We see distance runners present to clinic with all kinds of complaints, with fractures and tendon injuries being most common. These types of injuries are more often than not in a chronic state, meaning the runner has experienced symptoms for greater than three months.
Often these runners will present having developed some obscure coping mechanisms and tried all kinds of magical bullets.
It is these runners that usually require very close attention and sometimes intricate management strategies.
How to spot a runner in potential distress:
– They have had symptoms for greater than 3 months
– They have poor understanding of their injury or cause of symptoms
– They have tried many treatment strategies (often for short periods of time with ineffective results)
– No modifications to training are made and they continue to run through worsening pain
When consulting with distance runners you can often ask yourself “do they really want my help?
Initially, your advice or clinical recommendation is not always well received, however, when things are put into perspective the answer to that questions is ultimately yes, it’s just how you go about suggesting change that is the real make or break.
Golden rules to follow:
1. Keep it as simple as possible – the explanation, treatment strategy and goals
2. Get to know your distance runners. They have some strong coping mechanisms for pain
3. When they say it’s sore…IT’S SORE!
4. Symptoms will likely be chronic and will take time. Address pathology, formulate a plan and consider a multidisciplinary team
5. Never completely unload a distance runner. Try and keep them running – assess the risk
6. Have them contribute to the program, it equates to buy in and back a winner early, meaning get an early progression on the board
7. Know that some runners hate “how long is a piece of string approach”, so make it as criteria driven as possible and make sure that the criteria is met before progressing
8. Be ready to justify your decisions as a clinician and answer the ‘WHY’ questions
9. Finally, when the runner starts to recover and become asymptomatic, keep challenging your athlete and trust the plan you agreed on at the beginning
To finish this opinion piece, we’ll leave you with a quote from American Hall of Famer Rich Davis – “Long distance running is 90% mental and the other half is physical.”