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Welcome back to the Rehab for Runners podcast.
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I'm your host, Dr.
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Lisa, and today we're talking about the mental side of returning to run after an injury.
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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.
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You have that fear of the pain coming back.
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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.
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It's going to affect how you're recovering, and it's going to affect how your brain perceives pain.
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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?
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And that's what they keep thinking.
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They hyperfocus on it.
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Maybe even like after the run, too, depending on your pain pattern of when the pain comes on.
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But I hear all the time, I'm almost just like waiting for the pain to come.
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And then any small little like tweak that you feel feels like this impending feeling of doom, like, oh my gosh.
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And then your anxiety raises because you're feeling something.
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Your brain is perceiving something as an attack.
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It's perceiving something as like red flags, like this is not good.
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And the fear is really your nervous system's your nervous system's alarm system.
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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.
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And that's really like your nervous system, your nerves.
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So the second you feel anything, that alarm system is just like going off.
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I think about my ring alarm.
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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.
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It's going off through your body, it's going off in your brain.
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And I think one of the big problems is your brain is going to heal a little bit slower
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than your body.
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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.
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And that is like the that is facts.
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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.
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Your brain's job is to keep you safe.
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That's the role of it.
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When we're running, especially after an injury, it's like, I know this movement, I've done this movement before.
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And last time I did this, you know, to this degree, to this distance, that's when I started to feel the pain.
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So your bot, your brain's doing its job.
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We just need to calm the alarm system down, and we need to basically reassure it hey, it's okay.
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Everything is okay right now.
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If I feel a tweak, then I'm going to adjust my running.
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And sometimes you really just need to like think through your head, what is the worst case scenario?
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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.
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And if this happens, then I'm gonna do this.
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Versus like if you feel any sort of pain, then it's like all hell breaks loose.
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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.
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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.
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I always say like four out of ten is like that um that line, that pain threshold line.
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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.
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And you can continue to run with a little bit of pain.
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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.
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You definitely couldn't run without pain.
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You know, like you're going to adjust very quickly in order to address the pain early on.
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And sometimes, again, like you need to reassure your brain that like you need to have a plan in place.
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If this happens, I'm going to do this.
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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.
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We're not testing your endurance.
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And that's when it can get a little tricky because as a runner, you want to feel like a run is a workout.
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You want to feel a little tired.
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You want to feel like you did something when you ran.
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You know, like that's kind of like the point.
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We run for mental and physical health.
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But when you're returning to run from an injury, you're testing the injury.
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You're testing how your body is responding to the load you are placing on it.
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So if you're running two miles and let's say that doesn't feel like much, that's okay.
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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.
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Okay, that did good.
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All right.
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The next run, I'm gonna repeat that two miles.
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And the next run, I'm gonna repeat that two miles, double check everything feels good, and then I'm going to increase it.
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Because I always say, like, you want to run about three of your runs, should be the same before you actually increase it.
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And when you increase the the distance from two miles, maybe now you're going to two and a half miles.
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You're not going to like five miles.
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You're not also using one run as of a two-mile run as like a test and then increasing.
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So one week you're running two miles, everything felt good.
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The next week you're running two and a half miles, everything felt good.
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The next week you're running three miles, everything felt good.
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Okay, maybe we add in some strides, or maybe we continue to increase your endurance.
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It's up to you there, but you get the idea where it's like I'm slowly increasing my mileage.
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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.
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So next round, I'm actually gonna do it at 2.25.
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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.
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I'm in control of my turn return to run intervals, or not even intervals, but just like return to run plan.
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That is where you're mentally going to build a lot more confidence because you're in control.
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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.
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This is what we're gonna attempt to do.
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And then if it doesn't go well, I'm gonna do this.
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And if it does go well, I'm gonna do this.
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Having a plan can really relieve a lot of anxiety, a lot of just like, is this gonna hurt?
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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.
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So have a plan that's extremely conservative.
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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.
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So let's let's back it up a notch because this is again, you're testing the injury, not your endurance.
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And with that, you are also rehabbing.
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You are continuing to rehab.
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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.
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Or like when a PT office discharges a runner because they can start to run, and it's like, whoa, whoa, whoa, whoa, whoa.
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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.
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So you want to continue to rehab while you're running.
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The rehab should be addressing your areas of weakness, just like you did before you were running.
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The rehab has to continue addressing your areas of weakness.
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This can be a mental weakness, this can be a physical weakness.
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Usually it goes hand in hand.
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So let's say single leg hops feel really scary.
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They feel so scary.
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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.
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You're gonna add a little bit of like
a touch of modification.
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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.
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Now your nervous system alarm is going down.
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It's not as sensitive because you are training your brain and what you're telling yourself, you are reassuring, hey, everything felt okay.
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We're good.
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Even if you had a little bit of tweak, that's okay.
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I understand why.
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I am going to adjust it like this.
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This is my plan, you know, all of these things.
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It's not just like, hey, let's go run and hope for the best and la-da.
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Because that doesn't go well.
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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.
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First of all, maybe adjust how much you're running.
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Maybe you can run, let's say uh, let's say two miles straight.
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Maybe you can run two miles straight, but you have so you're so nervous about that stretch from 1.5 miles to two.
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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.
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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.
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Then I would run for time.
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I'd run for 20 minutes, I'd run for 17 minutes, like whatever it is.
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And do not look at your watch to that will tell you the distance.
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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.
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So hopefully that makes sense.
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The whole idea is to decrease your anxiety.
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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.
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Like, this is where distraction can really come into play.
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I am big on distraction.
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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.
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Distraction is gonna make that run go by a lot faster.
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And it's the same idea.
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Like, if you're hyper focused on like, oh my gosh, please, left ankle, don't hurt, don't hurt, don't hurt, please.
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Oh no, okay, okay.
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And it's just like you're hyper-focusing on it.
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Listen to something where you can take your brain off of that.
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Make a sometimes it's not listening to something.
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Sometimes you need to like make a list in your head of everything you need at the grocery store.
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Make a list in your head of everything you need to do this weekend, whatever it is.
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Just you understand the idea where it's like, let's distract ourselves.
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Because again, you have to train yourself that everything's okay.
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But sometimes with training yourself, you do have to get out of your own head too.
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So hopefully that makes sense.
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The big summary is hey, when we're returning to run, we are training our brain.
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We are trying to decrease our alarm system.
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You're continuing to rehab while you're running.
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Maybe you have to run for time, not distance.
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Maybe you have to run for distance, not time.
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Whatever flip it is, do it so that you are not, you know, totally hyper focusing on this pain.
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Have a plan.
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That's the biggest thing.
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Always have a plan.
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Plan is gonna always get you to your goals faster.
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Um, and hopefully that makes sense.
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I uh I feel like with my one-on-one clients too, like I talk about the mental aspect all the time.
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Like, what were you feeling?
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What were you telling yourself?
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And if even if you're not working one-on-one with PT, you can totally, totally journal this out.
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Like it's like really listen to what you are telling yourself.
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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.
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Like, what if you just cut out the noise and just like sat with your thoughts?
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Which he was like not pleased about.
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But you get the idea where it's like, what are you truly telling yourself when there's no noise?
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What are the things that you're telling yourself?
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Is that holding you back?
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So just something to think about.
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All right.
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I hope you have a great run.
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Enjoy the fall weather, and I'll talk to you soon.
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Bye.