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How well does the NHS look after runners?
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Is it really? my knee was awful before I started doing sports, in fact since I was quite young I used to complain to my parents of knee problems "it's growing pains" for a while, and then just down right being made to feel like I was lying about it whenever I went back. Yet someone who has dinky doughnutted themself to near death has a greater need than me? someone who had a problem, that wasn't bought on by myself can go on being ignored and issued with the standard "well, you'll just have to live with it" when it effects me doing something that will prevent me becoming another one of those obese statistics with the NHS funding my gastric band. While the doctors go over their visit time, and make the effort to look into a refer treatments for such people? I must say I disagree.
I'm a diabetic. I'm very fit and healthy though thanks very much and will be aiming for a 2:55 in London as a gauge of where I'm at.
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I'd not bother going to a GP with a sports related issue and have just gone straight to a physio before. I would like the GP's to be a bit better at acknowledging their lack of knowledge on some things though, although I will admit that my combination of marathon running, diabetes and a couple of other things is probably not that common in their experience. Would be helpful if they would just admit that they didn't know and send me to someone who does a bit sooner.
I hope it didn't come across that we were criticising diabetics that wasn't the case. I think its more just frustration that some people who appear to make little effort to look after themselves use a lot of the NHS resources. And yet runners seem to face a battle to get the support they need. Ideally everyone would get the level of treatment they need.
I'm hoping to change things where I work. I'm planning a presentation to the whole Physio team of 50+ people on treatment of running injuries, to get the views of a runner across and talk about conditions and their treatment. We might be able to set up a service for runners to assess and advise early in the injury process to keep people running and avoid the development of chronic conditions.
I've considered doing some work with local running clubs too, do you think this would be welcomed?
Just a bit "sensitive" to the term diabetic being used to mean things along the lines of lazy, fat, unfit, overeating, etc. Remember that Steve Redgrave is a diabetic too.
I'm afraid I've now reached the point where I go straight to my physio with any issues, and if she tells me it is something that might need a few sessions, or an MRI / X-ray, I then go to my GP to get a referral so I can claim for it on my private medical insurance....
I read it more along the lines of Type 2 diabetes which, I think is linked to lifestyles and specifically, over eating / obesity.
I think that your idea is a good one Tom, although I think that there is a significant need for people who run regularly but aren't members of clubs - they might be just as likely to need the medical attention but lack the network of contacts that you get in clubs. Chances are that if you're a member of a club, pick up an injury and need treatment, you'll know someone in the club to ask for recommendations or the club may well have their own people who can treat you. When you're on your own, it's more difficult to find someone.
That's a good point about members of running clubs probably having access to advice anyway. The other thing I'm working on is a blog, I'm putting together evidence based advice for a range of common running injuries. It's going to be an ongoing project but I hope it will be helpful for people.
I have a couple of pieces on there already on ITBS and how to decide when you should run and when you should rest. Have a look if you get a mo;
http://runningphysio.wordpress.com/
Any feedback (positive or negative) very gratefully recieved!
Thanks
Tom
Hi Jeepers
It depends on the GP - I have seen 3 different ones in the last month & the one I saw today is a runner. 10 minutes with him was far more helpful as he actually knew what i was talking about & didn't treat me as though I was a drunk turning up to A&E on a saturday night!
Does appear to be a real gap in the knowledge of sports related injuries, 1st GP prescribed drugs that would have caused more harm, 2nd GP finally referred me to a physio after 4 weeks openly saying it was a physios job to diagnose, said physio referred me straight back to doctor & wouldn't touch me without an xray - which is what I had told them in the first place.....
Having a sports clinic is a great idea - as it also identifies which GP's actually have knowledge in sports related injuries..
When I went to see my GP with a groin strain / potential stress fracture (following a trip to A&E a few days earlier) she confirmed that it definately was not a stress fracture, suggested I saw a physio and gave me pain killers. I went to see the physio (privately as am lucky enough to have health insurance from work) but when I finally did she couldn't believe that i hadn't been sent for xrays. She referred me for X-rays and an MRI and I eventually had the stress fracture pinned.
The consultant who pinned it was horrified that I had been walking about on a fracture which went right across the femoral neck without crutches for weeks.
This was sorted because I have health insurance from work for which I am extremely grateful. I am a big supporter of the NHS and never wanted to rely on private healthcare but without it in this case the fracture would have gone undiagnosed and in the interim it would have been quite likely to displaced which I understand is very serious.
What's the difference between a consultant surgeon and God?
God doesn't think he's a consultant surgeon!
