Today on the Doc On The Run podcast we’re talking about why you aren’t healing like a professional runner.
I actually did some research recently in preparation for a presentation I was going to be giving on running injuries at the International Foot & Ankle Foundation medical conference in Seattle.
When I went to Medline, which is the search engine that catalogs medical research articles for the National Center for Biotechnology Information, I entered the search terms “running” and “injury.” That search produced 5,093 articles that were published in authoritative medical journals around the world. So not only do a lot of runners get injured, apparently a lot of researchers are writing scientific articles about running injuries.
Out of all of those publications one of the most informative may be the one entitled “Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review.”
That study was a meta-analysis published in the British Journal of Sports Medicine.
By the way, if you want to get a free PDF of this study so you can read the whole study yourself, just go to the show notes page for this episode which you can find under the podcast section at DocOnTheRun.com. We have it there for you and it’s free.
The primary objective of that research study was to figure out the true incidence of lower extremity injuries among distance runners. Basically they wanted to figure out how often runners really get injuries like shin splints, stress fractures, Achilles tendinitis, and plantar fasciitis.
To accomplish that they actually reviewed all of the published research studies which discussed those kind of injuries among runners.
When doing this sort of research, the researcher has to make a decision about what to include and what to exclude. So of course all these research studies always have inclusion criteria and exclusion criteria.
First and foremost they have to define “what is a distance runner.”
1. Someone who runs distances of at least 5km (or 3.1 miles), but not further than a marathon or 26.2 miles.
Because they were trying to figure out what sort of injuries afflicted distance runners they chose to exclude sprinters and short course track athletes.
2. They also chose to exclude ultra-marathoners based on the assumption that athletes who run 50 or 100 miles might be outliers.
3. Runners are also considered to be either recreational or competitive runners, but we’re not professional runners or elite runners. This is an interesting point and you should pay attention here. The authors of this meta-analysis when choosing to exclude elite runners stated that they had to exclude them from the study because elite athletes “presumably can rely on a better medical support.”
Professional runners and elite athletes are presumed to have more attentive medical providers, more immediate access to qualified medical professionals, and, at a minimum more attentive and supportive care when injured.
Every time I lecture at a medical conference I bring up this point. When I bring up this important exclusion I always ask the doctors in the audience whether or not they agree that professional athletes have better medical care. All of them nod yes in agreement.
I basically throw up my hands and say, “If we agree it is best for professional athletes shouldn’t that medical care be the standard of care for all runners?”
And you, as a runner listening to this right now, should been thinking about that, too.
You need to think about why you’re not healing like a professional athlete.
You need to figure out what you can do that a professional athlete would be doing right now with your injury.
And I can tell you right now it’s not about having a more expensive doctor. It’s not about having a chauffeur who’s going to take you to the hospital.
It is about the small choices you’re making all day long that are either making you better or preventing you from healing as quickly as you potentially could.
After many years of teaching doctors about running injuries and personally helping runners figure out how to keep running when they get injured, I can tell you I’ve seen some recurring themes. The following are the top three reasons I really believe you probably aren’t healing like a professional athlete.
Let’s face it, when you get injured you get bummed out. You aren’t exercising. You’re just sitting around thinking about the race you had been training for for months, and you’re visualizing your goal race vaporizing. You’ve given up.
It’s almost like a mild form of depression. It’s like your dream turned into a nightmare.
Then you have this sort of lost opportunity cost kind of thing going on where you start thinking about how much time you wasted. You think about long runs in the rain. You think about all the times you could’ve been doing things with your kids and went out for a run instead. You think about all of those workouts you did before dawn. And all of it seems like wasted time now.
With that sort of focus it seems obvious you could have a terrible attitude.
If you asked 100 professional runners or elite athletes specifically about a positive mental attitude versus a negative mental attitude, I would be willing to bet at least 99 of them would say a positive mental attitude is absolutely critical to success.
They never give up. They see any sort of problem as something to be worked around. It’s a temporary obstacle. It’s a puzzle to figure out.
If you’re thinking about how you’re not going to be able to do your race, you’re cementing your failure.
You need to start thinking instead about how you might be able to do your race. You need to get all of your subconscious brainpower trying to figure out how you can heal and show up on the starting line.
For all injured runners that is really step one to healing quickly.
Over and over I see injured runners bail on their nutritional disciplines when they get injured.
