The Importance of Having a Health Care Team

Many of the athletes I coach are fairly new to running and triathlon so when things start to hurt and muscles start to get tight, they often ask me what I recommend.  Depending on what the issue is, my answer varies.  Over the years, I have assembled a team of people that I trust with my athletic health.   There are so many different types of therapies out there it's hard to know where to start so I'm going to break it down for you.

I'm going to classify things in terms of injury prevention and injury rehabilitation, mostly according to how I've ended up at each practitioner.  There is definitely overlap with all of these therapists as many of them can help in the healing of an injury as well as the prevention of an injury.

INJURY PREVENTION

My go to for any sort of muscle (soft tissue) related aches, pains and tightness would be my RMT (Registered Massage Therapist).   If you're going to have ONE person in your health care arsenal, I'd recommend it be an RMT.

For other muscle and joint related issues, I go to a chiropractor.  Chiros get a bad rap a lot of the time which is unfortunate.  My chiropractor also does A.R.T (active release technique) and acupuncture so that is what I go and see him for 95% of the time.  On occasion I have some low back / S.I. joint issues so he will do the odd adjustment or joint mobilization work.

Another excellent practitioner to have on your health care team is an osteopath.  I like to think of osteopathy as a combination of massage and chiropractic treatment.  Osteopathy, according to Wikipedia is a "therapy that emphasizes massage and other physical manipulation of muscle and tissue and bones."  I've used osteopathy for low back and SI joint pain with a great deal of success.

INJURY REHABILITATION

Physiotherapists are the folks that 99.9% of injured athletes end up seeing.  A physiotherapist will help rehab your injury by having you work at building strength back up progressively and safely,  They will also help correct the imbalances or weaknesses that caused the injury in the first place.  That's why they have you do all those exercises.  That's why those exercises should ALWAYS be a part of your fitness / strength routine.  Your body will eventually revert back to the path of least resistance once you stop.

A good sports medicine doctor is also a very important person to have on your health care team.  If they're really good, they can get you slightly faster access to imaging.  Sometimes they offer alternative treatments like PRP injections, cortisone injections etc.   Unfortunately you usually have to wait anywhere from a couple of weeks to sometimes a couple of months to get an appointment, depending on the doctor.  A sports medicine doctor will also be able to refer you to a surgeon or other specialist if required.

An RMT for massage, a chiropractor for A.R.T and acupuncture and a physiotherapist for when everything goes to hell in a hand basket.

But where do you find these people?

Word of mouth.  Ask your coach, or other athletes who they would recommend.  I'm in the west end of the city so if I know my athlete is west end or willing to travel a bit, I'll always recommend someone on my healthcare team.

If you don't know any other athletes, do a google search and read reviews.  I feel it's important that you see someone at a sports medicine clinic as they are usually much more attuned to the needs of an athlete.  In an ideal world, your practitioner is an athlete as well.

I've seen a lot of therapists over the years.  Sometimes it can take a while to build a network of people that you trust with your health.  Right now I think I have a pretty solid team of people that help keep me healthy.   These are the folks that help keep me healthy.

David Lamy, RMT at Synergy Sports Medicine
Peter Lejkowski, Chiropractor / ART / Acupuncture at Pivot Sports Medicine
Lauren Roberts at The Running Physio

Other folks that I'd also recommend:

Kris Sheppard, Chiropractor at The Runners Academy 
Mark Casmiri, RMT at Pivot Sports Medicine
Miranda Tomenson, RMT at Swansea Massage Clinic
Xsenia D'Abramo, Physiotherapist & NKT practitioner at Annex RMT

Having a group of therapists that know you, your sport and your body is so important to staying healthy and to addressing and treating injuries when they come up.

Do you have a group of people that you trust?  

~ Coach PK

Changing My Gait - A Visual Progression

 I've been talking about changing my gait and the work that I've been doing at the Runner's Academy for the last little bit but I've never actually gotten down to the nitty gritty.  Firstly, what IS the Runner's Academy?

