somebody like a great sports masseuse. I know rehab tends to be post injury. But if I had been able to get a personal trainer or somehow found to navigate my way into some sort of PT system that could help to me just to assess some overuse stuff that would’ve stopped there. But this is a shameless plug for your book because I love that book and I think its best way to start, if I could have done this all over again.
Dr. Segler: Well if you read anything, if you read blog articles and that talk about how to treat plantar fasciitis and you do those things and you don’t improve at all and you’re actually doing the treatments that should work for plantar fasciitis then right away you can assume “Okay well I may be have something different”.
Of course if you do respond, well then you’re going to get better. There’s so much value in just trying these other treatments before you really seek the standard approach by going to see a doctor.
Marla: Yes. Going back to your question, what ended up happening to me is I started actually feeling a lot of losses and control my life. I was now being dragged across the city to get massages and to get to then do a PT and then I was in a podiatrist office and then I was trying to see the chiropractor and I was going seeing acupuncturist and then a pain doctor. I literally felt like it started to consume me. Of course the way our medical system is set up is that nobody was talking to each other. What ended up happening to me is that I thought I was better by one person’s diagnosis or the other person’s diagnosis and then I was now finally getting out of the crutches. One of the big things again is we have to be advocates for ourselves.
Unfortunately, we have to get out there. Nobody helped transition me from injury to getting back in the sport and because I’ve never been injured before. I decided that finally it was time to go for a run and because my version of a run is six miles, not one mile, I was on a run at about three or four miles ended up getting myself a pretty horrible stress fracture. And Chris that’s when you came in. But this is one of my lessons learned. You really really need to advocate for yourself and start to build a team. Not only that, but really try to reset goals and figure out how to go from injury that is so bad that you are on crutches that makes you completely fatigued and everything to getting back to what is your normal which to me is a six mile run.
It might not be somebody else’s normal. For people who love to be extremely athletic and more are normal is much higher than what might be in the average doctor visits is that’s when you really need to start finding a team and really trying to figure out your own path to get into what your goal is hum.
Dr. Segler: Yes it’s true, you must have a team. There is no component of our medical system that is set up to provide people with that transition that you’re talking about. The fact is in the United States, doctors get paid for procedures. They don’t get paid for prevention. They don’t get paid for keeping you healthy or making you happy. They get paid for treating illness or disease with procedures. And the more things they do, the more they get paid. It’s true for all doctors and physical therapists, the more things they do, the more money they make.
It’s really not helpful when you’re an athlete and you get injured because that whole transition is not something that’s even evaluated. We talk about whether or not somebody is “healed”. We talk about what it looks on the X-ray. We talk about what it looks like on physical exam. We talk about sort of activities of daily living like can you walk, can you go to work, can you go to the grocery store, can you make food, can you go to the bathroom, can you move around your house and if you can do all those things then you’re sort of defined as cured. But if you’re a runner and you haven’t run in three or six or nine months because you had an ongoing chain of events and injuries that have incapacitated you and caused all that atrophy that you talk about. If you just go run six miles you’re going break something and there’s no code for how to help an athlete transition from the state of profound inactivity to full activity, which for you, like you said, it’s your therapy. It’s everything that is part of what makes you happy. It’s what defines you is being a runner going to run six miles before work. That’s just not a component of the process at least not in our system that we have.
It’s very very difficult. You have to find a team of people that will help you with that. That’s for sure. So when you were going through all that and you did sort of finally assemble a team. I would assume that they told you to start doing a lot to different things like get the perfect amount of sleep, eat the perfect diet, stay off your foot, do all these different things. But isn’t it possible that all trying to take in and follow all that advice can in itself be stressful?
