Photo Credit: By Otis Historical Archives Nat’l Museum of Health & Medicine (originally posted to Flickr as A44-341-7 therapy) [CC-BY-2.0], via Wikimedia Commons
One resource that many runners turn to when injured (or, even proactively if prone to injury) is a physical therapist. However, the quality of physical therapists as it pertains to their capability to help runners vary widely, so it’s helpful to know the warning signs that your therapist is not a fit for you.
Some therapists may be outstanding for getting people back a degree of mobility, or training certain types of athletes. This doesn’t guarantee their qualifications for working with a runner, or specifically for working with YOU! Here are some things to look for to help determine when it might be time to look elsewhere.
1. Catering to a clientele that doesn’t match your background or goals. I don’t mean to sound elitist here, but if the therapist’s main clients are those trying to rehab to get back to work or have some degree of mobility, this may not be a fit. You may get your first sense of this in the lobby – are the magazines more on the order of Running Times, or do they display Better Homes and Gardens or Car and Driver?
2. Taking too little time to learn about your background or goals. Yes, you are a runner, and maybe they figure that out. But every runner has different goals and needs, and your history is very important to understanding what may be driving your current issue. If he (I’ll stick to the male gender here out of simplicity) goes right into treatments without taking the time to chat for a bit, he’s likely to miss addressing your true needs.
3. Not investing time in finding the source of your current pain. Often the source of your current pain is one or a few “trigger points” – areas of tightness or scar tissue adhesion. Releasing these trigger points may be a necessary condition to feeling better. If the therapist just applies general area treatments in their massage or stretching approaches, your recovery may be delayed.
4. Focusing too much on short-term issues. There is often a longer-term issue that contributes to your injury (though not always – sometimes it’s just overtraining, for which you may not need a therapist anyway). If he doesn’t take the time to assess your history, mechanics, balance of strength, etc., then your therapist may well cure you temporarily only to get you back as a customer in a matter of months.
5. Focusing too much on long-term issues. While it’s great to identify ways to become more injury resistant, goal number one is getting back to training. If there’s not a clear enough plan on how he is going to do that, then you may be visiting for some time to come.
6. Not keeping up to date on running developments. There is a lot that is changing about shoe recommendations, perspectives on the importance of form, and other running-related techniques. While the therapist may not agree with these changes, he should at least be aware and able to have an intelligent discussion about such topics as minimalism. Professional development is important in most careers; physical therapy is no different.
7. Relying heavily on a single approach. A good therapist has a range of tools to draw from as needed, and frankly most runners need help in several areas (if at all). Flexibility and mobility, strength, balance, massage, and various treatments such as ultrasound should typically be part of the menu. If it feels like one area is emphasized over all others, and he can’t explain why, then it may be time to look elsewhere.
8. Not adjusting strategies in the light of new information. If a technique isn’t working, or if your pain is moving, the therapist should adjust their treatments accordingly. Obviously you don’t want to be doing something different each session and jump from one approach to the next, but some adjustments “at the margins” should happen over the course of your treatment.
9. Spending too much valuable session time on activities you could be doing at home. The therapist’s role should be to teach and monitor performance of specific exercises or stretches. If your session turns into nothing more than a “trip to the gym” that you could do on your own, where you are performing significant repetitive work, then you are wasting money and time.
10. The therapist himself is often injured. Many physical therapists are athletes themselves, and this is obviously desirable. However, if they get injured on a regular basis, you may fairly wonder about their own understanding and practice of running mechanics and injury prevention methods.
Physical therapy is a costly investment in terms of money (though obviously this may be reduced through insurance) and, more importantly time. Furthermore, additional lost time from running can hurt your short and even long term results, as can the development of the wrong habits. Don’t hesitate to make a change if more than a few of these warning signs are true for you and your therapist.
I’d be eager to hear other examples of issues you’ve had with physical therapy. Or, even better, please share any recommendations you have on finding the right therapist and making the relationship work for you.
I’ve also posted a case study of how physical therapy turned out wrong for one runner.