A recent foray onto the internet today had me stumbling across weblogs of a couple local ultra runners (Dan and Matt). As an avid trail runner/outdoor adventurer, I also consider myself an aspiring ultra runner. It's just a matter of time. But 'til then, I live vicariously through the stories shared and pictures taken.It shouldn't surprise me that, among obstacles and challenges discussed, injury reports were sprinkled amongst the posts. When your training log not only lists daily/weekly mileage (often triple-digits) but also elevation, then you know they're putting more "wear-and-tear" on their bodies than the average woodchip shuffler like myself.
When guys like these (and I'll take the liberty of lumping myself into this category, for this example) get injured, I imagine the Monday morning water cooler talk goes something like this:
- Cubemate #1: "Hey Dan, what's with the ice pack?"
- Dan: "Oh, my knee's been bothering me quite a bit lately -- I had to cut my long-run short at 20 yesterday."
- Cubemate #2: "20!?! Well no wonder why your knee hurts! "
Dan, or whichever one of us this situation befalls, is left standing there, frustrated and annoyed (and with a family-size bag of frozen peas Ace-wrapped to their knee!)
Why? Because it's all relative. If a person's never run a mile (let alone 20), they cannot understand how it is physically possible to do so without crumbling to pieces. However, the Dans out there are frustrated by this simple logic:
"If I can run ten miles (or 20, or even 30) a hundred times in my life,
why does my knee hurt on the 101st? "
why does my knee hurt on the 101st? "
The cubemates -- as well as most family MDs and orthopedic surgeons -- would argue the following:
- The "Your Body Can Only Take So Much" Argument (aka "The 30 Years Rule"?)
- The "You're Getting Too Old" Argument
Instead, I'll borrow from the world of structural engineering: the material stress model:
Stress = Force/Area
where Stress is the injury-producer and Force is how we choose to treat our bodies.
Age and genetics are the biggest determinants of the amount of Stress it takes to injure: individual bodies react differently to Stress, and the same body differently across a lifespan. It also varies in accordance to training adaptation.
And Force? A lot is said about Force. However, a ten miler's worth of "Force" may seem ridiculous to one but an easy day to another. Again, adaptation.
But the forgotten variable is Area. What is Area? In the case of a building material, it is the space through which that force is distributed. The greater the area, the more that force is "shared" amongst all parts of the material.
What's Area to a runner? EFFICIENCY.
There's a reason feet pronate and supinate, knees and hips flex and extend, trunks rotate, and arms swing -- to absorb, store and release Force toward a goal of locomotion.
EFFICIENCY is the idealized distribution of Force throughout the body. And, when all other parts of the equation are kept constant -- age, genetics, adaptation, and load -- it is the only thing we can control to impact stress.
Yet it is the Forgotten Man. Few, if anyone -- including most sports med professionals and athletes, themselves (especially runners!) -- believe that Running Biomechanics can be changed -- for the better or worse. There's a belief out there that "You're stuck with what you've got", and instead, the focus shifts instead to the Force variable:
“You might want to consider transitioning to lower mileage—
--you’d be surprised how well you can still race on 30 miles a week!”
--you’d be surprised how well you can still race on 30 miles a week!”
Here's what I say: "You might wanna consider optimizing your running efficiency!"
Injuries like Dan's occur for the following reasons:
- Too much, too soon, but more likely,
- You're doing something inefficiently, or less efficiently than you used to
It's that simple. Only The Efficient survive.
******
What does that mean to the Dans, Marks, and Joes out there? It means we must recognize the importance of form and technique, and its dynamic nature. Running is the only sport out there where little if any time is spent TEACHING someone to run; instead we're told, "Just run!", with the expectation that whatever permutation results is "OK".Here's where The Skilled Physical Therapist comes in: the PT, by definition is The Movement Expert. That is our job. We don't diagnose visceral disease. We don't prescribe tissue-altering medicines. We watch how you move and, if need be, we intervene to change it.
This approach can be used with running form, and has been, with great success. I am living proof. My own knee injury of nearly a year was abolished -- not with RICE, massage, ultrasound -- but with a biomechanical and motor control renovation.
It didn't happen overnight. It took a team approach between me as the patient, and my physical therapist. And, like a golfer honing his swing or a pitcher learning a new pitch, it took a ton of practice, repetition, and feedback.
But it did change, and how! Besides recovering from the knee pain, it has revitalized -- and revolutionized -- my running career. Because of my increase in efficiency, my "Area" is significantly greater. The result? My form isn't perfect, but the Force my body can take -- even as a 30+ year old -- is vastly greater than anything I could handle before, even in my early 20s.
How do we do it? Here are some nuts-and-bolts examples of what we do at Eugene PT:
- Comprehensive physical examination: What's weak? What's tight? What joints aren't moving, or moving too much?
- Real-world gait analysis
- Neurological/motor control testing: How do you control your body in space?
- Sport-specific intervention: strengthening, stretching, and drills designed to promote EFFICIENCY.
...and it won't even cost Six Million Dollars.
