Running

The Obstacle Is The Way

This blog post was inspired by Ryan Holiday’s book, The Obstacle Is The Way, which describes how employing the philosophy of Stoicism can turn our ‘trials into triumphs’.

This book got me thinking about how we approach issues such as sporting injuries, chronic pain and loss of function that we see in the clinic.

Obstacles such as chronic pain are becoming more prevalent in Australia, with one in five adults reporting they suffer with moderate to severe pain everyday.

It is clear, as a rehab community, we are collectively not doing a great job at helping.

The longer I work as a physio, the more I see how the right mindset and beliefs are a key factor in recovery.

Reading more about the Stoic philosophy, I could see how my values as a health care practitioner aligned closely with with this approach.

The average person has about 50,000 thoughts per day, and for someone who is in chronic pain, you could imagine a large percentage of those thoughts could be centered around these three questions:

  • what is going on?

  • how is this going to get better?

  • when is this going to get better?

When they experience injuries, it’s common for athlete’s (even weekend warriors) to feel anxious and depressed.

One study of 343 male college athletes found that 51 percent had some symptoms of depression after being injured.

Addressing beliefs and attitudes early on can provide the foundation to a successful return to full function.

Downward Spiral Of Injury

We know that a previous injury is the biggest risk factor for another injury.

And that means as a rehab community, we have some work to go in terms of educating and providing injured people a comprehensive rehabilitation program in order to prevent compensations and further issues.

Without inadequate rehab, a downward spiral of pain and injury can develop, eventually leading to burnout.

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Stoicism - a little background

Getting back on topic!

Stoic philosophy was founded in Athens in the early 3rd century BC, and was practiced by the likes of Epictetus, Seneca and Marcus Aurelius.

Ryan Holiday writes specifically of being inspired by Marcus Aurelius, whose quote inspired the book:

“The impediment to action advances action.

What stands in the way becomes the way.”


Marcus Aurelius, as well as being one of the most successful Roman Emperors, had his own private struggles with chronic pain in the chest and stomach.

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His personal notes practicing Stoic philosophy, The Meditations, refers many times to psychological strategies for coping with pain and illness.

His physical resilience and endurance was remarkable, despite not having ideal physical health he was to become one of the most respected emperors in Roman history.



Mindset Shift

One of the biggest lessons taught by the Stoics was to re-conceptualise your obstacles from something to avoid to something to welcome, as a means of growing stronger and more resilient.

Obstacles give you important clues as to where you may have some ‘weak links’ and provides an opportunity to turn them into strengths.

Following a Stoic philosophy involves re-wiring your thinking, shifting from negative emotions such as from worry, anger and frustration to calmness, gratitude and hope.

To be clear, negative emotions can be healthy and natural.

But at some point, they become more of a hindrance to your forward progress.

With the right plan in place, and plenty of patience, grit and perseverance according to leading sports scientist Tim Gabbett, you can turn yourself into an unbreakable athlete. 

“It is a rough road that leads to the heights of greatness” - Seneca

“It is a rough road that leads to the heights of greatness” - Seneca

Short Term Pain Coping Strategies

Of course if your only goal is to avoid pain, there are some strategies that can bring about some fast relief.

Using pain-relieving medication has it’s time and place.

But unfortunately we’ve seen the long term consequences of opioid medications (e.g. tramadol, oxycontin and codeine) that can sometimes lead to addiction and other serious side effects.

And we now know from the research that these drugs create a long-term increased pain sensitivity, making your pain levels greater than before you started taking them.

The other problem is once you come off the medications, you haven’t any had an opportunity to learn from your pain and injuries, so you essentially need to start all over again.


Instead of relying on pain medications, here’s eight practical strategies, inspired by the Stoic Philosophers, over 2000 years ago, to help you overcome your pain and live the best life you possibly can:

  1. Accept Pain And Injuries 100%

The Stoic philosophers were big on understanding the rhythms of nature.

Just like stormy weather, it would unwise and naive to believe you would never have a pain or flare-up in your body.

No one gets out of life without serious challenges along the way and no one is immune to experiencing pain.

However, the difference lies in how we perceive and respond to it.

A real life example world would be to consider how a sailing boat gets from point A to point B if there is a direct headwind blowing in their direction?

Would the sailor just give up and think it’s not worth the hassle?

