Congratulations and special shout out to everyone who participated in the Baltimore Running Festival! It is marathon season and you have just completed 26.2 miles! It is a lifetime achievement to be proud of and something that not many people can dream of accomplishing. The amount of preparation, hard work, and determination it takes to complete a marathon has paid off.
But now what? More than likely you never trained for the whole 26.2 miles, but rather only about 20 miles for your longest run and then relied on adrenaline and determination to get you to the finish line. By that 20 mile marker you could start to feel it deep in your muscles and joints. Asymmetries are bound to form as one calf tightens, you start to cramp in a hamstring, or your IT band becomes irritated as you push your body to its limits to reach the finish line. The soreness is from over-stressed muscles, which have caused micro tears within the muscle. Don't worry, this is a normal occurrence and your body will work to rebuild and become stronger. It does not change the fact that you may be sore.
Initially a hot/cold alternating shower to improve circulation, then refueling your body with proper fluids and protein should be taken into consideration. Starting the second day, a combination of rest with non-stressful movements to promote blood flow to sore muscles will be important to decrease tension. Try an easy walk, swim, stretching routine, or easy yin style yoga. You hope these areas of tension go away on their own with rest, but they often hang around feeling restrictions even with daily activities. After the initial rest period when you begin back training these muscle imbalances can hinder your body from performing at its peak ability and can lead to more serious injury.
It is advised that you follow up with a knowledgable physical therapist who can work these imbalances out through deep tissue work or even myofascial decompression. They will also teach you strengthening exercises to improve your running form by targeting the specific areas of weakness that lack the necessary endurance for such a long distance. If treated early you will often only need 2-3 sessions to get back to your baseline, plus you will have greater knowledge to maintain your body in the future. This is all at a relatively low cost considering registration fees, running shoes, hotel room, and your desire to continue your lifestyle in a worry free manner.
Pioneer PT has the ability to come directly to you via a mobile clinic and provide one-on-one care with a doctor of physical therapy for a full hour. Service is direct care meaning you will not need to waste crucial time going to your doctor or a specialist for a prescription. Pioneer PT is your musculoskeletal expert and direct point of access for heath related needs.
Ice or heat? R.I.C.E or M.E.A.T?
One of the most common questions asked by clients is what to use for their injury, ice or heat? Both have their place, both are beneficial for pain relief, but one may be better than the other. Ice constricts your vessels helping to limit swelling, and heat increases circulation helping the healing process by bringing beneficial nutrients and flushing out the waste. Both heat and ice also assist in reducing pain because they give our bodies another sensation to contend with. When ice or heat are applied, our larger sensory pathways kick in and help to overshadow the smaller pain pathways; therefore dulling the effects of pain.
Traditionally ice is used 20 minutes on, 20 minutes off for the first 2-3 days after an injury. This is where RICE comes into play. RICE stands for Rest, Ice, Compression, and Elevation. RICE along with NSAIDs or non-steroidal anti-inflammatory drugs such as Advil are often utilized. However, please consult with your doctor before taking over-the-counter medication, because NSAIDs have been shown to limit long-term bone and tendon healing. Swelling is at its peak at this point and it should be reduced, or should it? Reducing swelling will reduce pain short-term, but our bodies produce this for a reason. Swelling acts as a natural "splint" causing us to protect the painful area and promote healing when it is most crucial.
Now, the next step depends on the extent of injury and you should consult with your doctor or physical therapist before beginning. Here, MEAT, another method of dealing with injury comes into play. Timing can range from the day of with a minor muscle injury to 1-2 months for severe ligament or bone damage. MEAT stands for Movement, Exercise, Analgesics, and Treatment. I am a huge fan of early mobilization as long as there is no fracture or surgery requiring a lengthened rest period. Nothing crazy, but movement targeting gentle range of motion should be initiated early on after injury. Heat applied for 10 minutes prior to motion can promote circulation and allow greater ease of motion. Exercise should begin next, starting to strengthen the muscles surrounding the injury site. The easiest type of exercise is an isometric where you tighten a muscle without moving, like when power lifters pose by tightening their muscles or some of you may know Charles Atlas. Concentric exercises, followed by eccentric, and finally progressing to full body functional movements with the goal to return to activity. A is for Analgesic, which means dulling the pain like Tylenol or Acetaminophen. Tylenol helps to dull the pain without limiting circulation like NSAIDS. Pain relief promotes improved movement, but Tylenol too can have side effects. Those with liver problems may want to stick to ice and heat if pain is tolerable. Again with medication please consult with your physician or pharmacist if you are unsure. Finally, Treatment that involves mobilization and releases by a skilled practitioner such as a physical therapist, who is an expert in movement will help you return to full function and the activities you desire.