In some sense the shift makes sense. They say, “Well, I am not really training right now. I am just “sitting around” injured so I’m not burning the same kind of calories. So I don’t need to be eating the same sort of diet.”
Interestingly, many of them turn to comfort food. Maybe they are actually eating a little bit of pizza or a little more ice cream, or having a few more beers.
You have to really think about this. When you train, all you are really doing is causing deliberate tissue damage. Training is designed to injure the muscles, tendons, bones and ligaments just enough that they can repair themselves and become stronger than they were before your training session.
The over training injury only happens when that level of tissue damage exceeds your body’s physiologic capacity to rebuild that tissue before your next workout.
So really, when you have an over training injury you just have an exaggerated version of your normal training/recovery process. So nutrition has to be a primary focus.
If you eat 4 to 5 times a day to make sure you have the raw ingredients for healing in your body at all times when your training, you should certainly do that when you’re recovering from an over training injury.
You need to have frequent doses of protein, collagen, antioxidants, vitamins, minerals and trace elements. And I’m not talking about once a day. You need those things in your system continually. You need to be eating six times a day. And if you’re not eating six times a day, if you’re only eating three meals a day, then you should be supplementing in between meals so that you are effectively boosting your system with the raw ingredients it needs to heal all day long.
If you go to see a doctor when you have an over training injuring and your doctor just tells you to stop running, you need to hobble your ass out of that office is fast as possible!
Your doctor’s job is to help you get back to running. End of story!
If your doctor tells you to quit running, your doctor is not on your team. Your doctor is on your competition’s team.
You cannot and should not tolerate an adversarial physician. Any doctor who is not willing to align their prescribed treatment plan with your goals is an adversary.
Any doctor who hands you a pre-written, pre-planned, pre-prescribed treatment plan to you, is not working hard enough.
If that actually worked, I would pre-write your treatment plan and put it on the website so you should just get it and read it and heal.
But that’s not really possible. Every runner is different. Every runner has to do whatever is necessary to heal their particular injury as fast as possible.
But perhaps even more importantly you have to be able to make adjustments and individually tailor the healing process to fit your rate of healing. Young athletes heal faster than old athletes. People who have been exercising their entire lives typically heal faster than people who’ve just started exercising recently.
Runners with minor injuries heal faster then runners who have more severe, chronically neglected injuries.
Don’t let any doctor tell you that “your injury takes six weeks to heal.” And you could insert any particular injury into that equation.
So if a doctor tells you it takes six weeks to heal plantar fasciitis. Don’t listen.
If the doctor tells you it takes six weeks to heal a metatarsal stress fracture, you know that’s not true. It all depends on who you are, what you’re doing with your sleep, with your nutrition, and with your activity. Think “active recovery!”
There are dozens of variables that can speed up or delay your healing.
So when you get an over training injury and you want to get back to running the real question to ask your doctor isn’t “How long is it going to take to heal?”
The million dollar question that you should be asking your doctor, and frankly you should even be asking yourself, is “what can I do today, right now, in the next few hours, later today, and tomorrow that will shorten that timeline? What can we do to heal faster? What can I do to heal like a professional athlete instead of healing like a normal runner stuck with the usual treatment in a normal doctor’s office.”
Think about everything you did to recover from your workouts when you were at your absolute peak of training, at the previous pinnacle of your running career? How did you eat? What did you do to rest and maximize your sleep? What sort of hydration routine did you have? Were you getting massages or stretching or using pneumatic compression boots? What all were you dong to recover faster?
Think about all of the things you did differently that you’re not doing today. If you really think about it, and if you really talk to your doctor and pin your doctor down on the things that you can do to heal faster, you will have the potential to compress the healing timeline.
And if you and your doctor work hard enough you may even be able to show up on the starting line fully healed, ready to run with all the potential to finish your goal race and make it to the finish on time.
References: van Gent RN, Siem D, van Middelkoop M, van Os AG, Bierma-Zeinstra SM, Koes BW. Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. Br J Sports Med. 2007 Aug;41(8):469-80; discussion 480. Epub 2007 May 1.
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.
You can arrange a Virtual Doctor Visit with a true expert on running injuries. Right from the comfort of your own home you can meet online with the doctor, discuss your running history, talk about your running injury and figure out a customized recovery plan that will help you heal the running injury so you can get back to running as quickly as possible.
Book your Virtual Doctor Visit with Doc On The Run now!