Marla: Yes so when I say “team”, I also mean that loosely in the sense of just people who support you. So what I don’t mean is it’s nice to have that’s not professionally helping me along the way. But for me my sister was really beneficial in helping me get to running because she was just supportive. So I would say it’s in the goals that I have for me is when I say team I don’t mean all of the sudden get an army. For me they’re kind a few people that you are align. Make sure that you don’t end up with a million professionals that aren’t connecting, because now you’re going to be stressing yourself out again spending time and money going from this appointment to that appointment. When I was doing I realized the injury was owning me. No longer was I Marla ex-runner. Now was Marla the ex-runner who is now crazed and a victim of her injury and running around the city and has no time for friends or family because she’s off at this or that appointment or the other between work.
One of the things that helped me was really just to take a step back and realize I can’t let this thing run my life literally. All my spare time was spent taking care of this injury. So I kind of picked a few, one of which was you. I enjoyed having you as part of my team and then I found a physical therapist which again I actually went ahead and did a ton of research and found one that was aligned with my goals. I started at first finding the physical therapist that was right for me. But then really quickly with athletic background was able to move out about so then I found a place that was specific for endurance athletes and for athletes upon your suggestion. You had suggested AlterG and that was the only Institute I could find in San Francisco that my insurance covered.
For all of you out there, AlterG is an anti-gravity treadmill where you basically get to run in a bubble from the waist down. It’s really cool, and at least I could pretend and visualize running. So even if I was running at very very little body weight I was able to at least have my body move and remember how much I loved running which kept me really positive and helped me see the road light at end of the tunnel. It helped me believe that I would get to run again and it kind of felt a little bit that I could be a runner without pounding on the pavement. So that was nice.
But yes, going back to your question. I would say quality versus quantity. Find out some people that are really aligned with you and really aligned with your goals. So don’t align yourself with anyone who tells you stop running and I took that from you Chris too. It’s like I was done hearing that “just stop running”. So instead I’ve found a couple of people who could help. In my studies of injury and about healing I learned stress is really detrimental to recovery. And so not only with I stresses about going from this office to that office and going to almost all my spare time being gone. But now I was stressed about making sure that when I went to the grocery store and I was freaking out about was I only eating anti-inflammatories. And then I was stressed out about not being able to not have a glass of wine. I just added stress.
I generally have a very healthy diet. I think that there’s something to be said about balance and moderation. Whenever there’s something wrong in the world I would feel like there’s a reason we have this thing that everything is good in moderation I would highly recommend that you get back to friends and family and laughter versus just being in sitting in a doctor’s office. We forget how much healing it is to let ourselves not stressed about something. How healing it is to just forget about the injury and to be around our friends and families and loved ones and being at the museum and seeing art that we like. It’s all about what goes into the healing process. It’s not that simple, there’s not a cure or there’s not just a pill that you can pop or diet you can eat to all of a sudden go from injured to not injured.
Dr. Segler: That’s a great point. It kind of goes along with what you’re saying earlier about your team not just being a team of doctors, of therapists or whatever. It’s really kind of about what makes you happiest. The things that makes you happier are going to help you heal. Having friends, relatives, and people on your team as you say who are your cheerleaders, who are positive is extremely important. The worst thing would be if five of the people on your team if you had a doctor and then four people from a chronic pain group who have had chronic pain for twenty years and never gotten any better, you probably don’t want them on your team.
You need people that will help you remember, you’re going to run again. You’re supposed to be happy. It’s just those patterns of a pain recognition that lead to chronic pain. They become wired in the brain they become hardwired after a long periods of repetition. If you focus on healing and you focus on being happy and you focus on even keeping track, keeping a journal or something about what is positive like what do you have to be grateful for what improvement did you make today and you focus on those things, you will get more of those things and those patterns become wired as well.
Along those lines like what did you do to keep track of your activities, your improvements, any that kind of stuff.
Marla: I did do a journal. When I say a journal one of things that I’m big on is you don’t need to go and buy a fancy leather bound journal and make sure that you write in that specific journal. I’m a big believer in trying to remove obstacles. When I first tried to do that approach all of a sudden I rushed into the house too fast to write in my leather bound journal and now I’m on the train and now I can’t write in my journal and I have to do that when I get home and so I just ended up taking a pretty loosely of just back of the envelope, napkin, computer, phone, whatever as kind of just assessing. It’s okay if I skip a day or two, but generally tried two for the week of like what are my goals and then what was I able to do yesterday or today.
