How early diagnosis can save your running
17 October 2016
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Brad Brown: Welcome back to yet another edition of Old Mutual Live, it’s awesome to have you with us. You would have heard a podcast just a few days ago that I caught up with Ryno Griesel about a long term injury that he’s been struggling with for the most part of this year. He spoke a little bit about the mental struggles and some of the challenges he’s faced and some of the lessons he’s learnt, having dealt with this injury that’s plagued him for a long time.
One thing he told me about was the medical team that he’s put his trust into and worked together with and it is a team effort. We’re joined now by one of the members of that team, Ryno joins us again as well. Carel Viljoen, welcome onto Old Mutual Live. Ryno Griesel, welcome back.
Carel Viljoen: Hi Brad, thanks for having us.
Ryno Griesel: Good morning Brad.
BB: Carel let me touch on you here first. In our chat with Ryno he mentioned getting a proper diagnosis on the podcast that he heard Dr Jon Patricios talking exactly about that. From a medical side of things, you’re a physio, how important is that, that you’re not going to Dr Google. Trying to figure out what it is that you’ve got and trying to self-treat. How vital is it going to see someone who really knows what they’re talking about.
A real doctor over Dr Google
CV: Definitely Brad. We often get guys that have been running with their niggle for two or three months and then for me to try and sort that injury out takes a little bit longer. If I pick that injury up within the first week, I could have adjusted a programme, did the right treatment and that injury could have healed a lot faster. That’s why it’s quite important, rather ask someone that knows.
If you work from a diagnosis, you know exactly what you’re working with. Where on Google you wonder and you judge it yourself. So rather make the effort and see someone. If it’s nothing big, then you go on and if it’s a bit bigger then we adjust it and get it fixed quicker. Waiting with it, it just tends to end up badly.
BB: You made an important point there too, is don’t wait. If you’ve got an issue, get it sorted out sooner rather than later. Because if you can pick it up quickly and sort it out quickly, the rehab process tends to be a lot shorter than if you leave it for a long time and have to fix it later.
CV: Definitely, so if I use Ryno as an example. You run with a tendinopathy for eight years, it’s quite a challenge to sort it out. If I pick that tendinopathy up within the first 3-4 weeks, then it was a different process. It’s so important that with any running injury, if you have a niggle, it’s probably something that’s sitting underneath and you need to check it out. Because if you pick it up early, then you can progress a lot faster in the rehabilitation.
I just want to say that it doesn’t always mean, you shouldn’t be scared of the medical team. Sometimes guys are scared to go to a physio because they’re scared it’s going to end their running or whatever. It’s not always the case, our aim is to keep you in running as far as we can. But just adjust the factors around to keep you running.
Making the bold step to get the right diagnosis
BB: I think that’s a great point. Ryno, let me bring you in here, the decision to really take this thing seriously and get a good medical prognosis and a medical team put in place. How did you come to that and you ended up seeing Dr Jon Patricios, you took Carel with you as well. What brought that decision about and how did you come about choosing who your medical team was going to be?
RG: Brad, I think it was a bit of divine intervention there because my head is so strong that obviously I didn’t really see the injury as serious as it was. With the Addo 100 Miler the end of February, into the race, at about 100km I had to take a sleep. Because I literally couldn’t bear the pain anymore. I had a really tough race.
I took a proper sleep at 100km, woke up and then still finished the race. Which in hindsight wasn’t the best thing. Then after that I just realised that there is no other options, I can’t ignore this anymore. What I’ve learnt subsequently is that before you get to that point, rather seek help.
BB: Choosing to go and see Dr Jon Patricios and taking Carel with you, what was the thought process there? Obviously Jon is a phenomenal sports physician, he does some great work, his track record speaks for itself. I’ve been treated by him as well and I’m a huge fan of the work that he does. Going to see Jon and then deciding on putting a team together, how did that come about?
RG: I went to see Carel at the My Health Sports and Orthopedic Centre and he did a clinical diagnosis, just from his experience. Carel used to work with the Cheetah’s rugby team, amongst other sports professions. He kind of, when I chatted to him about, interestingly, when I came to see Carel, it was mostly about a stiff neck I had. It wasn’t even about the injury. I was still a little bit in denial.
Then we got chatting about my leg injury and he basically immediately said, this is what I expect it is, but let’s get a proper diagnosis. Let’s go and see Dr Jon. Carel has worked extensively with Dr Jon in the past and they’ve got a very good relationship.
So actually Carel accompanied me to Dr Patricios practice in Johannesburg and then there we did the ultrasound, we diagnosed it. From there, between Carel and Dr Patricios, Patricios then acted as the case manager. He was in charge of the injury and then between him and Carel, they designed a plan. Carel monitored from there going onwards.
Taking a diagnosis and planning treatment
BB: Carel, let’s talk about that plan, particularly in Ryno’s case, the stages and the steps that you’ve taken. You’ve made the diagnosis, you know what is, what do you do from there? How do you treat this thing?
