Tuesday, 15 April 2008

Is there a doctor in the House?

I've just finished watching series 1 of House on DVD. I'm a fan. One of House's stand-out traits is that he believes that patients lie: "I don't ask why patients lie, I just assume they all do". If they'd actually let me into medical school and if I'd qualified I fear that I may have turned out as curious as House and as irritable when faced with mundane complaints; but at least I'm a bit more of a people person. Still, where House believes his patients lie, I believe that patients don't listen to advice, especially when you have something to say that they don't want to hear.

I'm no exercise scientist; in hindsight I took the wrong fork down the road of medically-related biological studies. Nonetheless, I benefited from a healthy dose of cell biology, genetics, physiology, neurology, histology and anatomy. Still, none of these have anything on common sense, which no primary, secondary or tertiary education can teach.

There was the woman (about the same age as me) who I bumped into at the gym a few weeks ago. She runs for my old running club and has been battling with a stress fracture (anterior tibia) since November last year. She'd been in pain for FIVE MONTHS. Cause: too much running, too little rest - a lovely, common over-use sports injury. Symptoms: pain when running which diminishes after two days of inactivity but flares up just as bad as ever within 5-minutes of running. Her treatment: rest two days, try running again, be in agony, rest two days, try running again, be in agony...

I suggested that she rest, lie on the couch and watch loads of DVDs for a few weeks. I then offered sound rehabilitation advice that included walk/run sessions on grass and a steady build-up. Wikipedia has a fantastic paragraph about treatment for stress fractures:

"Rest is the only way to completely heal a stress fracture. The average time of complete rest from the activity that caused the stress fracture is three weeks. A fracture requires 4 to 8 weeks of recuperation, however, which may include no more than light use of the injured body part, as long as the activity does not cause pain. After the recuperative period, another 2 weeks of mild activity without any pain may be recommended before the bone may be safely considered healed and activity may gradually increase."

You don't need a MBBCh to understand this.

Aside from "Really?" she also said, "No, I couldn't do that". Although I hadn't yet watched House - I would have maybe learned some more articulate responses - I said, "Then don't and keep running in pain. Your choice."

A friend of mine ran a fantastic marathon this weekend. He went running today and "had a shocking run this morning". I replied, "I'm not surprised you had a bad run this morning. Give it a rest for a few days!" He probably won't. (I hope you're reading this friend)

Tonight I was chatting to a gym friend while we were on the Technogym Cardio Wave machine (love it!). We were discussing the fantastic Ironman results achieved this past Sunday (neither of us did Ironman).

"How long should you take a break after something like Ironman?" she asked.

"A week and a bit of doing nothing can only do good," I replied. "It's like saying 'Thank you Body. Enjoy the break 'cos I'll be needing your services again once you're rested'."

"Nothing at all?" she asked.

"Take the dog for a walk every day, do a yoga class... no running, no cycling, no exerting yourself."

A few years ago after a 60-odd hour adventure I took two or three days of rest and was feeling great. No sore muscles and my feet were in perfect condition. I felt like some exercise so I went to the gym, got on the treadmill, ran for 2-minutes, turned off the treadmill and went home. My body felt dog tired. When you're walking around at work and home you can feel fantastic but when you up the intensity that's when your body starts to talk to you. Open your ears and listen.

I returned a week later and was back on form. After long races I now always take a week off whether I feel fatigued or not.

Why do we seem to think we're missing the boat if we're not back in the saddle 24-48 hours later?

Continuing my discussion with Michelle at the gym I revealed my "Extended Rest Theory": "It's not just the race. It's the weeks of training before the race too. A week or more of rest and a slow build-up again is saying thank you for all of that too."

Her eyes lit up. "We forget about all of the pre-race training stuff, don't we?" she commented.

"Ja," I answered. "And it isn't just about the training, the race, the rest and the present. There's a big picture - the rest of your life. You should want to be in good condition for all those years to come and hammering your body with no thank you rests is ignoring the big picture."

Our 20-minutes were up and we went our separate ways.

How many people do you know with recurring injuries or little niggles that just don't seem to ever go away completely? We can probably count at least two, or three, or four - that is if you're not including yourself...

In 2001 I met a 67 year old German man at a 7-day staged ultra. Seven years later he is still running ultras around the World and even holds several Guinness Book records for his age group achievements. I also know an amazing 64-year old woman will beat me at a 15km road race (or even a half marathon) if I don't move it.

This is the big picture... it is my big picture. These people are my role models and I want to be just like them (or better!) when I'm in my 60's and 70's.

When you're next in the mall look at how many middle-age people hobble around. There could be various reasons: old injuries too serious for complete rehabilitation; injuries that could have been competely rehabilitated through disciplined correction and (my favourite); lack of exercise and body neglect. Since the latter are not related to exercise I'll conveniently ignore them. But disciplined correction... rest is a part of disciplined correction.

Bringing this back to House... most athletes don't lie about their injuries (I don't think they do?) and they do expect to be right-as-rain a day or two after completing a substantial physical challenge. And they expect to chase a niggle away with a run. Substitute a half-dozen training sessions for a box set of House; a week invested now will return a decade of weeks later.


Anonymous said...

Your advice came at the right time. Sent it to a fellow IM finisher who said he was feeling great and would continue training....well, I am glad to say that he took your advice. At least he will not learn the hard way :)

adventurelisa said...

Yippee! I'm very glad to hear this and lovely to get positive feedback ;) Lisa