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The experienced sailor would no doubt accept that unfavourable winds are going to happen some of the time - that is a normal part of life, and they wouldn’t get overly emotional when it occurs.

For the sailor who is committed to reaching point B, the solution, is to change tack.

If the boat turns onto a 45 degree angle, then the sails are able to pick up the wind and use it to the boats advantage.

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Progress is no doubt slow and frustrating, but it is still forward momentum and getting you closer towards your goal.

When the winds eventually turn favourably, you would have built up a decent reserve of resilience and capacity.

Bottom line: there is a season for pain and it is a normal and inevitable part of life.

Keep breathing, batten down the hatches if necessary.

The storm will pass.

2. Let Go Of Your Fight Against Pain

Following on from the first point, counter-intuitively, to overcome your pain, you must be at peace with your pain and fully accept it.

The struggle, the fight and the mental battle against your pain only ends up wasting precious energy and resources, that could otherwise be better spent.

Being trapped in a state of resistance and anxiety leads to your body into a fight or flight mode where your muscles are held in a constant state of tension.

This can lead to even more problems than your initial injury.

Common muscles that are involved in the fight / flight response are:

  • neck / trapezius

  • hip flexors

  • lower back

  • TMJ jaw

  • shoulders

Once you can find acceptance, a significant burden is literally lifted from your shoulders.

With the guidance of a health care professional, it’s important to let go of your anxiety and find a place inside that is relaxed.

“Sometimes, your only way out of the pain is through the pain”


3. Imagine The Worst Case Scenario

The Stoics proposed, rather than avoiding the pain, we must accept it and then confront it.

Once you are feeling more relaxed and in control of your emotions, Stoicism actually encourages you to imagine the worst case scenario in terms of your pain experience.

If you could courageously come to terms with the worst case scenario - and see how, while it would be difficult, you would definitely still be able to cope.

Practicing this exercise mindfully can help reduce the fear around pain, injury and loss of function, knowing that you will be able to manage, no matter how bad things get.

4. Good vs Bad?

Injuries can often be thought of as ‘bad’.

But are they really?

This reminds me a of a story about a farmer.

One day his horse runs away. And his neighbor comes over and says, to commiserate, “I’m so sorry about your horse.” And the farmer says “Who Knows What’s Good or Bad?”. The neighbor is confused because this is clearly terrible. The horse is the most valuable thing he owns.

But the horse comes back the next day and he brings with him 12 feral horses. The neighbor comes back over to celebrate, “Congratulations on your great fortune!” And the farmer replies again: “Who Knows What’s Good or Bad?”

And the next day the farmer’s son is taming one of the wild horses and he’s thrown and breaks his leg. The neighbor comes back over, “I’m so sorry about your son.” The farmer repeats: “Who Knows What’s Good or Bad?”

Sure enough, the next day the army comes through their village and is conscripting able-bodied young men to go and fight in war, but the son is spared because of his broken leg.

And this story can go on and on like that. Good. Bad. Who knows?

Be at peace with your path and have faith that everything happens for a reason.

There is no good or bad to the practicing Stoic, there is only perception.


5. Switch From Goal Oriented To Process Oriented

While you can learn the principles of Stoicism, the philosophy is actually one of action.

A Stoic needs to focus his attention on action in the present moment of time because neither the past nor the future can be changed.

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Being process orientated, you start to focus on all of the small daily things you need to do that all add up to produce the end result.

Come back to the present moment.

That is where the power is to change your life for the better.

Take the focus off being pain-free and instead put your focus on the process.

What are the small daily tasks you need to do to become pain free?

“Luck is what happens when preparation meets opportunity.” ― Seneca


6. Understand Your Pain

“We are more often frightened than hurt; and we suffer more in imagination than in reality.” Seneca

There is no doubt that ongoing pain that is unexplained can be frightening.

With the help of your Physio and Doctor, if you can understand that some degree of pain is a normal part of the healing process, you can relax in that knowledge.

It’s important to realise that whatever pain you experience should be related to a certain physiological process.

