The Therapy Corner – Signing Off
Several weeks ago, Jane Brody, the Personal Health columnist for the NY Times, submitted her final entry to the newspaper. Her column ran weekly for 46 years and Brody, having reached her 80th birthday, decided it was time to turn over her efforts to educate and enlighten readers on all manner of health, nutrition, and fitness topics to a member of the younger generation.
Though I still have a few years to go before I reach that milestone age, I too feel the time has come to fold my tent and submit this column as the last entry for my series that has now stretched over three decades.
After 140 columns, I’m fairly confident I have covered just about every body part and running injury that I know of. In fact, I have done numerous updates over the years on most of them, as current information and evidence have evolved with new research.
As Ms. Brody did in her last column, I’d like to summarize and highlight some of the more significant changes that have taken place over the past 30+ years in thinking about running injuries from the physical therapist – or at least this PT’s – perspective.
Foot Orthotics – one of the earliest entries in this series covered the purpose, uses, and abuses of foot orthotic inserts to address a variety of running injuries. From the very beginning, I tried to emphasize that these devices, designed primarily to control excessive or abnormal pronation (rolling inward) of the foot during gait, are not the panacea that many have touted. My opinion was based on the evidence that abnormal pronation of the foot can be caused by several different factors, only one of which is related to the bone structure of the foot. It is that factor that is most amenable to the use of orthotic devices to alter that faulty gait pattern. The other factors that can cause overpronation – muscle imbalances in the hip; limited motion in the ankle joint, to name just two – are not effectively addressed by using orthotics. And yet, orthotics continue to be overprescribed (in my opinion) for any injuries thought to be related to overpronation, despite increasing contradictory evidence over the past three decades. Additionally, more recent studies raise questions on the significance of overpronation (or even whether such movements are truly “abnormal”) in the development of overuse injuries. The bottom line: runners should be wary of any healthcare provider who recommends expensive, custom-fitted orthotics as the first line of treatment.
Runner’s Knee – the thinking about the causes and treatment of this most common of running-related injuries has evolved probably more than for any other subject. This problem, known most commonly as patellofemoral pain syndrome (but also as chondromalacia patella; anterior knee pain; or retropatellar arthritis), is essentially the result of excessive friction or compression to some part of the backside of the kneecap where it meets the thigh bone. For many years it was thought this was caused by an imbalance in the strength and timing of contraction of the four muscles in the front of the thigh (quadriceps) that pull the kneecap up and down as we walk or run. The treatment approach, accordingly, was to employ a variety of strategies (exercises to strengthen weaker muscles; biofeedback) to correct those imbalances. But some twenty or so years ago, it began to become apparent that the real cause of the problem was most often due to muscle imbalances and faulty movement patterns in the hips. Research on this subject over the past two decades has generally supported and reinforced this view and has been solidified by the successes therapists have had in treating this problem by focusing their interventions on this area.
Stretching – over the years, there has been no topic I have covered that has generated more raised eyebrows than the question of whether or not runners need to stretch before going for a run or race. As I’ve noted many times, almost every runner I’ve treated is of the belief that at least one reason for their injury is that they don’t stretch enough. I’ve reported on the accumulated evidence over the past 30 years that demonstrates this is most likely not the case, at least with respect to stretching just prior to running as part of your warm-up. There is just no evidence to support this practice as a means of either preventing injury or improving performance. (With respect to the latter, there is even compelling evidence that stretching just before running impedes performance!) So, I’ll repeat it again – while there is nothing wrong with a variety of stretching exercises or routines, such as yoga, my advice would be to forego them before your run and instead focus on dynamic exercises (squats, leg lifts, toe raises, etc.) that get your muscles working more actively, as well as just starting your runs more slowly until you’ve warmed up. If you want to stretch, do it some other time during the day or evening.
These are just three of the areas I’ve covered over the years that have seen changes in treatment approaches. Almost every topic I’ve written about has seen such changes, which is one of the reasons I’ve loved my profession for almost 40 years now – there’s always something new coming down the road, though not everything new is necessarily valid or beneficial. I hope that you, the reader, have found the information I’ve provided to be useful, or at least interesting, but now I think it’s time to perhaps turn this task over to someone else (hint to my PT colleagues out there) with a fresh perspective.
I want to thank the Syracuse Chargers for giving me this opportunity for so long. I may be signing off from this endeavor, but I’ll still see you out on the roads.