How should I treat my running injury?

September 11, 2006 1:10 PM

Physiotherapy or chiropractic?

I've recently increased my running mileage and am suffering from the dreaded IT band syndrome. My doctor wrote me a prescription for orthotics and physiotherapy, and told me I probably shouldn't register for the 1/2 marathon I've been planning on running in November. Physio costs $50 per appointment and I am a broke student.

I've also had an initial assessment done by a chiropractor who does something called Trigenics. A couple of the other folks in my running group have seen her and swear by her treatments. Follow-up appointments with her are $25, and none of my running buddies who went to her have had to stop training.

I'm located in Vancouver, Canada. Apparently chiropractic care here is more regulated than in the USA, so I am pretty sure my chiropractor is not a quack. :)

Do I stick with the doctor-recommended (but expensive) physio? Go with the chiropractor? A little bit of both?

posted by sanitycheck to health & fitness (23 comments total)

I've been to 3 chiropractors in my life. Each one of them was a complete and utter fraud, even though they were part of national organizations and had all sorts of official certificates. The last one I saw was admittedly an act of desperation to try and treat some lower back pain I was experiencing. When my doctor got the results back from my Xrays, he determined that I was severely constipated, to my chagrin.

The chiropractor? He had suggested I come in for a weekly adjustment and "prescribed" echinacea.
posted by thanotopsis at 1:31 PM on September 11, 2006

You're worth the money to see a real medical professional.
posted by grouse at 2:11 PM on September 11, 2006

Echoing thanotopsis, the quick bit of research I've done on Trigenics brings up this, which sets off every pseudoscience/bullshit detector I've got. We've had discussions about chiropractors here before, without reaching total agreement on quackery, but given the option, I'd take the physio. If you have a prescription for it, might it be covered by the same insurance that got you to the doctor in the first place?
posted by Mayor West at 2:14 PM on September 11, 2006

I've had chiropractors that were quacks (the one who wanted to diagnose my immune system needs via hair samples comes to mind) and others who have helped me tremendously in terms of pain relief. Just two weeks ago, I was suffering an extraordinary painful flareup of my sciatica, to the point where I couldn't sit for more than 10 minutes at a time (which sucks as I work at a computer all day) and I wasn't able to sleep without vicodin and a heating pad. One visit and and an hour later, my pain had diminished by about 90%, and has been holding steady ever since.
posted by scody at 2:17 PM on September 11, 2006

have you tried self-treatment before considering seeing someone?

i had iliotibial band syndrome earlier this year on the start of my exercise program...i resolved it by getting good high-stability shoes (i get brooks) and by doing a particular stretch in which you get a foam roller and you lie on your side, with the side of your thigh on the roller, and you roll up and down the thigh on the roller from the hip to the knee, balancing with your arms but putting all your weight on it...it can hurt (and the position and movement are awkward), but it shouldn't be excessive pain...i didn't stop running (though i'm not a marathoner) during my treatment...

if you do see a specialist, i would recommend a physiotherapist over a chiropractor, and ask to set up just one appointment so you can get a self-directed treatment program (tell them your finances are low), and they should be able to help out (and tell you any warning signs that require specialist consultation)...
posted by troybob at 2:24 PM on September 11, 2006

(also, if your doctor prescribed orthotics--are they custom orthotics or just shoe inserts? custom orthotics require a specialist and can be expensive, and you shouldn't skimp in that, but if he says over-the-counter stuff is fine, you might find that the combination of that with good shoes will bring much comfort)
posted by troybob at 2:26 PM on September 11, 2006

Chiropractic = quack...the theory that the whole practice is based on has no scientific basis.

You're worth a real doctor.
posted by griffey at 2:44 PM on September 11, 2006

I have found that the types of overuse injuries from sports are often the result of a muscle imbalance. For instance a runner will often have overdeveloped outer quad muscles with respect to their inner quad muscles. This will pull the kneecap out of alignment and cause knee pain. A physiotherapist (physical therapist here in the US) can diagnose these muscular imbalances and properly treat them with strengthening exercises and proper technique.

