UDSKRIFT 🔗
WEBVTT
00:00:00.000 --> 00:00:02.240
Welcome back to the Rehab for Runners podcast.
00:00:02.319 --> 00:00:03.040
I'm your host, Dr.
00:00:03.200 --> 00:00:09.439
Lisa, and today we're talking about the mental side of returning to run after an injury.
00:00:09.679 --> 00:00:30.160
Now, the last episode was more about rehabbing an injury, and this is more specifically about that transition, whether you're trying to increase your endurance and you've been running with rehab or you are coming back, you have you haven't run in a couple weeks or even a couple months, and you have that fear of getting reinjured again.
00:00:30.239 --> 00:00:32.320
You have that fear of the pain coming back.
00:00:32.560 --> 00:00:46.000
I hear this all the time, and I think this is why I'm bringing to light like the more mental side of rehabbing an injury because I do think what you tell your brain, what you're feeding your brain, is going to affect your body.
00:00:46.079 --> 00:00:51.840
It's going to affect how you're recovering, and it's going to affect how your brain perceives pain.
00:00:52.079 --> 00:01:04.079
I think a lot of the time when a runner is coming back into running, they have, you know, with every single run and maybe even every stride, it's like, when is this pain going to come back?
00:01:04.239 --> 00:01:05.680
And that's what they keep thinking.
00:01:05.760 --> 00:01:07.599
They hyperfocus on it.
00:01:07.920 --> 00:01:13.359
Maybe even like after the run, too, depending on your pain pattern of when the pain comes on.
00:01:13.680 --> 00:01:18.079
But I hear all the time, I'm almost just like waiting for the pain to come.
00:01:18.159 --> 00:01:25.200
And then any small little like tweak that you feel feels like this impending feeling of doom, like, oh my gosh.
00:01:25.359 --> 00:01:29.280
And then your anxiety raises because you're feeling something.
00:01:29.439 --> 00:01:32.480
Your brain is perceiving something as an attack.
00:01:32.640 --> 00:01:36.719
It's perceiving something as like red flags, like this is not good.
00:01:36.959 --> 00:01:43.120
And the fear is really your nervous system's your nervous system's alarm system.
00:01:44.640 --> 00:01:56.319
So when you're having some sort of pain, and even like your brain is used to that pain, even though you're feeling a little bit better, the alarm is very sensitive in your body.
00:01:56.400 --> 00:01:58.799
And that's really like your nervous system, your nerves.
00:01:58.959 --> 00:02:04.319
So the second you feel anything, that alarm system is just like going off.
00:02:04.480 --> 00:02:06.959
I think about my ring alarm.
00:02:07.040 --> 00:02:14.960
I always arm it at night, and it's like that alarm is like if someone even like cracks the door open, that alarm is going off.
00:02:15.120 --> 00:02:18.319
It's going off through your body, it's going off in your brain.
00:02:18.560 --> 00:02:27.680
And I think one of the big problems is your brain is going to heal a little bit slower
Load full transcript
than your body.
00:02:27.840 --> 00:02:35.520
So even if we just face what's in front of you and it's like, okay, right now, you know, you can run two miles pain-free.
00:02:36.159 --> 00:02:38.639
And that is like the that is facts.
00:02:38.719 --> 00:02:49.439
That is everything feels pretty darn good, like you're doing really well, but you still have that fear of the pain coming back because your body is gonna heal before your brain catches up to it.
00:02:49.599 --> 00:02:52.400
Your brain's job is to keep you safe.
00:02:52.719 --> 00:02:53.919
That's the role of it.
00:02:54.000 --> 00:03:00.080
When we're running, especially after an injury, it's like, I know this movement, I've done this movement before.
00:03:00.319 --> 00:03:07.360
And last time I did this, you know, to this degree, to this distance, that's when I started to feel the pain.
00:03:07.439 --> 00:03:09.599
So your bot, your brain's doing its job.
00:03:09.759 --> 00:03:17.120
We just need to calm the alarm system down, and we need to basically reassure it hey, it's okay.
00:03:17.439 --> 00:03:19.840
Everything is okay right now.
00:03:20.240 --> 00:03:24.800
If I feel a tweak, then I'm going to adjust my running.
00:03:24.879 --> 00:03:30.319
And sometimes you really just need to like think through your head, what is the worst case scenario?
00:03:30.479 --> 00:03:42.000
Which I know sounds dark, but sometimes when we think through the worst case scenario, it actually allows your body to realize, like, okay, that is not that bad.
00:03:42.080 --> 00:03:44.080
And if this happens, then I'm gonna do this.
00:03:44.319 --> 00:03:48.879
Versus like if you feel any sort of pain, then it's like all hell breaks loose.
