Saturday, December 22, 2012

Going to a PT - From the Inside

"I intend to live forever. So far, so good" - Steven Wright

Almost every Sunday, I'll be asked, in the parking lot before our long run, a question about a little niggle or strain that one of our runners is having. Having been a Physical Therapist for over 40 years and a long distance runner for over 30 years, I guess I have some street cred on both counts. The streetside consults I give are pretty superficial and very brief - after all, I'm usually ready to run, just finished running, freezing cold, or the question only requires a brief response. I honestly don't mind at all giving some honest, fairly straight-forward advice to my fellow runners, but sometimes, things happen and you don't have a friendly runner/PT right there in the parking lot and you find you actually have to go to a medical office for your care. What to do and how to act?

First of all, if you have an injury that requires medical attention, find a Doc and/or a Physical Therapist that understands what you do and your passion for the sport. The most effective path to take for this is simple word-of-mouth through your running community or the local running shops. Whatever you do, don't go to the Yellow Pages and blindly pick a health professional just because they say they treat sports injuries. Once you choose someone, go in with the open frame of mind that you are going to do exactly as he/she says. Sure, you've already researched your problem on the internet, but put your faith in a specialist that you trust, rather than throwing everything but the kitchen sink at the problem. If you enter a therapist’s clinic with the preconceived notion that you are beyond repair, you’ve already created a self-fulfilling prophecy for yourself.  I have much better outcomes with patients who have a positive attitude throughout their treatment. Patients with an optimistic mind-set are generally more likely to follow their rehab program and get better faster.

When a patient (athlete or not) presents to me, I like to give them a simple question like "So, what brings you in?" and let them open up. Usually, I find a patient will tell you 50% of what you need to know before you ask another question. After gaining a fairly comprehensive history and physical, my first treatments will usually consists of teaching them some home exercises to begin with. That's when the fun begins.

One of the first questions I like to ask my clinic patients during a follow-up treatment is “How are you doing with the exercises I gave you?”  If they look at me like a deer in the headlights and they say “umm, I didn't really do them”, then chances are it will be a prolonged recovery and a lot of frustration on my part and the patient saying therapy doesn't help.  A major reason for patients not performing their recommended exercises or stretches is because they fail to see the correlation between the exercise and their injury.  They think “how can this possibly help?”.  Athletes will usually have a good grasp on the connection between rehab exercises and their injury, but with non-exercisers, well, it's a battle for them to connect the dots.

It amazes me that even the first time I see a patient may be right after they get a cortisone shot, which is a strong anti-inflammatory...then they're compliant with their therapy for 3 weeks, start to get better and then hit me with "I guess that shot is starting to take effect". Geez!! But, some will make the connection and continue to be compliant with their program. However, some will stop there and the mechanical cause of their injury will resurface and they're back in the same boat.

It's like when you first began running. Let's face it, all the pieces didn't fit together just like that unless you stayed with it. Rehab has to start easier than you want it to. I'll get these super-fit folks (except for their injury) and they're very reluctant to start with the pink "girlie-weights", but that's where they HAVE to begin! Most of my common folk (non-athletic) patients don't do as much as I want them to, and most of my athletes want to do more. It's a balance I go through all less...Aw heck, just please do what I tell you! Percentage-wise, I see many fewer athletes than I see regular folks, and so, I try to make every rehab program for them as simple and fundamental as possible. But, I like to think the fact that I'm a runner sways some of the athletes into thinking that I might actually have an idea what I'm talking about and they might actually accept what I say. The point is, if you go to a therapist, LISTEN, like you would your mechanic, plumber, accountant, or whatever. I may not know a fuel pump from a sump pump, but I can help you understand why running downhill hurts like the dickens and running uphill doesn't. Or why you can run some days and the next day you can't walk. Or why some days you can't even walk without your knee buckling. If you want to frustrate your therapist, perform some hill repeats when you’re nursing a strained hamstring, hammer out a set of fast intervals on a bad Achilles, or get that 20 miler in when you’ve been told you need two weeks off running..."Al, this therapy doesn't seem to be working!". Good Grief!!! 

Sometimes, a Parking Lot consultation just doesn't get it, so if one day you find yourself engaging the assistance of a therapist, the best thing you can do for yourself is to enter their clinic with an open mind, positive attitude, and willingness to put as much effort into recovering as you do training. Sure, it can be frustrating to be sitting on the sidelines lifting the Girlie-weights, but take it from me, if you have a plumbing problem, DON'T try to fix it yourself - call a Plumber before all hell breaks loose!! That is not an analogy, but the plumber story is the subject of a future blog post.

By the way, along the PT lines, on my post this week on TRAINING WITH AL, I addressed form while running, so some of you might be interested in reading that.

Also, I just want to repeat that those of you training with us for the Mercedes Marathon, we will be running on the Mercedes course on January 13th and February 3rd. Email me for more details.

I hope you all have a great Holiday and be mindful of things to be thankful for. For those of you in Birmingham, I'll see you on the roads - AL

"One child lost is too child saved can change the world"

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