A chiropractor won't fix issues that result from having tight muscles, range of motion issues, and other chronic issues that arise from a lifestyle that includes lots of running and sports. Ask the doc about orthotics as well, they can correct a lot of common problems with stride and other knee issues.

One more thing... You only get one body. Treat it well and remember that skipping a half marathon might allow you heal properly and will give you an extra 5 years of running. Your knees have to last you the rest of your life, treat them well and do whatever you have to in order to properly heal.
posted by tumble at 2:52 PM on September 11, 2006

Echoing thanotopsis as well, I went to a couple chiropractors to help with my back.

After a few sessions with one I did a test, stretching so my back cracked before a session. The chiro was amazed at what great alignment my back was in, and patted himself on the back (no pun intended) for doing such a great job on me. I didn't go back to him.

A while later I pulled a muscle in my back and on advice from my then-girlfriend I went to her her chiro, who soon promptly went into a spiel about selling me custom orthotic supports to put in my shoes. The next session after I turned that down he stretched me so hard and long that afterward I had to call a taxi to take me home because I was in too much pain to drive. None of his efforts did any good but time, exercise and heating pads did wonders.
posted by Kickstart70 at 2:53 PM on September 11, 2006

I concur with the advice so far--I have only missed five days of running in over 35 years--good shoes with the right foot plant, regular rotation of shoes and orthotics if necessary (even if it means trying some good over the counter ones to start with). If you are a broke student you might check if your University has a program in kinesiology or if there is a kinesiologist available to the athletic teams--it is a vastly underutilized speciality. From wikipedia:

"Kinesiology is the scientific study of human movement. It should not be confused with the pseudoscience applied kinesiology (AK). While an understanding of kinesiology is fundamental for the analysis and treatment of problems in the musculoskeletal system, it is not - unlike "applied kinesiology" (AK) - a method for the treatment or diagnosis of illness.

Kinesiology encompasses human anatomy, physiology, neuroscience, biochemistry, biomechanics, exercise psychology and sociology of sport. The relationship between the quality of movement and overall human health is also studied.

Kinesiological information is applied in such fields as physical therapy, occupational therapy, chiropractic, osteopathy, exercise physiology, kinesiotherapy, massage therapy, ergonomics, physical education and athletic coaching. The approach of these applications can be therapeutic, preventive, or high-performance. The application of kinesiology can also incorporate knowledge from other academic disciplines such as psychology, sociology, cultural studies, ecology, evolutionary biology, and anthropology. Related interdisciplinary fields in motor skills, skills research are graphonomics, i.e. the study of handwriting movement control and the study of motor control in speech.

The study of kinesiology is often part of the curriculum for some of the areas in which kinesiological information is used (akin to a medical study – see sports medicine)."
posted by rmhsinc at 2:59 PM on September 11, 2006

There's a reason physio costs more and is doctor recommended. Besides the things already mentioned physio is goal and cure oriented, aimed at achieving some measurable long-term result. Chiro can be good at either causing or temporarily relieving pain, it's symptomatic relief only like taking an aspirin for a headache instead of addressing whatever is causing the headache.
posted by scheptech at 3:16 PM on September 11, 2006

Get the physio. Chiropractic (why is it not called chiropracty? it always sounds wrong to me) may give you some temporary relief, but will not fix anything. Your real problem is paying for the treatments.

Do you have health insurance through your student union? Check - you might be paying for it through your student union fees and not even know.

Call the Dept of Health. My understanding is that most provinces only cover physio if it's as part of a worker's comp thing, but BC might have a program to help you. It can't hurt to ask.
posted by joannemerriam at 3:34 PM on September 11, 2006

troyb - I have been doing some self-treatment (stretching, ice, roller) but it hasn't been enough. I will definitely talk to the therapist today about making my treatment as self-directed as possible so I don't go broke from physio.