There was a time when I couldn’t get to the grocery store or when I was on crutches where making a cup of tea was difficult. It’s nice to see that there are one of the key things I remind myself is you don’t recover in your own way that there will be flare ups and there will be ups and downs but having a journal and just knowing I had a little bits of pieces of paper could just at least put together in a folder of some sort was just a reminder of how far I had come. And so that was really helpful. Even if you just use a piece of paper it’s still something that is if you do a lot of research on a psychology and what helps people make happy in general. It’s actually the process of writing and not so much of even going back and looking in re-reading it. It’s that somehow when we go from the brain to writing, it makes it just feel more real for whatever reason. I’m just a big proponent of trying to just somehow get that from the brain down and so that was one of the things that I did for my journal.
I think it’s important to not only capture what your goals are and how you make your goals but also just the small things that you did on a daily basis like going to grocery store, like going to dinner with friends and reminding yourself at those are actually movement forward. Even though it might not seem like it.
Dr. Segler: That’s a great point. I recently did a podcast on keeping a pain journal. A lot of people heard that and they think they’re going to be focusing on their pain but the fact is you’re trying to focus on improvement and even having a column and like all what could I do, what did I do yesterday that I couldn’t do the day before. That stuff matters and the reason it matters is that most runners all they see is that I can’t run six miles today. They focus on those things which again like just does more that negative rewiring in your brain is not helpful. So just having a column where you have something positive to put down that you can recognize those improvements and see those improvements to build on and keep moving is really important.
I actually went through this myself one time where I had a reconstructed knee surgery and I had a complication. I was in the hospital for a couple of weeks. But as athletes we have this idea of who we are with this identity around it and our capabilities. A lot of times those capabilities are not even tied to our physical fitness state at that point. When I actually was getting out of the hospital, I called my friend Frank and said “Hey, would you come pick me up and bring my clothes. Let’s go to the gym because I’ve been in a hospital bed for a couple of weeks.”
Obviously, I was smart enough to at least know had lost a lot of fitness. When I went to the gym the first set of exercise I was going to do was the Lat Pull machine. I had an immobilizer in my left leg. I used to do the entire stack of weights at this one gym on this one machine. I usually did the whole stack, but I was going to be sensible, I thought I’ll just do half the stack. What it did not think about was that first of all I was so weak, I should not have been doing even close to that but that I could only hook my right leg underneath the pad and not my left leg because I have the immobilizer on it and the very first rep, I’m not kidding, the very first rep when I sat down at that machine in the gym that day, I pulled down and I ripped an abdominal muscle. Frank had to take me back to the emergency room. The ER doctor was like looking at the computer and he said “Is this right? Did you really just got discharged a couple hours ago?” and of course I felt like a complete idiot.
I had sort of this vision of who I was and it was completely inaccurate at that point. So when you get cleared or approved to start exercising, what did you think? What went through your mind? How did you move from that sedentary state, you’ve been on crutches and to get back into activity without trouble?
Marla: I think there are couple of things that come to mind right away. I feel like I’m the only person in the world who buys Fitbit and a heart rate monitor to make sure I don’t do too much too soon because that was my problem. As I was recovering from the stress injury, the stress fracture injury and I haven’t run for about a year and four months or so. Because of getting out of that about just over a year is that I was determined to not to get another stress fracture. I think that some of those tools that we used to enhance our performance can also have the same goal.
I would recommend using the tools that you think of just going faster and stronger is also useful for when you’re just transitioning back. If you’re going to use your Fitbit that maybe you don’t if your goal is ten-thousand when you were not an injured person. But now you’re injured, make sure you have twenty five hundred to this week, five thousand the next week or whatever. I think those are really helpful tools. I’m a big proponent of trying to move before you get complete atrophy.