CV: Brad, obviously each injury has its own patterns to sort out. But definitely for tendinopathy, you first have to calm the condition down. Because this thing is so flared up that even with stair climbing he had pain. The first phase is obviously to calm the thing down, let the symptoms settle.
From there on you start building muscle endurance a bit more. Ryno had good endurance because he kept on running. So you have to build endurance from the beginning. Then you have to go to a strength phase. Ryno never did any strength training on the side. So there’s all the factors just went backwards.
You have to go into a strength phase from there. Then you go to a phase with a bit of biometrics and agility. Even with running long endurance, you still need to be nimble, over rocks etc. So that’s still a big factor of it. Then the last, final phase will be going for a return to play.
Ryno’s at the place where he can run a 30km at the moment, but I’m not just releasing him and saying: Go crazy. Because he needs to go and do 100 miles. So you have to gradually get there and you have to keep on a strength training programme to prevent all this stuff from happening again.
There’s very set phases and there’s set stuff we do. If we tell you, listen, don’t run, there’s a reason for this and this, so there’s good reasons. We don’t just guess around. I think that’s the main thing the runner needs to understand.
How condition helps keep a runner moving
BB: Carel, you mentioned that you don’t want it to happen again. In an ideal world we don’t want it to happen in the first place. Where there any things that Ryno could have done? I know it’s been coming on a long time, but were there things he could have done that he wasn’t doing prior to him getting this injury, that he could have done to prevent it?
CV: Yes, Brad. I think one of the main factors is when you do that type of distance that Ryno does, you have to condition your body as well. You can’t just keep on hammering the miles, you have to do some strength training with that.
Let’s say for instance, specifically in his case, your gluteal muscles need to fire quite good. They need to be strong to assist the hamstrings. If you just keep on running and running, at the end stuff fatigues and there’s muscle imbalance and you end up with overuse injuries.
It’s important to get onto a strength programme, even if you run Comrades. You can’t just keep on doing the miles, you have to do some strength training. That’s one of the biggest parts of prevention. But obviously every single injury has a different set of exercises.
So it depends on what injury, but it comes down to, you can’t just run, you have to do some training, strength training specifically in between as well. I don’t mean CrossFit or just cross training, it must be specific stuff for your sport.
BB: Carel, it’s interesting you say that because it’s also, we’re talking long stuff here, obviously Ryno does really long, 100 Milers, you mentioned Comrades. But it’s also important, even if you’re running a 10km or 21km or a 42km, those are fine. But those also require some strength work and additional work on the side. Is there a programme you could do? You talk about being sport specific. As a running, what are the sort of things that every runner should be doing?
Tips on what runners should be working on
CV: Brad, that’s the most difficult part, because every single person is an individual. Obviously with an evaluation you check and see what that person needs and we’ll address it. But obviously the common stuff is like gluteal strength and core strength, that’s obviously if you want to jump in and do something, start with that. But we can’t just generalise it to every single person.
Some people will come with good caution or it can be external factors as well. It can be that the shoes are the problem or just that the miles went up too quickly. You have to look at every single person holistically and design it according to that. But it comes down to core and glutes, is one of the most important. But they’re not the only things, there’s more stuff to do.
BB: I think that’s a very important part, we are all an experiment of one. Our imbalances are different in each athlete, so it’s important to get something that’s particularly tailor-made for you. Carel, I didn’t ask Ryno this question because I wanted to ask you. Because I think he might give me a different answer. What’s the prognosis, when is he going to be up and running and racing the way he was prior to this injury?
CV: You see Brad, at about the three-month stage, we talked about five months. Five months doesn’t mean for five months resting and not doing anything. Into the next phase, we started with a running protocol already. So I could have released Ryno and said to him, listen, at the three-month mark go and race. But the chances of this thing flaring up again is massive. You don’t want to do three-months rehabilitation and then just lose it again from there.
We have goals and we’re aiming towards maybe the end of the year, maybe for a longer marathon type of distance. Maybe from February on, maybe 100km and above again. Just with these type of distances, you just have to monitor things very well, you can’t just go out. But his case, we’re looking at, for his normal racing distance, maybe from February one.
BB: Ryno, what’s it like to be running pain-free?
RG: Brad, it’s awesome, in a nutshell, I actually ran with a niggle for so long that I forgot how great it is to run for the fun of it. It’s a phenomenal feeling.
BB: I love that. Gentleman, thanks for your time. Carel, if people want to find out more about you and what you’re up to from a physio perspective, where can they get more details?
BB: You can send it to me, we’ll pop it into the show notes. So we’ll put the links as well to the centre as well. Thank you very much for your time, much appreciated. Ryno, best of luck on the bounce back, I know it’s frustrating, been there, done that and best of luck. It’s testing your patience I’m sure, but it sounds like you’re well on the mend and you’re in good hands with Carel, thanks for your time.
RG: Awesome, thanks so much Brad, really appreciate it.