00:03:49.039 --> 00:03:59.039
Like you're anxious, you're sad, you're frustrated, like it's just like I can't run for two weeks, you know, like it's just kind of like jumping off the deep end here.
00:03:59.280 --> 00:04:06.560
But really, if you feel any sort of tweak when you're running, if you still feel any sort of pain, it's actually okay to keep going.
00:04:06.719 --> 00:04:11.759
I always say like four out of ten is like that um that line, that pain threshold line.
00:04:11.840 --> 00:04:20.160
Like if your pain is like just it's coming up, it's a little discomfort, it might be a little frustrating, but that's okay.
00:04:20.800 --> 00:04:26.399
And you can continue to run with a little bit of pain.
00:04:27.519 --> 00:04:48.879
And even if the pain increases, what you're going to do is tweak your running plan immediately, restart some previous rehab exercises immediately so you don't get back to maybe that like dark place where your pain was really high and you really couldn't walk without pain.
00:04:48.959 --> 00:04:50.639
You definitely couldn't run without pain.
00:04:50.800 --> 00:04:58.160
You know, like you're going to adjust very quickly in order to address the pain early on.
00:04:58.319 --> 00:05:03.839
And sometimes, again, like you need to reassure your brain that like you need to have a plan in place.
00:05:04.000 --> 00:05:06.720
If this happens, I'm going to do this.
00:05:07.040 --> 00:05:20.879
This is also where really conservatively building your running is important because I see it as, you know, when you're returning to run from an injury, we are testing the injury.
00:05:21.040 --> 00:05:22.800
We're not testing your endurance.
00:05:22.959 --> 00:05:28.959
And that's when it can get a little tricky because as a runner, you want to feel like a run is a workout.
00:05:29.120 --> 00:05:30.639
You want to feel a little tired.
00:05:30.720 --> 00:05:33.040
You want to feel like you did something when you ran.
00:05:33.199 --> 00:05:35.199
You know, like that's kind of like the point.
00:05:35.360 --> 00:05:37.519
We run for mental and physical health.
00:05:37.759 --> 00:05:42.800
But when you're returning to run from an injury, you're testing the injury.
00:05:42.879 --> 00:05:47.439
You're testing how your body is responding to the load you are placing on it.
00:05:47.680 --> 00:05:53.360
So if you're running two miles and let's say that doesn't feel like much, that's okay.
00:05:53.519 --> 00:06:00.720
You're seeing, okay, how is my, let's say, ankle responding to two miles during the run, right after the run, and the next day.
00:06:00.879 --> 00:06:01.920
Okay, that did good.
00:06:02.079 --> 00:06:02.399
All right.
00:06:02.480 --> 00:06:04.639
The next run, I'm gonna repeat that two miles.
00:06:04.720 --> 00:06:11.600
And the next run, I'm gonna repeat that two miles, double check everything feels good, and then I'm going to increase it.
00:06:11.680 --> 00:06:18.800
Because I always say, like, you want to run about three of your runs, should be the same before you actually increase it.
00:06:18.959 --> 00:06:24.399
And when you increase the the distance from two miles, maybe now you're going to two and a half miles.
00:06:24.480 --> 00:06:26.240
You're not going to like five miles.
00:06:26.399 --> 00:06:31.600
You're not also using one run as of a two-mile run as like a test and then increasing.
00:06:31.920 --> 00:06:35.040
So one week you're running two miles, everything felt good.
00:06:35.199 --> 00:06:38.639
The next week you're running two and a half miles, everything felt good.
00:06:38.800 --> 00:06:41.279
The next week you're running three miles, everything felt good.
00:06:41.439 --> 00:06:47.439
Okay, maybe we add in some strides, or maybe we continue to increase your endurance.
00:06:47.759 --> 00:06:54.480
It's up to you there, but you get the idea where it's like I'm slowly increasing my mileage.
00:06:54.800 --> 00:07:09.279
So if something comes up and I say I make the jump from two miles, which felt good, to two and a half miles that didn't feel great, then it's like, okay, at the 2.3 mile mark, I started to feel something and it didn't feel great.
00:07:09.439 --> 00:07:12.399
So next round, I'm actually gonna do it at 2.25.
00:07:12.560 -->
00:07:21.279
I'm gonna run two and a fourth of a mile because I now know like I'm I'm in control of my rehab.
00:07:21.439 --> 00:07:27.439
I'm in control of my turn return to run intervals, or not even intervals, but just like return to run plan.
00:07:27.839 --> 00:07:34.639
That is where you're mentally going to build a lot more confidence because you're in control.
00:07:35.040 --> 00:07:47.040
Having a plan automatically makes, you know, even if the plan is like mediocre, let's say, it's still gonna allow your brain to be like, okay, this is what I'm gonna do.
00:07:47.199 --> 00:07:49.040
This is what we're gonna attempt to do.