Getting creative about movements is really important. For me with the stress fracture, it doesn’t mean that you can’t use your arms or your abs. I was tired with the crutches as I ended up going to yoga class and just doing it for the whole thing on my knees. But that also allowed me to be part of the community which was also part of my identification. Going to the gym and being the person that shows up on crutches. Part of recovery is not being ashamed, not being afraid to look weird and kind of going with what does and doesn’t hurt but kind of playing around and taking a lot more of a playful approach as opposed to any sort of athletic definition of it. So that’s really what I tried to do in the effort of trying to be positive and making fun is I would get to the gym.
Dr. Segler: Its two things, it’s not just community, it’s also not being embarrassed to be a part of a community that you’ve always been a part of and it’s difficult. You have to basically be able to do that if you want to really recover as quickly as possible. We always think it’s the injured part. You’re not an automobile, you don’t just replace the alternator and then take off down the highway. It doesn’t work like that. So you have to take everything else in the system and fortify it and build it up so they can better support your injured foot when you actually do go back to running. The weaker the rest of your body is, the more forces are going to get transferred to that injured part and that is going to put you in trouble.
Marla: I had people in my life personally or professionally you said that there was only this or that was the right way to do it. One of the reasons why again that you really helped me to beyond it is that when you came to see me you were like “Hey what about water running, what about AlterG”? You can still be an athlete or still play or still be athletic and not with injury. I think that’s really important that you don’t have somebody who tells you “Oh you’re crazy for going to the gym with crutches”. Instead have friends that say “that’s awesome!” Can I drive you there, can I get you there and now when I see someone at the gym that has crutches or a walking cast and they take it off and they play around. I think half the people are getting weird looks and the other half I mean I’m there to high-five them and I don’t want to ask them about the story. I don’t need to know what happened. Your body is actually the fastest way to recovery. So as much as we can also give back to others to have that kind of injury or look that way I think is part of the larger community.
Dr. Segler: It really is important to encourage others. So then what about one of things that can really help is not just sort of doing stuff but also picturing things happening and athletes do this all the time. We use lots of visualization in order to sort of in advance see ourselves achieving a specific goal and that helps us stay motivated to work toward achieving those goals. What about you? What about visualization and how did it help you heal through your process?
Marla: Yeah I think there’s a famous a YouTube video with Michael Phelps about how he basically has already swam the race five times over before he actually jumped to the pool. Something along the lines of that. But yes I have to say and that was one of the things I would do was one thing I did to help recover and to make things easier is I bought myself a little spin bike that doesn’t need to be plugged in that has wheels that you can roll into a closet and everything. But one of things that I would do would be on this bike and would just slowly spin on it but close my eyes and imagine that I was out running along the beach which is where I live and love to run. So I would use that time while doing some sort of other activity but just kind of pretend I wasn’t doing one activity and replace it with running and then what worked for me, a lot of beyond just visualizing myself back to my sport was also having a conversation about the pain that I was going through.
I think there are some YouTube videos that talks about the psychology of pain. For one thing is that we do have the survival instinct. What really I’m really trying to say here is that yes touching my foot was painful but this become wired into my head even though the nerve pain was kind of on but I literally would flinch if anything touched it and so part of my visualization journey too was to pretty much tell that foot nerve pain to go to hell and that you’re not real. I would walk down the street aside and that would have a random kind of just all the sudden a little shot of electricity and instead of flinching or stopping walking, I just would say “you’re not real, you’re not real, you’re not real.”
One thing I would say is do you research or read. Knowledge is power. But one thing I have read about pain psychology is that the nervous system is totally fascinating and that pain isn’t necessarily synonymous with injury. I’m not recommending this advice for somebody with compound fracture but it’s not always our best guide. Sometimes it’s okay to kind of poke around and try to really think inwardly. Is this really painful? Is this a story that my nervous system and my body is telling me or something I’ve been wired to expect? In addition to just visualizing your goal, it’s important to really kind of look inwardly and try to understand what’s going on with your body.
