A couple weeks ago I interviewed running-injury specialist Bruce Wilk, PT, OCS. Many of you have met him on twitter, now you have the opportunity to know him better. He authored The Running Injury Recovery Program, owns a Running Specialty Shop in Miami, FL, and completed 27 Marathons & 4 Ironman Triathlons! Make sure you check out his fantastic blog – it’s full of valuable information related to running and running injuries. Read more about Bruce at PostInjuryRunning.com. There’s lots to learn from this interview, so read it twice! Enjoy!
What first drew you into Physical Therapy?
I began to run in 1971 as a way to get out of physical education, where I was the favorite target in dodge ball. So the teacher told me to run around the track instead. By 1972, I realized that running brought balance to my life, but it also brought running injuries that no one seemed to know how to fix.
Trying to fix my own running injuries is what led me to become a physical therapist. As it turned out, I did not actually learn anything about running injuries in physical therapy school, but I did learn a lot about injury management in general. PT school also taught me the value of good, competent manual therapy — and I still emphasize that to the young physical therapists I teach in my clinic today. Becoming a physical therapist was just the first step on my lifelong quest to understand running injury management.
How has your clinical practice evolved since your first days as a Physical Therapist?
At first, my practice was physician referral driven. I was worried that what I told the patient would have to agree with what the physician wanted me to tell the patient. It started out being profit-driven. But then, slowly it evolved into a patient-driven practice. People came to my clinic because they heard from their friends how wonderful their results were. And, that’s been a blessing. That’s what really inspires my work.
How have perspectives on running and running injuries changed since your early years as a runner?
My first running injury was as a kid running in my first minimalist shoes: Converse — and that made me think that a running injury has a simple external cause.
However, now that I have seen many hundreds of running injuries over the years, I know that treating running injuries is more like diabetic care: Some injuries are very simple and have external causes, but some of them are more complex and are caused by a combination of factors, both internal and external. Now when I treat a runner for an injury, I consider everything from psychology to running habits to training techniques — I try to treat the cause of the injury as well as the effects.
Minimalist shoes have been all the craze over the last few years. What are your thoughts on five-finger shoes and other minimalist footwear?
One of the interesting things about my life is that I get to see some things from the different viewpoints of a PT, a running coach, and a running store owner. For example, something odd happened a few years ago: As the owner of a running shop, shoe salesmen come to me every year to show me the new models of running shoes. One day, a sales rep showed me the Vibram Five Fingers (VVF) – which is a very flat, unsupportive shoe – and told me it was a minimalist running shoe. The funny thing was, that same sales rep had already introduced the VVF to me on a previous visit, when he had told me it was a water sandal! As a coach I know that some runners do well in a flat, unsupportive shoe, but many others do poorly. As a PT, I have seen patients with severe foot injuries from running in unsupportive footwear and not paying attention to red flag running injury symptoms. I also know it not safe to use an unsupportive shoe for many running injury tests and recovery interventions. I can see the different viewpoints of people who choose to run in minimalist shoes, but I don’t let my injured patients wear them to postinjury run. I do use them as racing flats and fashion footwear post recovery.
What prompted you to write your books? How can they be purchased? [Amazon, website, etc.]
I have been treating injured runners for more than 30 years and I found that, with many of my patients, I was able to successfully return them to healthy running after they had been to many other healthcare professionals, and they been put through many other treatments that had failed. That is the fault of the healthcare system, not the individual practitioners, because there are just no medical protocols that are designed to treat running injuries. The fact is that runners’ injuries are different from similar injuries in non runners and they have to be treated differently — so I developed very specific protocols to do that.
I used these methods in my clinic and published some papers, but I never organized them all together and wrote them down.
For years, people kept telling me — over and over again — “You should write a book” because there was so much confusion and misinformation out there in the world of sports injury management. I really believed that if I could educate runners about running injuries, then they could get the right treatment in a timely manner, or even treat their own running injuries.
Time is a critical factor in treating running injuries because if you keep training on a running injury it will get worse — and if you don’t train because of a running injury you can lose your conditioning and increase your risk of further injury. That is why I wrote this book to speak directly to runners instead of to healthcare professionals, because the runner is the one who has to take the initiative in a running injury. It is important that they know how to recognize a running injury and understand how to deal with it even before they see a healthcare professional, because they can get sidetracked and lost in the healthcare system. I wrote The Running Injury Recovery Program to help runners deal with that. Coaches and healthcare professionals can also use these books to help their runners, or they can sign up for my classes and get a certification in post injury running management.
My website is called postinjuryrunning.com, and it has a lot of great information about running injuries for runners, as well as information on the certification course for coaches and physical therapists. You can buy The Running Injury Recovery Program book and workbook from the website or on Amazon, and there is also a Kindle e-book version on Amazon.
What are the biggest misconceptions out there today regarding running and rehabilitating running injuries?
One misconception is that running injuries are simple to fix. The most common treatments for running injuries include dope, tricks, tips and avoidance.
Runners are given medicine for pain and inflammation which actually makes it more dangerous for them. Running with drugs in their system not only masks the pain of a running injury and allows it to get worse; some drugs can also trigger chemical changes in a runner’s body that can lead to serious medical complications such as a heart attack.
Healthcare professionals also use several techniques that just trick the runner. They use tape or stretchy bandages on the skin that trick runners into thinking they are getting protection against injury. They get massages or electric shocks that block pain and make the injury feel better but do nothing to promote healing. They can order redundant exercises that don’t address the injury or strengthen the body for running. These are all forms of placebo medicine that have nothing to do with the problem but give the runner a sense that something worthwhile is being done.