I do have health insurance through my student union but it only covers $20 per visit to either a physiotherapist or chiropractor (so my $50 physio visits would cost me $30, but the $25 chiropractor would only cost $5).

As for orthotics, I am lucky enough to have $350 per year of coverage, which should cover *most* of getting them made. I already have a great pair of running shoes with lots of support and lots of miles left in them.
posted by sanitycheck at 3:51 PM on September 11, 2006

Look at it this way, sanitycheck; the $30 physio visits may well help you. The $5 chiropractor visits are $5 you might as well light on fire and save yourself the trip.
posted by Justinian at 4:12 PM on September 11, 2006

Physiotherapy, physiotherapy, pyshiotherapy.

I have found physiotherapy to be aimed towards getting you well again, rather than treating the symptoms. When I have talked to people about their chiropractic treatment, the conversation tends to end like this:

"So how long do you think it will be until your back is better?"
"Oh, it's ongoing, I need to see them twice a month to keep it under control"

Oddly enough these people will claim that `big pharma' and medical science is all about making money.
posted by tomble at 5:12 PM on September 11, 2006

Oh yes, and for proper orthotics, they will analyse your gait, measure your feet and most likely take a cast of your feet too. Had it done a while ago and it sorted out some problems, but it certainly felt odd at first!
posted by tomble at 5:13 PM on September 11, 2006

Maybe check around for prices of physio. I am currently seeing a physio for a similar problem in Burnaby and my cost per session is only $35.
posted by metaname at 6:18 PM on September 11, 2006

metaname - I actually live in Burnaby! Can you tell me what therapist you go to?
posted by sanitycheck at 7:59 PM on September 11, 2006

sanitycheck - do you go to UBC? because their sports massage clinic helped me with my ITB several times. deep tissue massage is very painful treatment, but that is what helped me with the discomfort of advanced ITB - and got me back to running in a few weeks.

physio - sorry, that just does nothing for me. I'd rather see a personal trainer (trained in kinesiology)

as for chiro, if you want two names of two excellent chiropractors, one in Metrotown and the other in Langley, send me an email (in profile). good luck --
posted by seawallrunner at 8:57 PM on September 11, 2006

I do go to UBC. I've been to the massage therapy clinic at the aquatic centre a few times - not sure if that's the one you mean - but never for ITB. I think I am going to give the physiotherapy a go first.

I also have a personal trainer I see about once a month through UBC REC. Never thought to ask her about the ITB problem - I'll mention it at our next appointment. I'm pretty sure she's a kinesiology student.
posted by sanitycheck at 9:21 PM on September 11, 2006

I have to agree with Troybob
here, I suffered from the same problem and spent a good deal of money on doctor recommended PT with little success. The Foam Roller method worked wonders for me. It only cost about $20 dollars, and is certainly worth a shot before spending hundreds on PT.
posted by HoldFast at 8:43 AM on September 12, 2006

here ya go:
Lougheed Physiotherapist Corporation
Phone: [phone]
Address: 9622 Cameron St. (right beside Lougheed Mall)

I think it was $45 for the first appt. and $35 since then. It is kind of a run down looking office, but the physios seem knowledgeable.
posted by metaname at 1:55 PM on September 12, 2006

I am currently in physiotherapy school. We have to learn a tremendous amount of stuff (3 years in a medical school environment), including a med-school level semester in the cadaver anatomy lab. Then we have five clinical internships that take a year to complete. On top of that, PTs are considered novices until they have five years experience in the clinic. It's incredibly hard stuff, and we are responsible for an extraordinary amount of material. Physical therapists are musculoskeletal experts.

I would not place my faith in a chiropractor. I would not entrust my delicate vertebral arteries to someone who wants to adjust my cervical spine at high velocity.
posted by jennyjenny at 1:37 PM on September 15, 2006