Dr. Segler: It is fascinating! I remember when I was medical school, one of the lectures on the neurology I remember the guy saying “pain is in the brain” and it is. That’s where it’s born, that’s where it lives. You feel it in your foot, you feel it in your injury. But it’s all about perception. It is interesting the whole psychology of pain. It is a fascinating thing. If you can understand a little bit more, you can use it better to help you heal and continue to get better. So many people that get chronic pain, they wind up with chronic pain because they’re so focused on the pain and the focus makes it stronger.
Marla: They have examples of people that have perfectly normal MRI’s on their backs, they have an excruciating back pain and then there are people who have an entirely dysfunctional looking back and they are in no pain. A lot of it is kind of the story of who we are and how we are in our body. Sometimes we don’t feel hurt when we’re experiencing pain when it should necessarily be there. So that’s also not good, it’s a fine balance of one thing to be heard but then also knowing that you can overcome that pain.
Dr. Segler: One of the things you talked about earlier is about everybody being on your team. Some of the people who many times inadvertently limit us the most are the people that actually care about us the most. This is true when you get injured. It’s very very true in the business world. Like I have read a number of business books that have talked about this specifically and they’ll say if you decide to basically quit your job and start your own business. You need to be prepared like your spouse, your parents, your siblings. The people who seem to like have the most care for you will try to convince you to not do that. They’ll say you can’t do this is crazy because they want you to be safe, they want you to be secure. They will you be taken care of so when you tell them I have pain and I want to run, a lot of times they will tell you you’re crazy. You can’t run, what are you doing and that that’s not really helpful. I don’t think.
Mere acquaintances don’t seem to offer unsolicited advice. They don’t start telling you what you have to do and how you should do it and you shouldn’t do it. Why you shouldn’t run, why you should give up running. But loved one do many times. They want the best for you. The truth is they don’t know what they’re talking about half the time. They don’t really understand injury. Certainly there’s no way that anyone who cares about you once you’ve had like a year of trying to work through an injury understand as much about the injuries as you do. So they’re not really in a position to make that decision for you. Especially when you’re not asking for advice. How do you deal with that?
Marla: Yes, well luckily, I have been fortunate enough to have people that know a little about the body and encouraged me. My sister encouraged me and she’s done a lot of helping educate me in all of these things and sending me articles about the importance of load and importance of not getting atrophy and you were part of that and that was part of the team but it’s tough, I’ve gotten to the point where I’ve told people who are close and friends, “I’m not asking for your advice.” It’s a tough conversation to have. It’s been tough and I’ll be honest because I’ve been feeling with this for a long time it really has helped me assess who aren’t are my friends.
It’s changed really the nature of my friends and who they are. On the other hand also didn’t want to have this injury and just sit and do a couch potato and eat and drink the entire time. I wanted to be active. I wanted to challenge that and so I found more people who are athletic and really into sports and really into the nutrition and into just the way the body works (mind, body, spirit). So I’m again a super positive silver lining person. I have to be almost thankful for this experience because it did really challenged a lot of my relationships and help them evolve and helped me also drop off some that were not necessarily healthy. I think that it’s really important to find people who had the overall goal of living a long healthy life. That’s one of the good things that’s come out of this injury is that I’ve really been able to get to the core of some of my friends values systems and align myself among people who care about those things.
Dr. Segler: It is important though, you have to realign yourself, make sure your values and your goals are in alignment with the people that are working with you.
Marla: I would tell people if you ever get told this, I think anyone here ever uses the word crazy, I think that’s going to be an abusive word. I have a thing in life that there’s only one problem in the world and its communication and so if you do you find one of these challenges with somebody that you love you can say hey this is where I am coming from. This is the research I have done and you can say I understand where you’re coming from and let’s have a conversation about this.
Dr. Segler: When you actually started getting back in all your workouts, you went to yoga and you were using very different form than you would when you were standing on warrior pose. As runners we think about the way we run, we think about our form or where our posture is, where our elbows are, what sort of foot strike we have. But when you’re getting back to running or back to any activity at all, what’s your advice on form?
