“You probably shouldn’t run anymore, get a bike.”
Those are the words of every runners’ nightmares, and what was said to me by an orthopedic surgeon three years ago following a cartilage injury to my knee.
I did get a bike, because bikes are awesome. I also got a new doctor.
Refusing to give those defeatist words the final say-so, I spent the subsequent couple of years engaged in a lot of physical therapy and other activities geared towards addressing my weaknesses with regards to stability and strength in and around the injured joint, combined with a heck of a lot of plain old-fashioned patience, and with time I found myself slowly able to increase mileage. But I was also led to explore other options that might get me just a little bit closer to one hundred percent–even if not all the way—and back to racing.
From acute injuries that come out of left field and throw a wrench into our running for months at time, to more chronic issues that can arise and make training and competing in the future a big question-mark, we are sometimes left believing that we have fewer options to getting back on track than we truly do. Sometimes all it takes is some extra exploration and research to uncover some of those options are and if they are feasible for us, but in many cases, they are indeed out there.
The field of Orthobiologics and Regenerative Medicine encompasses methods like Plasma Rich Platelet therapy (PRP), prolotherapy, and emerging stem cell treatments now exist as possible alternatives to surgery or even ending one’s running. Those options can enable soft tissues with limited healing capacity like cartilage, ligaments, and tendons to heal or regenerate themselves naturally, where often that ability is otherwise extremely limited due to lack of natural blood flow. While our everlasting quest of continually seeking that extra edge when it comes to staying injury-free sees various treatment modalities continue to surface, lesser known options like dry-needling, infrared saunas, and laser treatments serve to allow healing and recovery, and avoid the dreaded prolonged downtime.
Stem-Cell Treatment
Less invasive than surgery and possibly equally as promising under the right circumstances, stem cell injections are on the rise as a treatment option for certain injuries. In my own case as with many others, damage to the articular cartilage–in this case the articular cartilage that covers the ends of the long bones within the knee and act as a vital shock absorber–does not heal and becomes degenerative over time, resulting in osteoarthritis within the joint. The go-to surgical options available for injuries of this nature are quite invasive, sometimes have questionable or shorter-term outcomes despite exceptional amounts of post-operative time off and rehab. Stem cell injections on the other hand, use the body’s own bone marrow or adipose (fat) tissue, and have shown promise in regenerating cartilage and mitigating further degeneration of the joint.
While nowhere near as invasive as most orthopedic surgeries, the procedure itself is not entirely non-invasive. Obtaining bone marrow requires bone marrow aspiration, a process which involves drilling into the posterior superior iliac spine (the hip bones at the lower back), tapping in an impressive needle with a mallet, and suctioning out bone marrow. Similarly, adipose is obtained by liposuction of sorts, where a small amount of fat is suctioned out the “muffin-top” area above the hip, or the abdomen.
After the stem cells are obtained from the byproducts of this “harvest”, they are injected directly into the site of injury with the help of fluoroscopy, which is essentially live-action x-ray.
The whole process takes roughly three hours and, depending upon the area of injury, sometimes requires a period of non-weight bearing. This is to allow the stem cells to basically set up shop undisturbed and start the process of regenerating damaged tissue, which takes roughly nine months.
Although I wildly oversimplified the actual process of cartilage regeneration because my understanding of it is remedial at best, many studies thus far appear promising given the right circumstances, and promising enough that I was willing to roll the dice on it. While the ultimate end result of the treatment takes months to fully emerge as a success or failure, with any luck, the result will be many more miles to come.
Plasma Rich Platelet Therapy (PRP)
More commonly known and widely utilized, PRP is a treatment modality utilizing one’s own blood, and is meant to generate healing in avascular tissues. To put it simply, blood is drawn, centrifuged to concentrate the platelets, then injected into the injured area. On occasion, more than one injection is performed over a given a period of time. Sometimes a period of minimal or non-weight bearing or immobilization is needed depending on the affected area. Not to be confused with things like cortisone injections that simply numb the affected area to disguise the pain–sometimes to the athlete’s detriment–PRP is not an instantaneous, quick fix, and usually entails several weeks to allow actual healing and regeneration to take place and for new tissue bonds to strengthen.
Multiple-time US Mountain Running Team runner and Nike Trail Team member Ryan Bak faced a less-than-stellar prognosis for his perpetually injured achilles in 2012. After an 80% rupture of the tendon following his 2:18 performance at that year’s Fukuoka Marathon, Bak sought advice from an orthopedic surgeon.
“The doctors said that surgery was the only option to fully repair the tendon,” he explained. “Unfortunately, I would have less than a 25% chance of running at a high level again.”
Daunted by such grim odds, Bak’s search for an alternative led him to Dr. Payson Flattery at the Center of Integrated Medicine in Bend, Oregon, who introduced him to PRP.
“Dr. Payson had years of experience with PRP, and many success stories. I had two rounds of PRP about 8 weeks apart, and it was hugely successful. I was able to get back to running at a high level, and I was able to be pain-free for the first time in many years.”
Less than two months later, Bak made the US Team for the Bupa Great Edinburgh cross country race in Scotland.
Bak offers a few words of caution with regards to PRP however:
“The effectiveness of this treatment can be related to the skill and precision of the practitioner, as well as properly adhering to the recovery protocols afterwards.”