00:07:49.199 --> 00:07:51.600
And then if it doesn't go well, I'm gonna do this.
00:07:51.680 --> 00:07:53.839
And if it does go well, I'm gonna do this.
00:07:54.160 --> 00:08:01.199
Having a plan can really relieve a lot of anxiety, a lot of just like, is this gonna hurt?
00:08:01.360 --> 00:08:08.160
Oh, I'm so nervous for this run, and this run feels like a lot, then you've probably increased your mileage way too much.
00:08:08.319 --> 00:08:11.759
So have a plan that's extremely conservative.
00:08:12.000 --> 00:08:21.199
I cannot emphasize that enough because many runners will be like, oh, I tested my run, my pain with five miler, and then I that felt good, and then I did a seven miler.
00:08:21.680 --> 00:08:28.079
So let's let's back it up a notch because this is again, you're testing the injury, not your endurance.
00:08:28.319 --> 00:08:30.879
And with that, you are also rehabbing.
00:08:31.040 --> 00:08:32.799
You are continuing to rehab.
00:08:33.039 --> 00:08:45.279
I feel like it gets really annoying to hear as a PT that someone is like cleared to run and they're like, okay, well, I'm cleared, so like I can just run and I don't have to do my rehab anymore.
00:08:45.440 --> 00:08:53.200
Or like when a PT office discharges a runner because they can start to run, and it's like, whoa, whoa, whoa, whoa, whoa.
00:08:53.279 --> 00:09:00.159
This is this isn't we are not at, you know, the goal is to get back to running, but the goal is also to increase your running.
00:09:00.399 --> 00:09:04.159
So you want to continue to rehab while you're running.
00:09:04.399 --> 00:09:09.919
The rehab should be addressing your areas of weakness, just like you did before you were running.
00:09:10.080 --> 00:09:12.960
The rehab has to continue addressing your areas of weakness.
00:09:13.120 --> 00:09:15.840
This can be a mental weakness, this can be a physical weakness.
00:09:16.000 --> 00:09:17.279
Usually it goes hand in hand.
00:09:17.360 --> 00:09:20.639
So let's say single leg hops feel really scary.
00:09:20.799 --> 00:09:22.000
They feel so scary.
00:09:22.159 --> 00:09:32.399
Okay, we're gonna start doing a transition of like double leg to single leg, or you're gonna hold on to a bar, or you're gonna hold on to a resistance band while you're jumping.
00:09:32.480 --> 00:09:36.399
You're gonna add a little bit of like
a touch of modification.
00:09:36.639 --> 00:09:45.360
And then as you continue to do it rep after rep, day after day, your brain's like, oh, okay, this isn't as bad as I thought it was gonna be.
00:09:45.600 --> 00:09:49.679
Now your nervous system alarm is going down.
00:09:49.919 --> 00:09:59.360
It's not as sensitive because you are training your brain and what you're telling yourself, you are reassuring, hey, everything felt okay.
00:09:59.519 --> 00:10:00.159
We're good.
00:10:00.399 --> 00:10:03.200
Even if you had a little bit of tweak, that's okay.
00:10:03.360 --> 00:10:04.639
I understand why.
00:10:04.960 --> 00:10:07.200
I am going to adjust it like this.
00:10:07.360 --> 00:10:10.320
This is my plan, you know, all of these things.
00:10:10.480 --> 00:10:15.440
It's not just like, hey, let's go run and hope for the best and la-da.
00:10:16.879 --> 00:10:18.159
Because that doesn't go well.
00:10:18.320 --> 00:10:34.559
The other thing I want to add to is like when you are returning to run, if you have, and I tell my one-on-one clients this all the time, but if you really struggle with that anxiety of like, I feel like my pain is gonna come on, I feel like this is not going to end well.
00:10:34.799 --> 00:10:38.960
First of all, maybe adjust how much you're running.
00:10:39.200 --> 00:10:43.759
Maybe you can run, let's say uh, let's say two miles straight.
00:10:44.000 --> 00:10:52.000
Maybe you can run two miles straight, but you have so you're so nervous about that stretch from 1.5 miles to two.
00:10:52.799 --> 00:11:05.279
I would, even if you can run two miles, you're you're physically can run two miles without pain, I would slowly increase it like 1.6, 1.7, 1.8.
00:11:05.759 --> 00:11:22.399
Or this is where I talked about this in the last episode, but this is where run for time, not distance, because your brain is like stuck on that 1.5 mile mark or that 1.75 mile mark, whatever mile mark it is, where pain usually comes on.
00:11:22.960 --> 00:11:24.159
Then I would run for time.
00:11:24.240 --> 00:11:27.759
I'd run for 20 minutes, I'd run for 17 minutes, like whatever it is.
00:11:28.000 --> 00:11:31.440
And do not look at your watch to that will tell you the distance.