Marla: So this is where again I think just doing some research and empowering yourself is useful. So I just kind of started getting into this and my reactions was doing the gait analysis and then I was encouraged, I ran into a piece of work, Greg Lehman, I love of a lot of his work and he does a lot of the psychology on pain and injury and pretty specifically on runners and in certain places. But I went to one of his workshops and he showed videos of an Olympic athlete that has scoliosis that she’s an Olympian, no one is going to argue with that just because she does not have a perfect spine that she’s a bad swimmer and then he showed us some videos of some of the runners of marathons and sprints that kind of have a little bit of sloppy gait but then again you’re not going send them to gait analysis them to have a perfect form.
Things like that start to becoming really liberating. I started looking around and really watching. I live on the beach and so I can see a lot of runners at my door. I remember when I was injured in the very beginning when I felt victimized by this whole thing was that person has awful gait, how did that person get to run and I don’t and so I kind of let it go and realize “Oh my gosh, but the thing is that person’s running and I’m not.”
And so I think that when you can get creative, as long as it’s not hurting or that you’re at least being able to change upload or change just the way you’re moving in and so you get a little bit more of a cross training effect of it. I kind of just let go of form. I think that in society we have a lot of this expectation that it’s all or nothing. Perfect or nothing, I let it go, realizing that I might not look graceful or it might be clumsy. I think a really important part of my recovery is that to just not really care what anyone thinks or what it looks like or what it should look like. One of the things I would do is also I opened up my mind to “what is exercise.” So I randomly got into Zumba. I like dancing in general because I found that I was able to kind of like run in place for a little I’m in stop and go, run in place, I like even going to the museum. I would at least be walking around and then it doesn’t feel like you’re necessarily exercising but we are and so I just wanted to get movement into my life.
Aside from just being creative in gait and form also just be creative on helping you scale up is getting movement on your feet, getting moving around, but yeah I think that if you’re doing what you love and you’re not in pain then that’s probably a pretty good form.
Dr. Segler: That’s a good point. You really do have to shift your focus away from the pain towards success, away from sedentary stuff to “I’ve got to do this today.” If you do it really builds on itself.
I am a surgically trained podiatrist. I did a three-year reconstructive foot and ankle surgery residency and one of the things is that I just really remember is when I was chief resident, we had these conferences every Tuesday night with surgical apartment. Occasionally I would get a case where basically at somebody had a really bad looking MRI or CT scan and I would put up the images and I would just skip the whole introduction part about this is the patient, this is what happened, this is what they have complained about, this is why they can’t do and I will just show the images and I would just say any thoughts? And of course the surgical residents would immediately start saying “Oh they have this condition, you need to do this surgical procedure”. In every case that I did that they would ten different suggestions on surgical procedures to fix the “problems” that they saw on the images. Then I would say, “Okay well it just so happens that this patient has no pain whatsoever. This patient has actually recovered from this other injury and this is what looks like now but the patient has no complaints. Do you still need to do that surgery?”
That’s because we’re trained to think that way, we’re trained to identify problems that we can fix and we want to fix them as quickly as possible. If we think we can fix it with a corticosteroid injection then we want to do that. We want to do that right away. If we think we can fix it with orthotics or with a surgery or an implant or something like that, we want to do it because we do want you to get better. So along those lines what is your advice when you get those suggestions from a doctor?
