Physical Therapy: The Mental Component

I have been in physical therapy for my injuries for about six months now.

We finally finished rehabbing a few weeks ago, and now we are focused on prevention.  What my therapist calls performance-based therapy has consisted of strength and explosive exercises.  The exercises are sport specific, and he observes my running pattern, as well.

I can’t help but admire how far I have come.  As I have said in the past, recovery doesn’t mean getting back to where I was before; it means getting to someplace very different.

Before my injury, I ran a marathon.  While I likely cannot head out the door to run a marathon today, I am a far better athlete than I was on the day that I first called myself a marathoner.

I am stronger.  My form is better.  I understand my body better.  And I am light years faster than I was before.

Physical therapy has been a journey.  It hasn’t been about results all along.  Sometimes it took weeks to feel like any progress was being made; but as I look back now I see how much I have changed.

The changes were not merely physical.  There were things that I needed to work on in my own head in order to fully benefit from physical therapy.

Allowing Myself to Complain

I don’t like to complain.  I consider myself to be a “good sport” and  I can “hang in there” with the best of them.

As a runner, you know that you are going to have some aches and pains.  You accept that.  It is just the way it is.

When I started at physical therapy and my therapist would ask me “How are you today?” I would say, “I’m fine thanks.  How are you?”  And that’s all fine and polite and everything, but it sure as hell isn’t going to get you the right treatment.

In order to get proper treatment for my injuries, I had to learn how to complain.

Being able to verbalize and volunteer what hurts, how it hurts, what makes it hurt worse, what stops it from hurting, how often it hurts, are the things that helped my therapist help me.

It was essential to my recovery.

Even now, it still feels weird to walk in and answer “How are you?” with “My butt hurts.”  But you know, you gotta do what you gotta do.

Letting Someone See Me Sweat

The exercises that we do now are hard!  And an outpatient rehab facility isn’t a gym with high a/c.  It gets warm in there and I leave my appointments soaked on most days.

I have to sweat in front of people.  And be okay with it.

Vanity is out the window.

But clearly, this isn’t just about actual sweat.

My therapist has seen me at my absolute worst:  in pain, feeling helpless and hopeless, wondering if I would ever get better, struggling through exercises, whimpering through body work (yes, there was whimpering…but only twice!).

There was no way for me to hide any of these things from him. They were written on my face.

I can be tough all of the time.  But I can’t be too tough in PT.

You should always work with a therapist that you trust, because in order for it to work there has to be a true transparency.

You have to be willing to let go of all of your crap and just let someone help you.

Calculating the Errors of My Past

This has been perhaps the hardest part of my journey.

I have put off dwelling on the errors of my ways and the things that got me to physical therapy in the first place.  Yet, as I have made my way back on to the roads and trails and I am beginning to think about my future endeavors as a runner, I have to focus on where I went wrong in prior training cycles.

Some things I couldn’t have learned on my own.  By being observed in physical therapy, my therapist has been able to point out how precisely my form suffers once fatigue sets in.  He has educated me about which muscles I end up compensating with and how that hurts me in the long run.  We are working on strengthening those muscles and also pushing the point at which my body begins to fatigue so that I can rely less on those compensatory movements that lead to injury and flare up.

That is huge.

But the rest comes from within.

A few weeks ago, I took a look at my Garmin statistics from the last few weeks of marathon training and my first few runs back, before my injuries set in.  I don’t know what I expected to see, but I noticed that my runs in those last few weeks were significantly slower than the ones from early marathon training.  As I thought about it, I remembered being anxious before heading out to run a race-pace run  or other speed work.  I was beginning to have concerns about my paces falling off, but it didn’t alert me to anything at the time.  It should have, and it does now.  I was over-training and it had a negative impact on my running overall.

There were other signs of over-training, such as how I managed to come down with a nasty cold each time I completed a 20 miler.  This type of thing had even happened to me in the past, in my early twenties and teens when I spiked my mileage or trained for a hard race.  I never thought much about it before, but I do now.  Over-training weakened my immune system and I got sick.

When I began training for the New York City Marathon, I chose a training plan that had only three key runs per week.  Just three runs, so how could I possibly over-train?  Right?  But they were three key runs.  A different training plan may have had me running four times per week, but only two of the runs would have been hard runs.  That type of plan would have given me more mileage, thus putting “more hay in the barn” and pushing my boundaries of fatigue, which would have strengthened me for race day.  It also would have been easier on my body because I would have only been pushing hard two times each week instead of three.  That means that I would have had more energy for my two hard runs and could have gotten more out of those workouts.

There are a few other things that I did that I would absolutely do differently the next time I train for a marathon.  For starters, I used to let myself take breaks during my long runs.  Not just bathroom breaks, but legit breaks of up to a half hour.  Clearly, I had no intention of doing that during the actual marathon, so I shouldn’t have done it during long runs either.  I should have done a better job of simulating race day conditions.  By failing to do that, my body was inadequately prepared to run 26.2 non-stop miles on race day.

I didn’t take a long enough break after the marathon.  I felt great and I wanted to head back out there so badly.  I love late-autumn running and I was on such a high from finishing my first marathon.  I thought, plenty of people run a couple of marathons per month — why should I have to take weeks to recover before starting to run again?  Well, those guys are more experienced than I was.  This was my first marathon and my body was worn and beaten down by the time I crossed that finish line.  It wasn’t just about the 26.2.  It was about the four months of hard training that came before it, too.  My body wasn’t used to that and I needed rest.  The slowing paces were a sign of that and it is a warning that I would absolutely heed if I saw it happen again.

If you are like me and you know that you crave a run, it is critically important to have another sport that you can do safely when you need to take time off from running.  I didn’t have one before, but as I have been recovering from this injury, I have been spending a great deal of time in the pool.  I love it, and I know that the next time that I need to take a significant break from running, I can focus on swimming for a while.  That will give me peace of my mind and a phenomenal physical outlet.  Just knowing that I have swimming makes me less afraid of those times when I will need to take a break from running, such as when recovering from a hard race.

One more thing that I did wrong was that I did not race during marathon training.  Races are a great opportunity to check in with yourself.  The marathon training cycle is a long one and having a few smaller races as a component of your preparation helps you focus on speed work and see where you are as a runner.  Are those shorter distances getting easier?  Were you able to run close to your 5k PR?  If you answer questions like those in the negative, you likely need to revisit your marathon training plan and make a few adjustments.

We all make mistakes in training.  We all get injured.  The best way to improve as a runner — scratch that, the best way to improve at anything — is to constantly revisit and assess.  Keep records of your training, figure out what works and what doesn’t.  Create a journal that will enable you to see when and how things began to fall apart.  That is how you can repair and change and grow.  Experience is everything.  It is the foundation for knowledge.

Learn your body.  Learn how to train it.  And I promise you will become a better athlete than you ever imagined.

Getting better means ending up someplace very different than where you began.

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