Prolotherapy
While not a new treatment method and used for decades, Proliferation Therapy, more commonly known as prolotherapy, is another method of giving injured areas the ability to heal and regenerate and sometimes it still flies under the radar as a potential treatment option. This technique is particularly useful in treating ligament injuries, especially in instances where ligaments have become more lax—or in other words, have more “slack” than they ideally should, making the joint with which it is associated unstable–due to repeated injury, such as in the case of those pesky ankle sprains that just keep recurring.
In the case of prolotherapy, inflammation is deliberately caused at the site of injury by creating multiple tiny punctures within the infected ligament. This creates “microtrauma” within the tissue and is followed by injecting a dextrose solution that serves as an irritant to the area. The process essentially “tricks” the body into sending inflammatory agents to the area, helping the avascular tissues to rebuild and regenerate, spurring along a repair process that may otherwise not occur.
“My trail and mountain runners are most commonly treated with Prolo for repetitive foot and ankle injuries or chronic SI joint instability,” Colorado Springs physical therapist and trail runner Nat Collins explained.
Once again, it is important to emphasize that the treatment is not a quick fix or a magic bullet, and its success is largely dependent upon the rehabilitation protocols following the procedure.
“The process of rehabilitation is super athlete-specific,” Collins explained. “In short it comes down to: damage, which is the Prolo treatment, rest, re-educating the injured area, and finally, re-loading it.”
Collins has seen success among athletes dealing with joint instabilities and tendinopathies, but emphasizes the importance of proper rehabilitation to maximize the potential success of the treatment.
“In the same way that vitamins don’t off-set a bad diet, Prolo won’t save you from your own bad mechanics. You have to treat the underlying issue to have the best shot at returning to running at a high level. Whatever the case, the athlete has to do the work.”
As a final word of when it comes to the field of regenerative medicine be it PRP, stem cell treatments, Prolotherapy, or others, many treatment modalities are still in their infancy despite many success stories and there is not always conclusive evidence in terms of efficacy, and treatment protocols can have tremendous variation. Generally, the procedures can be very expensive and are not covered by insurance. To that end, athletes seeking such treatments would be well-served to do their research prior to committing to a procedure, and equally important, to do their homework post-procedure.
Dry-Needling
While it appears to be a similar treatment, dry-needling is not to be confused with acupuncture. Mountain running veteran and physical therapist Simon Gutierrez uses the treatment often in his practice, inserting tiny needles into muscles’ “trigger-points,” releasing areas of tension to allow the affected muscle to return to full efficiency.
“I use dry-needling for the prevention and rehabilitation of soft-tissue injuries and muscle mobility. It decreases painful, guarded areas, improves mechanics, and enhances performance,” Gutierrez said.
Developed in the ’80s, dry-needling centers around trigger points in muscles. When injured or over-used, muscles develop areas of extreme tightness and irritability, sometimes causing pain in the specific area of that point, or effecting nearby tendons, ligaments, or fascia.
Gutierrez sings praises for the effects of dry-needling that he sees in his patients, but like Collins, is quick to note the importance of corrective exercises and functional activities after needling to get maximum, long-term relief.
“It’s highly effective for a wide variety of running-related injuries,” explained Guitierrez. “If an injury is primarily trigger-point related or an issue of muscle restriction, it can be the silver bullet. In many cases, if you catch an issue early on, it can be a very effective and quick solution.”
Infrared Sauna
For those who haven’t yet found themselves in the clinician’s office and wish to maximize their chances of staying out of it, there seem to be an ever-increasing variety of ways to maximize recovery and injury-prevention beyond diet, sleep, and a well thought out training plan.
One lesser-known option that seems to have made its way onto the social media platforms of many high-level runners—like Jordan Hasay–in recent months is the use of the Infrared Sauna.
Badwater 135 champion Zach Gingerich prompted fellow ultrarunner Anthony Kunkel to give infrared therapy a go, and the two would train on treadmills in front of an infrared panel as part of “infrared jogging sessions.”
“Recently the science on infrared has been catching up, but I’ve known that it works for over a decade,” Kunkel said of infrared technology.
“My excessive use of it is about staying bullet-proof: fewer sick days, quicker recovery, and basically no injuries.”
The theory behind the infrared sauna is that heats the body and tissues at a lower temperature, increasing core temperature and triggering increased circulation, detoxification, improving cellular health, blood plasma levels, and muscle recovery. Hand-held infrared lasers like those used by many physical therapists exist to treat target areas of injured tissues.
The results of the use of full-body infrared saunas are comparable to what we see happen when utilizing the dry sauna, with which many of us are familiar, but infrared allows the body to be heated similarly, but at a much lower temperature than that of a dry sauna, to derive the same benefits. Dry suanas are not always easy to stay in and endure the extreme heat and perspiration long enough to reap the full benefits.
The end result? Hyperthermic conditioning.
“There is huge evidence for muscle building and recovery, gut health and hormone health,” Kunkel said, “it’s like mitochondrial doping.”
Suffice it to say, whether you’ve sustained an injury or wish to take extra steps to avoid it, there are a myriad of lesser-known modalities that exist beyond the commonly known rest, ice, and heat, or–in the case of serious injury–that exist beyond the orthopedic surgeon’s office.
Shannon Payne is a Colorado native currently residing in Auburn, California. She was a two-time qualifier for the US Mountain Running Team, two-time winner of the Mt. Washington Road Race, and a seven-time All-American at the University of Colorado at Colorado Springs.