Marla: Educate, educate, educate. Educate yourself, knowledge is power. My advice would best to get a second opinion. But I also think it’s important to get opinions of different professionals. So I think when we think of getting a second opinion that means one from one podiatrist maybe getting a second opinion from a different podiatrist. That may do well and serve some purposely think it’s also worth your while to maybe go to a massage therapist or a chiropractor or a PT or a personal trainer or something. I just try to read as much as you can about it too. If for some reason you start Googling this injury and you kind of go down the rabbit hole or in some specific neuroma or something like that and you can identify it’s not that. That will help you better explain to your doctor what you think it is. If you have a doctor who listens to you and you have a hunch of what’s wrong with you, it’s probably pretty likely that you’re right. I think it’s really important to find somebody who is a doctor who is going to listen to you, a doctor who is aligned with yes, that you will run again or that you know is aligned with your goals and won’t tell you to just stop running and then to a doctor that will help listen to you about your exploration of your body. I can’t stand it when you get to a doctor and you told them that you Googled your injury and they roll their eyes at you. I mean it’s our body, we get to try to do research and really try to figure out what it is, so don’t make me feel bad about trying to understand what’s going on with me.
I think that it’s a journey together and going back what I said before, there’s only one problem really and that is communication.
Dr. Segler: Try to evaluate it in terms of how the pain fits into the picture about what you can do to modify your perception of the pain, about what you can do to see yourself as an athlete who is actually improving and getting back to activity as opposed to someone who is in an injured state in unable to do things and that stuff is not something the most doctors talk about.
But you as an injured athlete, it’s your responsibility to get better as quickly as possible. It’s the doctors responsibility tell you what they think will help. But then it’s up to you to really sort through that information find out what really is right and useful for you. It is different for everybody. It really is helpful to have your perspective and that I’m really grateful for you are willing to talk about it.
Marla: I love it! That was the other thing I was going to say is that your podcast has been so helpful to me just to hear other people recovering and just to feel not alone. The community doesn’t have to necessarily be a person. It can be a community of podcasts too because I can’t tell you how much I thank you. It’s really helped me.
Dr. Segler: Well I don’t know if you know this but you are actually the reason I started the Doc On The Run podcast. So we we’re actually having a conversation one day, sitting on your couch. What happened was you had an X-ray and I remember one conversation we had this sort of fit into it was that you had an X-ray, the physical therapist or somebody told you that it looks really bad. It actually wasn’t that bad. It looked bad on the X-ray but it was a positive sign and would said like it would be great if somebody would talk about that stuff so that people could figure out those differences because obviously when somebody wearing a white coat or uniform tells you something is bad then you naturally assume it’s bad and your case it wasn’t bad and so we were having a discussion. But you said it would be great if there was a way to talk about that and I actually thought well I have been thinking about doing a podcast so maybe I’ll do that and that was basically the whole reason that I started doing it. I had a number of different people tell me “What are you crazy, you’re going to do a podcast. Like why are you going to waste your time doing that?”
My job is to help people understand their injuries and understand how to get better. The more people understand about them then the more they Google them, the more they research them, the faster they get better. You were the original inspiration for the entire podcast. So for that I’m really grateful.
Marla: Well I have to say you just made my day, my year, my life because if I can honestly help one person out there and I know that you helped me so in a funny way I helped myself. It’s a completely selfish endeavor but no honestly like I remember your first one was the woman that had her heel shattered and how she was going to swim and I was like this is where I don’t need to look crazy anymore. I was like I’m done, I’m going to the gym. If this woman can swim with casts on, I can sure as hell show up to the gym on crutches.
Dr. Segler: That’s right.
Marla: But I really hope that I can give somebody some sort of help. Because it’s tough and recovery is not linear, it’s definitely and up and down. I’m a positive person, trust me. I’ve had my horrible down days, really sad days and its conquering those and coming to the other side is important and hearing stories of other people’s recovery and or journey, it’s just a helpful in the process.
Dr. Segler: Well thank you so much for taking the time out of your schedule to come on and share your whole experience to help other runners understand what they can do differently to recover faster. It’s really been great having you on the show today!
Marla: And thank you so much for having me. I really really appreciate it. It’s been fun.
Dr. Segler: Alright!
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!
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.
But if you are still confused and think you need the help of an expert, a “Virtual Doctor Visit” is the solution. He has been “meeting” with runners all over the world and providing just that sort of clarity through online consultations for years. He can discuss your injury, get the answers you need and explain what you REALLY need to do to keep running and heal as fast as possible.
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