Unfortunately there is no straightforward answer, but I will try to clarify. I prefer a combination, as pieces of both RICE and MEAT have their benefits. Swelling acts like a natural "splint" for a reason during the initial healing process. At a micro level our bodies need this crucial rest period to heal. However, do not wait too long because humans are the best at compensating and will often find other ways to function, which is not always the best. Ice can and should be used early on for the first 2-3 days after injury then a combination of heat and ice can be used to promote circulation during the rehab process.
1.) Improved mobility : You will have greater flexibility and freedom to move as you like through targeted mobilizations and stretches that are catered specifically to you and your problem.
2.). Strength gains: You will have improved strength and control during simple and complex functional tasks by addressing the correct muscle groups.
3.) Decreased Pain and discomfort: With an increase in range of motion and strength, you will have less inflammation of tissues and decreased pain. This decreases the need for long term pain medication use and it's potential side effects.
4.) Have tools to manage symptoms: Physical therapy is unlike chiropractic work or massage therapy, because we encourage active participation in wellness through education. Education of posture, a specific home exercise program catered to you, and information on how to best deal with your condition.
5.) Do what you love to do without restriction: Improving flexibility and strength, as well as decreasing pain and providing intentional education allows for you to return to activities that you love with decreased discomfort and fear.
The vision statement for the American Physical therapy Association is "Transforming society by optimizing movement to improve the human experience." That is my role and my wish to share with society. We are only here for so long, so why not enjoy the treasures that life can offer?
What does a physical therapist (PT) do? I wanted to address this, because I am not sure enough people know exactly what PTs can do to help. Our job is to reduce a client's pain and improve or restore full mobility through hands-on techniques, individualized exercise programs, and education to prevent or manage their condition. We work on everything from head to toe that is musculoskeletal in origin. Some of the most common problems include rotator cuff issues, and neck or back pain. Both acute, or chronic issues can both benefit from a proper treatment plan. Treatment often allows clients to avoid costly surgery or the need for prolonged use and side effects from pain medication. We promote life-long health benefits by promoting fitness or wellness oriented programs that allow you to be more active.
How do we do all of this? First off, we are highly-educated and licensed health care professionals. I went to Ithaca College for both undergraduate and graduate degrees, graduating with a Doctorate of physical therapy. Graduating from an accredited university is a prerequisite prior to sitting for an intensive state licensure exam that you must pass in order to practice. Then, one of the most important parts, we evaluate each client as an individual, gathering a history of their health and current symptoms. Evaluations typically start out similar to an interview delving into what is going on, how long it has been going on, what makes symptoms better or worse, etc.. We will then proceed to a systems review, palpate tissues and joints, screen strength, range of motion, and functional mobility. If problems are apparent, special tests can be performed, which allow a physical therapist to be able to confirm a diagnosis. For example tenderness to lateral or outer joint line of the knee alone has been shown to be very accurate in diagnosing meniscal injuries. Between the history and evaluation we are able to have a really good idea of the diagnosis without the need for MRI. After the area of dysfunction is determined then our education on tissues and their healing processes as well as medical conditions sets us apart in prescribing a specific and appropriate plan of care for each individual. Goals are set for each client's needs and desires so we can get them back to doing what they want. To stay on top of our game, it is required that physical therapists take continuing education classes every year, not only to maintain our license but to stay most current with new techniques and research.
Until now, physical therapists typically work in the hospital, nursing home, rehabilitation settings, in schools with children, outpatient clinics and with home health agencies. Pioneer PT introduces a new delivery of treatment via a mobile "outpatient" clinic that makes treatment easier and more private for the client, all while giving the best one-on-one care possible. No longer will you have to have the extra hassle to find a ride when you are unable to drive or take the extra time out of your day to travel to an outpatient setting. Pioneer PT travels to you whether your home, office, or wherever we deem fit. You also won't be crammed into an outpatient setting where you spend very little time with the actual physical therapist before being passed off to a technician who solely trained on the job. Clients will receive a full hour of one-on-one care with a doctor of physical therapy. Pioneer PT will fill the gaps where traditional delivery of care is lacking.
Hope to see some of you soon, so we can restore your movement and fuel your passions!
James Dulkerian, DPT
Active outdoorsman with an honest soul and a passion for health.