Some may offer the runner tips which are just general information and not necessarily the specific professional advice that runners really need and deserve. Healthcare professionals need to get to know their runner. They need to work with their individual habits, equipment and techniques. Otherwise it leads to avoidance and the feeling of failure.
Treatments should have clear goals with objective measurements and clearances that will take the runner through 4 management phases that are based on specific criteria, not a date on the calendar. Even physical therapists who have a good, phased injury management program may only take their runners through phases 1 and 2, which gets them over the acute injury, but does not strengthen the runner to return to running and reduce their risk of re-injury, which are phases 3 and 4 in my program.
Which authors/books have impacted you the most as a professional and an individual?
When I became a physical therapy student, non-fiction, self-help books, were on my personal priority list. Specifically, Be Here Now by Ram Dass — which is a simple, yet not-so-simple book of philosophy, and how to live life — helped me make the commitment to become a physical therapist.
Professionally, I was influenced by Treat Your Own Back by Robin McKenzie. I like this book because it is an open protocol which is simple enough for the ordinary person to follow, and technical enough for the professional. When I was writing, The Running Injury Recovery Program and the workbook that goes with it, I was influenced by this approach, so I tried to get as technical as I could for the professional, but easy enough so that the average runner could still understand it.
I enjoyed your blog post on “Running as Meditation“. Describe the psychology of a runner as s/he runs a marathon.
There really is a psychological condition that runners get while running, called the runner’s high, which is caused by very specific chemical changes in the brain. Even before a runner starts to run, he gets excited thinking about it and adrenaline is released. That’s part of the runner’s high, and it kicks in very early into running.
Then, as a runner starts to run, there’s lots of bouncing and shaking. The shaking of running causes a different kind of high than other types of exercise. It stimulates a neurotransmitter, cannabinoid, which is a naturally occurring chemical similar to marijuana. So, when runners are injured, and they have to bike or cross train, they’re often very unhappy that they can’t run because they are missing the runner’s high from the cannabinoid.
The third chemical effect is a kind of euphoria that runners get when they run for a long period of time, anywhere from one and a half hours for an experienced runner to 2 hours for a less trained runner. That’s when the pain-killing endorphins kick in, and they have a psychological effect that is similar to morphine.
The fourth effect is that running together with other people releases a social-bonding hormone called oxytocin. This is the hormone that bonds couples together, and it produces a similar effect with soldiers during combat that helps them protect and care for each other.
All these chemical changes mean that, when people run, first they get excited, then they get high, then they get stoned, and then they fall in love.
Which big ideas/concepts would help every Physical Therapist become better/smarter/wiser?
My big idea is: Every physical therapy session should be individualized as much as possible. In my profession there is too much emphasis on “cookie cutter” treatments, meaning that every patient who gets the same diagnosis usually gets the same treatment. The problem is, the same diagnosis can have different causes and different outcomes in different people. For example, plantar fasciitis is a diagnosis of pain in the bottom of the foot, but there are actually many different types of plantar fasciitis because people do different things with their feet. Some wear high heels, some run. The diagnosis of plantar fasciitis is completely different in a runner than it is in a person who walks, and I will treat them differently.
In my clinic, we don’t just treat the diagnosis, we treat the individual person. We customize treatments to each patient’s condition, their habits, and their preferences — which may change from day to day. If a patient comes into my clinic for treatment and is depressed, or angry, or tired that day, then I will adjust his treatment and exercises on that day to optimize the outcome. A good P.T. must know his patient — just like a good coach must know his athlete to get the most out of his training. In physical therapy, the best outcome results when the patient and the P.T. work together to create an individualized program.
You’ve just travelled back in time and are standing face-to-face with your 23 year old self. What advice would you give yourself?
It was 1980 and it was my senior year of physical therapy school. I was disappointed because I was hoping to learn about running injury management and how to keep people running healthy. It took years to reach that goal, but I finally made it.
My advice: Stay the course.
Balancing work & life can be a challenge; especially as a small business owner. How do you manage this?
As a physical therapist, and owner of a running store, and a running coach, I have to make work play.
I make time to play with the people I love.
What is the best birthday present you’ve ever given? And received?
The gift of love and companionship: My wife, Sherry, arranges trips and fun around my birthday, and gives us time to play together. (For her birthday I gave Sherry a hydroponic tower garden.)
Where would you like to see Physical Therapy in 5 years? How do we make your vision a reality?
I am hoping that in the future, more running injury patients will be treated with good physical therapy protocols instead of surgery. Too many physical therapy clinics are POPTS (which are physician owned). The problem is, a physical therapist who works for a physician cannot be objective or make an independent diagnosis. In POPTS, physical therapists must follow doctors’ orders and many patients go for surgery.
Clinics that are financially independent from doctors, like mine, allow for checks and balances. The non-surgical core treatments can work and even produce better long-term results. We’ve treated thousands of patients who were scheduled for surgery and, after 10 minutes to 6 weeks of competent therapy, have cancelled their surgery.
For me personally, the FUTURE is my NEW course, The Post Injury Running Coach/ Physical Therapy Certificate Program. All our information is at postinjuryrunning.com.
Life is an adventure. Tell us about one of your more memorable adventures.
It was 1999 and my focus in life was the inaugural Ironman at Lake Placid. A week before the race I was trained and ready — then my wife, Sherry, had a suspicious biopsy that turned out to be a malignant breast cancer, and my world changed. Sherry became my focus, and I helped her through a long recovery process. I kept on training, and I went to Lake Placid the next year. At that point, I was finally able to think only about the race, and not about the cancer.
Bruce, thanks for the incredible interview! My readers & I have learned lots from it. Let’s do this again sometime.
Find Bruce on twitter – @BruceWilk
And connect with me @CinemaAir