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The Role of the Physical Therapist in Running and Cycling Injury Prevention: A Conversation with DHMC's Kirsten Gleeson, PT

Reconsider the role of the physical therapy

If you are like most people, you think of physical therapy (PT) as the end of the process. After a car accident or after surgery, your doctor or surgeon sends you for grueling sessions to restore function. This aspect of PT is invaluable. But we find that physical therapy is under-used in early stages of injury and certainly as a means to prevent injury.

The physical therapy department at DHMC stresses prevention. It may be possible to see a physical therapist if you suspect injury or are starting a running or cycling program and would like to create a customized strengthening and stretching program tailored to your body type, your age, and your activity level.

If you live in the area and are a patient here, talk to your insurance company to find out whether this type of consultation is covered, and if not, what it might cost. Wherever you live and obtain healthcare services, talk to your doctor and consider this option for yourself.

Another factor is that it is often easier to treat injury in its earlier stages. For example, a runner experiencing Achilles tendinitis should address the inflammation (swelling) and overuse of the tendon, in its early stages. After two months of experiencing symptoms but not altering your activities to allow your body to recover, chronic tissue change may occur. Called tendinosis, this stage of the injury is significantly more difficult to address. If the tendon ruptures, then surgery may be necessary. Read what DHMC's Dr. Hecht has to say about common runners' injuries.

Athlete to athlete

Gleeson knows what she's talking about. A longtime athlete, she was a cross-country skier for 20 years and competed at the national level. She was a competitive trail runner and bike racer at the national level as well. Her current role – mother to a toddler and a young baby – has changed some of her habits, but she remains committed to exercise. Now, she jokes, "my greatest workout now is towing around a two and a half-year-old and a six month old on skis." Yet she has resumed the four-mile lunchtime run that she has been running for seven years on the DHMC campus trails.

She practices but, as a physical therapist, avoids preaching. Having coached skiers and suffered injury herself, she knows just how important it is to create a recovery or prevention program that is adequate to each individual. She describes it as an art as well as a science. Years of athletic involvement and clinical training have enabled her, along with the rest of the physical therapy team, to formulate an appropriate individualized exercise prescription for the people who come into their clinic.

Safe cycling: a good fit and seat height

Gleeson encourages people with new bikes who are not sure about the proper bike fit and seat height to bring their bikes in during their appointment. The bike shops can do a great job but sometimes further examination and adjustment can prevent or treat injuries of the knees, hips, back and neck due to bike position. For example, Gleeson notices that most people err on the side of setting the seat too low. Even 5 mm in seat height can be the difference between safe riding and knee or nerve pain.

What are some signs your seat height is too high or too low?

  • Hips are swaying: too high
  • You must reach with your toes to touch the pedals: too high
  • Your toes flex up when you pedal: too low
  • Able to comfortably maintain a straight leg but not locked knee with foot parallel to ground at the bottom of the pedal "circle": correct height

Safe running: what or how to stretch?

When you come into the physical therapy clinic, Gleeson evaluates a great deal of information before setting a program tailored to you. She considers:

  • How you walk (your gait biomechanics)
  • Past and current fitness levels according to strength, flexibility and aerobic capacity
  • Age and weight
  • Your intentions or goals, including: level of intensity or speed, type of terrain and surface, how often you will run, how long since you last exercised, are you eyeing a marathon or 5-K run or just a few weekend miles at an easy pace
  • Previous history of injury and current health concerns

This is why, when asked what or how to stretch for running, she hesitates. She explains the concerns of individual anatomy – body type – that make a "cookbook" or generic assortment of stretches inappropriate and occasionally, harmful.

For example, a high percentage of runners may have tight iliotibial (IT) bands, the wide band of tissue – fascia – that runs from upper thigh to knee. Symptoms of IT band syndrome include pain and burning at the sides of the knee or up the thigh. But diagnosis can be difficult and often involves eliminating other diagnoses. So not only should you determine whether stretching your IT band is good for you, but getting instruction in technique that best suits your body type is important.

Starting "slowly"

Another reason to consider a visit to the physical therapist before injury is to determine just what starting slowly means for you. Every time you read or hear someone discuss a safe exercise program, starting gradually is at the top of the list. A similar question you should ask is how can I return to running or cycling after an injury?

This can be more complicated than it sounds. Each person has his or her own best rate and this can change over a person's lifetime, too. So not only is one person's "slow start" different than yours, your current safe level of exercise can also be very different from what you were able to achieve in the past, even the recent past if you are still recovering from injury.

For information about physical therapy services and injury prevention at DHMC, call Rehabilitation Medicine at (603) 650-5978. Visit the American Physical Therapy Association for injury prevention information.

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