This is their mission statement and vision:  The Runner’s Academy is a health and wellness studio offering Chiropractic, Massage Therapy, Personal Training and Run Technique Coaching. The Runner’s Academy is targeting the running community of all skill levels and ages, by bringing education, treatment and performance training to this specific clientele. We will teach you how to Move better and Run faster!

They offer gait analysis, massage therapy, personal training, acupuncture, Chriopractic therapy AND they even have an Alter G treadmill!  It's a Runner's Nirvana.  I have the lovely Sasha Gollish to thank for recommending this place to me.  Specifically one of the founders, Dr. Kris Sheppard.   Herein referred to as the Running Wizard.

I had been getting frustrated with my lack of progress in terms of my knees.  I had gotten my glutes and hamstrings firing but I was still having problems.  I was working on adjusting my gait but I couldn't seem to put it all together.  Enter the Running Wizard.

My first visit was an evaluation.  I was ill prepared for it as it was a last minute appointment.  I at least had some shorts but I was wearing a sweater and borrowed running shoes (Sketchers Go Runs, which were AWESOME btw).   I got up on the treadmill and started running.   Kris took some video.  Here's a screen grab of that first run.

screen grab from Runner's Academy Ubersense Video

It doesn't look *that* bad, right?

He gave me some things to work on - specifically high knee drills, really focusing on picking my legs up and upping my cadence.  The goal was to create more of an oval shape with the movement of my legs vs. a tear drop shape and I had to stop over striding.  That was putting more load on my knees than was necessary.  The goal was to have my foot land as close to under my body as possible.

I came prepared for my next appointment.  He immediately had me get up on the treadmill and start running.  This is what I looked like.  Worse than the week before.  Maybe I should have put the Sketchers back on, ha ha.  Kris had me to a bunch of drills involving jumping over hurdles and running with high knees and then he put me back on the treadmill.

screen grab from Runner's Academy Ubersense Video

This is what I looked like after.

screen grab from Runner's Academy Ubersense Video

My foot is landing a bit more under my body, and my leg isn't trailing out the back in the swing phase of my gait.  It's moving in a tighter circle as you can see by the lack of space between my legs.  I'm getting good push off with my leg and my knees are driving forward.   The first few times I started running like this I felt like I was hopping.  It was very bouncy.  But as I've progressed, I feel like there is less bounce and more forward motion.  It still feels a bit odd to me but it's only been a few weeks.  I know I'm definitely using my glutes and hamstrings because they have become perpetually tight.  I can also feel the power I get from them when I'm pushing off.  It feels so much different than the way I used to run. 

You can really see the difference in the videos so I'm going to see if I can get them from Kris.  

My knees no longer hurt when I run so that is a plus.  However, there are all sorts of other small muscles that I guess I wasn't really using before that I certainly feel now.   I usually gauge my effort by heart rate but when you change your gait, especially your cadence, any sort of heart rate based training goes out the window.  You're moving differently than what you're used to, therefore your muscles are using more oxygen, which in turn taxes your aerobic system.  Until your body gets used to these new movement patterns, your heart rate will remain elevated.  I know I'm making progress because with each run my average heart rate seems to be dropping. 

I'm still doing my physio exercises and Kris has given me a few more things to do involving various sized rubber bands.   The big one is used as a resistance band for my high knee drills and my VMO strengthening exercises.  The small one is used to help fire my gluteus medius (also known as your side bum!)

Tomorrow I'm headed back to have my first session with Justin, who is a personal trainer that also works with some of the U of T track team.  He's going to add to my list of things I can do in the gym.  I desperately need some help in this area.   I've been working my upper body and core but neglecting my legs, other than doing the things prescribed by my physio.  So my legs have started to get "soft".  They also feel like they've lost some strength so I'm hoping he can help me get it back.  Stay tuned for an update on that!

I'm looking forward to the day when all of this is history.  I'm keeping my fingers crossed that day comes soon.