For example:

Ankle sprain —> inflammation around the ligament, you can expect some soreness for 4-6 weeks

Lower Back pain —> occasional flare-ups, especially if sitting too long. Disc injury takes around 3 months to heal

Tendon degeneration —> worst in the morning and with sudden changes in training volume, hills or speed work

Knee - patello-femoral syndrome —> (pain in front of the knee cap) take on average 3 months to get better and pain relates to irritation behind the knee cap and gets worse with squats, kneeling and stairs

Nerve related irritation or damage —> could be many months or years of altered sensation in the affected area

Muscle pain —> the most common source of musculo-skeletal pain - lack of oxygen to the muscle from poor posture, excess muscle tightness or injury.

Chronic pain (more than 6 months) —> relates to increased sensitivity in the nervous system which magnifies minor tissue problems. It may come down to the fact, that we all have wear and tear and issues in our body, for whatever reason, the body and nervous system has decided to heavily focus on that particular area.

If there is ongoing pain and you are not sure why, then you may need to talk to your health care provider in more detail.

7. Develop A Growth Mindset

Stoic philosophy has a lot in common with the Growth Mindset approach, developed by Carol Dweck.

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According to this approach, the most important word in the dictionary is ‘yet’.

Re-frame your challenges…

“I haven’t completed the marathon…yet”

“I haven’t felt strong and pain-free in my lower back…yet”

“I’m not sure what it feels like to walk without pain…yet”


8. Train Your Mind To Endure Pain And Discomfort

It takes practice to exhibit self-control with our perceptions of life’s obstacles.

You can practice - the next time your stub your toe or get a paper cut.

Pause for a moment and see if you can absorb the sensation of discomfort - without reacting to it.

One of the great things about exercise is that it is a form of discipline where you willingly put yourself in a position of discomfort for a period of time, with the hope that you will come out the other side better off physically or more importantly mentally afterwards.

As you practice pushing yourself to the threshold, you will build a reserve of willpower to draw from as necessary, creating a “Inner Citadel” of strength and resilience.

For me personally, that is one of the reasons I enjoy the process of running so much.

Every time I go for a run, I know I will confront the pain of a body wanting to stop.

To achieve any sort of reasonable time, you need to learn to listen to your bodies pain, but constantly re-directing your attention and keep pushing to achieve your goal.

“Faced with pain, you will discover the power of endurance” - Epictetus


Conclusion

Pain and injuries are never easy.

But with the right attitude, they can be an valuable internal guide to making you better and stronger than before.

What seem like insurmountable obstacles become once in a lifetime opportunities.

If you’d like to find out more about Stoic philosophy, I’d highly recommend you check out the book, The Obstacle Is The Way.

Now it’s over to you,

What’s the biggest obstacle you’ve faced? What benefits were you able to derive from it?

I’d love to hear your thoughts in the comments section below.

Running Might Protect Against Knee Arthritis

This study reported that runners had roughly half the incidence of knee osteoarthritis as walkers.

https://www.ncbi.nlm.nih.gov/pubmed/23377837

"Recreational running at any time in life does not appear detrimental, and may be protective in regards to developing knee osteoarthritis”, the researchers concluded.

So why is there such a deep rooted belief that running causes knee arthritis?

Maybe it's the runners with a poor foundation (poor flexibility, core strength, hip strength) that give running a bad rap and find their knees getting overloaded.

But it is clear now that the biggest risk factor for developing knee arthritis is being overweight and having a high BMI.

The clear message from the research is:

Being inactive and over-weight poses a much greater risk of developing knee arthritis, than if you keep fit (especially with running) and maintain a healthy body weight.

Having accurate beliefs is so important, and understanding that running plays an important protecting role against arthritis forms an important part of keeping your joints healthy.

For runners who have experienced some joint pain, it’s about building a solid foundation of muscle strength and capacity to offload the joints.

Want to learn about about how to build your foundation for running?

2 Things Every Runner Needs For Success

Two things every runner needs for success:

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1️⃣ Cardiovascular Economy (VO2 Max)

This is the max amount of oxygen your body can take in, transport and use during running.

Gifted athletes have a high VO2 max that means they can sustain high work loads over a longer period of time, before getting fatigued.

The rest of us have to rely on consistent training over the years to improve. Ultimately you have a set limit that relates to your genes (and your age).

If you have a high VO2 max, but your tissues aren't ready to cope with the high loads of running, often that can lead to overload and injury (a common scenario among triathletes).

