Navigating the maze of treatments with a sceptical eye.
I often get emails along the lines of: “What do you think of [X]? Will it [fix my injury/make me faster/allow me to live forever]?”
Some of these messages are easy to answer. If X = some new supplement, for example, my answer is generally no. There are a few supplements that seem to be helpful, but the vast majority have little or no real evidence behind them.
But many of the questions are trickier. They might be about some patented form of manual therapy or massage, a particular type of stretching or strengthening, foam rolling, various forms of compression, heat or cold, shoe inserts, running form cues, and so on. As with supplements, there’s generally no solid evidence to go on – but in these cases, my answer is a little more nuanced, and it depends on the precise question.
If the question is: “Do you think this technique really does what its proponents claim?”, my best guess is usually no.
But if the question is: “Do you think this will help me?”, then my answer sometimes shifts to maybe.
The reason, though this may sound a little nihilistic, is that I think our ability to pinpoint the specific cause of individual running injuries is pretty rudimentary. Sometimes there’s an obvious weakness or imbalance or training error that can be corrected, and if so, that’s the first priority. But that’s not always the case.
An interesting example is the idea that weak hips lead to problems like runner’s knee and iliotibial band syndrome. There’s been some very interesting research supporting this idea from people like Reed Ferber of the University of Calgary and others. So that means that hip strengthening should help get rid of those injuries, right?
But when Ferber and his colleagues tested hip strengthening compared to strengthening the muscles around the knee in patients with patellofemoral pain (runner’s knee), both groups saw similar improvements after six weeks. Doing something seemed to help, but it’s not clear that it mattered what you did.
My feelings are similar about things like platelet-rich plasma injections. I’m sceptical that the platelets are making an appreciable difference to your tendon… but getting an injection into the inflamed tendon might well trigger some sort of response. Or minimalist running shoes, or forefoot landing: regardless of whether any particular running form is “right” or “wrong”, if you’re perennially injured, a change probably has more chance of helping you than hurting you. The list goes on.
The analogy that I think of in these cases is of banging on the side of an old cathode-ray television when the picture went fuzzy. You didn’t necessarily know what was wrong, but if there was a loose connection somewhere inside the TV, banging on the side would often seem to jostle it back into place.
Of course, sometimes the picture was fuzzy because some atmospheric disturbance was interfering with your reception. (I know all this talk of TVs and antennas is betraying my age.) In that case, banging on your TV didn’t actually do anything – but the picture would nonetheless return to normal after a bit of banging, so you’d have the impression that it helped.
Here’s how the various possibilities play out:
With those outcomes, it’s understandable that we all used to spend a lot of time hitting our TVs. While it involved some wasted effort, you avoided the worst possible outcome of just sitting there and not having the picture come back. The problem is that it produced false beliefs: you often thought you were “fixing” the TV, whereas really you were just banging it for no reason while a cloud passed.
I think we should always start by searching for rational causes and solutions to problems like injuries. But if those don’t succeed, it’s not irrational to tumble down the evidence ladder and try other things. After all, one thing we can say about a persistent injury is that it’s telling us that the status quo is not working, so change is needed.
The important thing is to bear in mind that distinction between thinking something might help, and believing the stories we tell ourselves about why a particular product or technique works. Stay sceptical, and if you try something and it doesn’t work (after an appropriate period of time), move on and try something else. And if it’s really expensive, look for a cheaper way of banging on the TV.
