Functional Physical Therapy for Runners

I have been through so many different treatments over the years for various injuries and ongoing aches and pains it’s hard to keep track. All treatment modalities have their usefulness. I have found many to be palliative (temporary or immediate pain relief) but lacking the lasting “cure” effect.

Over the past few years my own running has been on hiatus due to ongoing, lingering, nagging, pain-in-the-ass slow going improvements followed by more breakdowns. I am a born skeptic (ok, not born but more likely grown). Though I will try almost anything I do not go in thinking “this is the cure” or “this is the secret” to being healthy, strong, well, etc. I am also an avid reader of research. Therefore, if the science doesn’t support it (i.e. 99% of all supplements) I have a very difficult time climbing on the band wagon to every new thing that comes along (i.e. barefoot running, Bikram yoga) being posed as the new panacea to healthy running. That being said, it does not mean I wouldn’t try any of those things – in fact I have. It does mean that the effects have to be proven to me. the anecdotal “wow, this made me who I am today” crap that is stated so often, simply doesn’t wash for me. The bottom line is that I am not easily influenced by what is called the Placebo Effect.

Great introduction huh? Well, what I wanted to introduce is something I have been introduced to over the past months. My physical therapist (Nicole Armbrust – Spooner Physical Therapy) is in a fellowship program that emphasizes functional physical therapy. Now, PT has always been in some ways functional. But the past approaches are almost always focused on the part that is hurt (Achilles tendon), and isolated exercises (1-legged squat, stretches).

But that is where the programs through the Gray Institute for Functional Performance in Michigan differ.  The approach is a systems approach. The assessments are systems approach.

After a complete assessment which is actually ongoing Nicole was able to isolate two major themes contributing to my Achilles issues. My feet had lost flexibility in the forefoot and calcaneal articulations and lower ankle as well as rigidity up in my thoracic spine. As a result:

  • She is using a top-down and a bottom-up approach in my therapy.
  • I am NOT doing Achilles tendon specific work (or at least VERY sparingly)!
  • She is integrating full range of motion exercises as well as balance exercises (some traditional and some not so).
  • She reevaluates systematically each visit the effects of the previous workouts and then does some truly interesting creative use of combinations of exercises to get desired results the next time.
  • She has different and progressive exercises every visit. I do NOT do the same lame exercises day after day and week after week.

We have been working together for the past 3-4 weeks and I ran on the Alter-G treadmill last Friday (2 miles -14:45 @ 81% body weight) without symptoms for the first time in years. Over the past years as I have attempted running, I have always had some lingering “something” down there. I don’t right now.

So, through looking at my medical issues through a different lens – a systems and holistic lens we find the chain reaction of issues which contribute to my tendonitis. When various parts of the chain do not function as a fluid unit, something has to pick up the stress. That stress translates into over using some muscles and tendons (some very small) aggravating them to the point of pain and injury. And the weakest link is the link that will break.

My weakest link is my Achilles (contrary to what some people in my life will say – that it is my brain). My Achilles tendon problems (tendinosis, tendinitis, surgeries, scar tissue…) are indeed my Achilles Heel.

My advice – find a physical therapist who has completed the Gray Institute for Functional Transformation. Better yet – go see Nicole @ Spooner Physical Therapy if you are in the Phoenix area. Nicole even has a magic wand – just ask. I think she may have used it on me for my attitude adjustment – but not for a Placebo effect.

I’m still on the comeback trail and there is light at the end of the tunnel.


About Dean Hebert

I’m a mental game coach, author and speaker. I work with individual athletes, parents, coaches, and teams on sports performance enhancement. Beyond my academic post-graduate work in sports psychology - the psychology behind athlete performance – I am a certified Mental Games Coaching Professional (MGCP) and certified hypnotherapist. I’ve authored several books and hundreds of articles. “Coach, I didn’t run because…” (2008) is a seriously light-hearted look at making excuses not to workout and how to overcome them. “Focus for Fitness” (2009) and “Screw the Goals Give me the Donut” (2010) are two of my eBooks on mental game approaches for the everyday athlete. I wrote these because I believe that everyone can benefit from the powerful mental techniques that the world’s best athletes use. I have been cited in Runners World, Best Health magazine (CN), SWEAT Magazine, and the Washington Examiner amongst many other publications. I have been a featured mental games coach in Runner’s World and for the internationally acclaimed trail running resource - I also regularly appear on sports and fitness talk shows such as LTKFitness, Runnersroundtable and for more than three years I have co-hosted a weekly video series with Coach Joe English for I specialize in mental toughness training. My clients include tennis, synchronized swimming, golf, race-kart, soccer, motocross, volleyball, MMA, cycling (road, off-road, time-trialist), running, duathlon and triathlon, basketball, football and baseball athletes. I have coached world-class athletes and athletes internationally. I have a passion for working with youth athletes and helping them apply mental game skills and techniques to all areas of life. Most importantly, my aim is to have people enjoy sports and life to their fullest through peak performances.
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8 Responses to Functional Physical Therapy for Runners