2️⃣ Biomechanical Efficiency

This is where we can have the most impact, preparing our bodies for running, through optimal:

✅ flexibility in the right places (ankles, hips, upper back),
✅ core and gluteal stability
✅ strength and capacity in the muscles, tendons and bones
✅ efficient running form
✅ a sensible load management plan

This is what we 💯 focus on in The Resilient Runner Workshop.

Building you up from the inside out so you have the capacity to unlock your potential as a runner.

One of the reasons I love running is because it a barometer of your physical foundation. You can learn so much from listening to what your body is telling you, getting stronger and healthier than ever before.

The next workshop is coming up Murray Bridge March 9th (limited places left). Also excited to be heading to Clare Crossfit 5451 in May, check out the website for all the details.

PRE-hab is the new rehab

When it comes to building your running capacity, putting together consistent training weeks / months is how you reach your potential.

Sounds simple in theory, but the most common set-back is niggling injuries that force you slow down or take time off all together.

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You can find yourself in the the land of 'boom-bust' where you reach a plateau of performance that can be frustrating, dis-heartening and confusing.

And it's easy to blame the running, saying that you're not meant to run.

The truth is, running is one of the most challenging, high level activities you can ask of your body.

Running efficiently and pain free comes on top of a foundation of adequate flexibility, core strength and movement efficiency.

After 20 years of studying human movement, I can say very few of us have the natural foundation to run efficiently.

In the modern age, due to pain, injury, stress and too much time sitting and driving, we are losing touch with our bodies and what it means to have a good physical foundation. Movement compensations and imbalances have become the norm.

The thing is, in the short term you can still get by with a less than ideal foundation.

You will be able to run because your amazing body works out a way to get the job done. The problem is, the compensations have a limited time span before they burn out and pack it in. Then you are really stuffed - you're in pain and you can't keep running anymore.

Now you have 2 choices:

(1) Accept that "running is not good for you" and avoid it the rest of your life; or

(2) Learn about how your body works and set a plan to achieve your goals.

The good news is that you can learn to fine tune your body to prepare it for running. You need to be smart and listen to your body - and have patience and dedication. You can overcome your weaknesses and actually turn them into strengths.

The idea behind The Resilient Runner Workshop is to teach you the strategies and skills you need to safely build your capacity, BEFORE injuries and niggles set your training back.

Full disclosure:

This process does take an investment in time and energy. You may not see improvement straight away. But with discipline and dedication, all a sudden you start seeing results that may surprise you.

The hardest part is getting to base-camp.

It can be a steep learning curve.

But once you've got there, you have a rock solid foundation, that nobody take away from you and will set you up for a lifetime of pain-free and enjoyable running.

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Are you interested in attending The Resilient Runner Workshop...

Currently we have 3 spots left in Fullarton (next Saturday 9th Feb) and 5 spots left for the Murray Bridge (March 9th).

Hope to see you there & if you have any questions please let me know :-)

Dan

Quick Tip To Ease Shin Pain

In a recent study, runners with a slower step rate (i.e. lower cadence) were found to be more likely to experience shin injuries than runners with a higher cadence.

The researchers studied 68 high school cross-country runners through the season, monitoring their cadence as well as their injury rates.

They found the runners with the lowest step rate (≤164 steps per minute) were more likely to experience a shin injury compared with runners with the highest step rate (≥174 steps per minute).

Running with a higher cadence may help reduce the peak load of force going through the leg.

Combined with a sensible training plan and good recovery strategies, making this small shift in your running style may well pay dividends and help keep shin pain away.

If you’ve been getting shin pain, next time you run, try increasing your cadence to 175-180 steps per minute and see how you respond during your run and the 24 hours following.

Most GPS watches track your cadence, but you may need to fiddle around with your settings so you can view it in real time.

Another option is to download a free metronome app on your phone and try and match your step to the beat.

Other quick tips for shin pain would be: buying a new and supportive pair of shoes, work on your glutes/core strength and having dry needling done to your calf and tibialis posterior muscles that re-set the tension.

If you would like some more personalised support for your shin pain and you wish to get relief right away, use our simple online booking system to make an appointment.  If you would prefer to speak to us directly,  call us 1300 657 813


Reference:

Influence of Step Rate on Shin Injury and Anterior Knee Pain in High School Runners.

Luedke LE, Heiderscheit BC, Williams DS, Rauh MJ.