Running Injury - Asking better questions - Socratic Method

As a clinician and as a participant in internet discussion forums related to running injuries I have the opportunity to observe and respond to questions. The questions asked by individuals who are striving to solve repetitive use injuries are varied, in terms of type of questions and the degree of sophistication of the questions.    

Many of the questions that I observe suggest the questioner lacks understanding of the problem, and the question is relatively unsophisticated.  For example a frequent question is “I have this running injury, what stretches should I do to stretch it out”?  You probably recognize that running injuries occur because of running too much, in a faulty manner, not because of not stretching enough.  One wonders if the individual asking the question believes the injury occurred because he/she disobeyed the 11^th commandment “thou shall stretch before running”, and he/she is being punished with an injury which needs to be “expelled out”.  Hopefully, you the reader will see the folly in the belief that a repetitive use injury can be solved, by “stretching it out”.   

Some scholars and teachers practice the Socratic method of teaching, in which asking questions is used instead of lecturing and telling.  Scholars have refined the Socratic method of teaching, into taxonomy of critical thinking and questioning.  The lowest level of questioning is asking questions to gain knowledge or facts.  Given the knowledge or basic facts questions can than be asked so that comprehension and understanding is achieved.  Once a basic understanding is achieved questions can be asked which apply the understanding according to principles.  After the principles have been applied questions can be asked to analyze the various parts.  This leads to questions which allow synthesis, followed by evaluation.   

Examples of questions at the lowest level of the taxonomy seeking knowledge are: how long should I leave the ice on my tendonitis; how do I stretch my Achilles tendonitis; should I use ultrasound and massage for my piriformis syndrome; can you inject my plantar fasciitis?  These are valid questions, but lacking in understanding of the basic principles related to repetitive use injuries.  Ice, stretching, ultrasound, massage do not address the cause of repetitive use injury.  Understanding that repetitive use injuries are caused by repetitive use, the condition of what is being used, and the manner of use should facilitate more sophisticated questions.  Examples of questions seeking understanding which is a higher level on the taxonomy of questioning and critical thinking might be how much do I need to decrease my running to allow healing, why is only one heel injured when running is a symmetrical activity, what way (running form) should I run to alleviate the injury?   

As a clinician observing the types of questions clients ask some individuals who ask the same question repeatedly, in the very same way, or in a slightly different way despite the fact that valid a answer has already been provided several times.  What the individual may actually be doing repeatedly asking the same question is hoping to get the answer they want.  Unfortunately, the answer they want and expect may not be credible. Here is an example; a patient comes in complaining of shin pain related to running.  When taking the history the patient reports they have tried various types of shoes in an effort to alleviate the symptoms.  During the examination they ask if they’re wearing the correct type of shoes.  After observing the client run it is obvious that they strike the ground with the heel first, and with the knee straight.  When running in this manner they experience shin pain. After instructing them to modify their running form avoiding striking the ground heel first, and to shorten their stride they immediately report they are no longer experiencing shin pain when running.  As part of the process of learning to run with out a heel strike, I have them run barefoot on the treadmill and they do so without experiencing shin pain.  When I finish the evaluation, I ask the client do you have any additional questions, often they ask which running shoe I should buy.  Apparently their expectation is that there is a running shoe which will alleviate the shin pain, or the slow motion video analysis of their running form, will determine which magical shoe will solve their problem, despite the fact that the major factor leading to their repetitive use injury was the manner in which they were moving, not what they were moving on.     

Socratic questioning is used to stimulate discussion, additional questions, creative thinking and learning.  If running is a symmetrical activity why do injuries occur on one side of the body?  Given scarce resources which approach is better choosing interventions which address the source of the injury (the specific tissue), or choosing interventions which address the cause of the injury?  How much should the training load be decreased to allow an injury to heal?  Is there a running technique which has a greater risk of leading to an injury?   How long does it take to learn to run with ideal form?  Given the wide spread belief that it is important to have good form when playing tennis or golf, why is there the belief that it is unimportant to practice good form when running?  Why is there such wide spread belief that stretching exercises prevent and alleviate injury?  If these questions have raised additional questions I am interested in hearing from you.  Whether you think your questions lack an understanding of the principals or the answers to the question is not what you want to hear keep asking questions.  Your questions are important and questions stimulate discussion, additional questions, creative thinking, and learning. 

Damien Howell MS, PT, OCS

www.damienhowellpt.com