  1. david Gunn says:

    Without knowing it, I think I have always been a skeptic when it came to PT. It was too specific to be of any long term use. You have provided a scientific basis for my skepticism. Great information!

  2. Aric Keith says:

    I think PT is always more art than science- there are so many complex interactions within the body that it’s near impossible to isolate ‘what works.’ I, too, am therefore skeptical of most PT treatments and have not had much luck with them in the past. I’ll be interested to see how the method you recommend develops over the next few years. I’m glad it’s working for you so far!

  3. ivy says:

    This is a huge endorsement — looked up Gray Institute — very interesting! Thank for blogging about this — I’m feeling hopeful that this could be the right fit for me!

  4. Sierra says:

    Thanks for your devotion to helping other runners. My goal is to run a 5k five times per week at a comfortable pace (5.6 mph) just to stay in shape. I’m 30 years young and am female. I have new onset Achilles tendonitis and posterior tibial tendonitis, just as I thought I was mainly rehabbed with PT from Sartorius muscle irritation from poor running form a year ago. My old PT had me doing a lot of stretches because he said my Sartorius and entire quad was very tight. I did all these lower ab strength training exercises he prescribed a few times per week and slowly increased my distance (10% weekly). I was a former heel striker but unintentionally began overpronating after misreading an article on proper running gait; i believe several months of that caused my Achilles last month, which started to get better after correcting my foot strike, icing, heel raises, stretching plus rest. I just got this posterior tibial tendonitis last week as soon as I started my run and decided to push through, against better judgment now. Since I’m still having Sartorius problems after six months and a completed PT regimen, I’d like to see Nicole at Spooner but I’m not sure which location she’s at. On their website, there is a Nicole Armbrust at the Ahwatukee location, is that her? It’s pretty far for me. Do you think I’m safe choosing any of the locations?

  5. Loraine says:

    Hi Coach Dean, we’ve chatted before about achilles stuff – you recommended pool jogging. Well, I’m about 2 years in to dealing with chronic achilles tendinosis (or rather about 1 year of actual treatment). I’ve tried PT, ART, ASTYM, PRP, eccentric stretches, strengthening and probably other stuff I’m forgetting. Still no difference – in fact I think I had quite a setback after the PRP as everything just seized up and became very stiff. I have a small vertical tear and I’m at a loss as to why this is not improving. I can’t even seem to find docs that agree on which way to go with this, having heard everything from ‘you should be completely immobilized in a cast for 6 weeks’ to ‘you need to do maximum loading eccentric stretching’. I’ve had 2 consults with surgeons who think surgery will not help. I’m currently trying an overnight split (not the sock – more of a semi-boot) as my latest ortho thinks this will be my secret weapon!

    I wish I knew how to move forward but I am so stuck. I think the overnight splint is reducing the morning stiffness somewhat but I am living with this little lumpiness at the back of my heel. I’ve gone from being an enthusiastic runner to someone who can’t walk 3 miles without pain and can’t even go up on my tip toes without pain either. Any advice?! I feel like nothing I’ve done has really moved me forward. I’ve been pool jogging and recently switched to stationary bike.

    • Dean Hebert says:

      It sure looks like you’ve done everything under the sun to get this thing under control. Surgery is of course invasive so it should be a last resort… but the fact that you have conflicting advice is troublesome to me. Seems like a tear if not healing would warrant surgical intervention. I don’t personally feel immobilization for 6 weeks will do it.. BUT that of course is more conservative and in the light of conflicting advice… I’d go conservative… you’ll lose nothing.

      What’s a few weeks at this point? BTW the lumpiness may never go away.. what you should focus on is how it feels when you work out. If you could run again… lumpy or not… it would be great right?

      Your splint is a good approach. I wish I had a magic bullet for you.

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