00:11:31.519 --> 00:11:48.000
So the whole idea is like we're kind of playing a little bit of tricks on your brain, but the tricks are to calm your nervous system down, and the tricks are to allow you to face what's in front of you and not have the fear of the future affect your running or affect your pain level.
00:11:48.159 --> 00:11:49.200
So hopefully that makes sense.
00:11:49.279 --> 00:11:51.200
The whole idea is to decrease your anxiety.
00:11:51.360 --> 00:12:03.519
The other thing that I recommend too is like if you have in your head, like, oh my gosh, I'm so nervous about the pain coming on at this mile mark, you could also listen to an audiobook, listen to a podcast.
00:12:03.600 --> 00:12:06.960
Like, this is where distraction can really come into play.
00:12:07.279 --> 00:12:09.120
I am big on distraction.
00:12:09.360 --> 00:12:17.120
I am really big on like, hey, like even if you're not injured, let's face it, like if you're running for endurance, distraction is key.
00:12:17.360 --> 00:12:20.720
Distraction is gonna make that run go by a lot faster.
00:12:20.960 --> 00:12:22.080
And it's the same idea.
00:12:22.159 --> 00:12:27.360
Like, if you're hyper focused on like, oh my gosh, please, left ankle, don't hurt, don't hurt, don't hurt, please.
00:12:27.440 --> 00:12:29.039
Oh no, okay, okay.
00:12:29.200 --> 00:12:31.840
And it's just like you're hyper-focusing on it.
00:12:32.080 --> 00:12:36.080
Listen to something where you can take your brain off of that.
00:12:36.320 --> 00:12:38.639
Make a sometimes it's not listening to something.
00:12:38.799 --> 00:12:42.720
Sometimes you need to like make a list in your head of everything you need at the grocery store.
00:12:42.879 --> 00:12:46.639
Make a list in your head of everything you need to do this weekend, whatever it is.
00:12:46.879 --> 00:12:50.000
Just you understand the idea where it's like, let's distract ourselves.
00:12:50.159 --> 00:12:54.960
Because again, you have to train yourself that everything's okay.
00:12:55.120 --> 00:12:58.799
But sometimes with training yourself, you do have to get out of your own head too.
00:12:58.960 --> 00:13:00.159
So hopefully that makes sense.
00:13:00.320 --> 00:13:05.519
The big summary is hey, when we're returning to run, we are training our brain.
00:13:05.679 --> 00:13:08.080
We are trying to decrease our alarm system.
00:13:08.240 --> 00:13:10.960
You're continuing to rehab while you're running.
00:13:11.120 --> 00:13:13.279
Maybe you have to run for time, not distance.
00:13:13.440 --> 00:13:15.039
Maybe you have to run for distance, not time.
00:13:15.200 --> 00:13:21.840
Whatever flip it is, do it so that you are not, you know, totally hyper focusing on this pain.
00:13:22.080 --> 00:13:22.879
Have a plan.
00:13:22.960 --> 00:13:24.080
That's the biggest thing.
00:13:24.320 --> 00:13:25.200
Always have a plan.
00:13:25.440 --> 00:13:28.320
Plan is gonna always get you to your goals faster.
00:13:28.559 --> 00:13:31.279
Um, and hopefully that makes sense.
00:13:31.600 --> 00:13:37.360
I uh I feel like with my one-on-one clients too, like I talk about the mental aspect all the time.
00:13:37.440 --> 00:13:38.399
Like, what were you feeling?
00:13:38.559 --> 00:13:39.919
What were you telling yourself?
00:13:40.240 --> 00:13:46.240
And if even if you're not working one-on-one with PT, you can totally, totally journal this out.
00:13:46.399 --> 00:13:51.039
Like it's like really listen to what you are telling yourself.
00:13:51.279 --> 00:14:00.159
Um I was just talking to my husband about this because I'm like, you always are listening to a podcast or like scrolling on your phone recently.
00:14:00.240 --> 00:14:05.840
Like, what if you just cut out the noise and just like sat with your thoughts?
00:14:06.480 --> 00:14:08.480
Which he was like not pleased about.
00:14:08.720 --> 00:14:14.159
But you get the idea where it's like, what are you truly telling yourself when there's no noise?
00:14:14.399 --> 00:14:16.159
What are the things that you're telling yourself?
00:14:16.320 --> 00:14:17.840
Is that holding you back?
00:14:18.159 --> 00:14:19.840
So just something to think about.
00:14:20.000 --> 00:14:20.320
All right.
00:14:20.399 --> 00:14:22.080
I hope you have a great run.
00:14:22.240 --> 00:14:24.240
Enjoy the fall weather, and I'll talk to you soon.
00:14:24.320 --> 00:14:24.720
Bye.