I'm suffering with plantar fasciitis at the mo - and a possible heel stress fracture - and rather than see the GP, went straight to my insurers, had a 20min conversation with one of their panel physios where we discussed my issues and he was happy for me to be referred straight to the sports injury clinic without seeing my GP - just needed to pay a £75 excess. the head man at the clinic is a well respected sports medic and so far I've had a 30 min consultation with him last week which included an ultrasound scan of my foot. that was inconclusive so I'm now booked to get a MRI scan this Friday to get a better look at what's going on, and that should then decide a) what the problems are, and b) a prospective cure.
all that's happened in less than 2 weeks so far - I think £75 excess and of course the policy costs is well worth the service so far as I wouldn't get that speed through the NHS.
I think the NHS are fantastic at covering acute care issues, and many aspects of palliative care but for people with chronic issues who desperately need sorting and don't have private healthcare, then they fail badly. likewise sports injuries unless seriously acute are often dismissed as we're at the margins of what the NHS specialise in.
Thought I'd just add my input on this, I have been referred to NHS physios 4 times (possibly more?) in the past few years and each time bar one it has been a fairly negative experience.
Initially I was referred after an X-ray showed no problems with my calf which hurt to walk and run on. I was told it was nothing to worry about, the physio instructions were to improve my balance and hop on the painful leg until it felt easier, that it was just about building up the muscle and I just needed to build up my pain threshold. I left after 4 sessions- 1 per week, after it became too painful to walk. I remained with the idea that I was too pathetic and was being OTT when complaining about the pain so I didn't go back to my GP and instead tried to run through it. It was too much and I ended up laying off running for a good 6 months before on a whim going back and having a go- my leg pain seemed to go...for about 4 months then it was right back.
Luckily I was sent to a provate physio who explained to me that shinsplints and stress fractures and many other injuries would not be picked up on a general xray (which by now was several years out of date anyway). She suggested I see an orthopedic doctor as it was an injury and caused by my fallen/weak arches rather then my core stregnth which never had been that bad in the first place.
My GP refers me to the physios again until the orthopedic referal comes through, the physios were actually worse. The women I saw prodded my leg and said "well it can't be anything serious or you'd be on the celing", I did remark tht it hurt but tbh I had run hopped and massaged the thing and the pain caused by those things were bad and I'd gotten used to them after being told I was being weak not to. She asked me to run, I stated where I felt pain and at the end of the assessment she told me nothing was wrong.
Orthopedic doctor runs a few scans, an MRI comes back, water retention so he sends for a nuclear bone scan, this shoes up a clear stress fracture as well as other injuries in my knee and ankle. (Orthopedic doctor then says never run again).
Now I am sent back to the physios who look at me as though I have just told them I steal pocket money from kids. I am told that running is an extreme sport and that I should never run again, its almost a closed case, nothing to talk about and nothing they want to do. I am told I need to do Pilataes for my back (secondary back issues) which did not help (probably because the lessons were so badly run) and then told there was nothing more they could do for me. It was as if they couldn't get rid of me any faster!- Not that I minded!
I have to say I have not really had any help from them and find that infact all the help I manage to get is via forums like on here, websites like sportsinjury, physioroom and so on and books such as the Anatomy of Injury by Brad Walker. I end up teaching myself but actually, I wouldn't take away that for anything, its given me a whole new understanding and depth to things. I can respect my body and its limitations and recognise just how amazing it is in a whole new way when before I would just feel as if there was something wrong with me and I was a waste of space as a result. I guess its a bit of a hidden blessing.
Oh and to answer your questions directly:
Did you get seen quickly enough? Was the GP reluctant to refer you to Physio?
Normal wait is anything from 2 weeks (when I was referred to a private physio about 14 months ago) to 2-3 months when I was referred in 2009 but in all fairness they lost my referral. Apparently should have been 6 weeks.
Did the doctor or Physio seem knowledgeable when it came to running?
Nope, saw running as an extreme sport and a stupid thing to do "well you are going to get injuries with that" and as if it was only a matter of time before both my feet fell off and ran away from me in disgust.
Overall did it help?
Private referal? Yes! NHS referal? Nope, and the Pilataes they offered was so bad it made me want to stand up and offer to take the class myself. OK it was a very mixed class but they could have done things so much better and I can count the number of Pilataes classes I'd had prior to that on two hands.
Do you feel the most likely thing the NHS will do is just say "stop running" and offer little alternative?
Yup. And that is exactly what they did: they told me there was nothing they could do and only running would stop my problem and if I recovered and then went back running again it would just come back along with every other problem they could think about. I restarted running last year, slowly and with a different technique which I had looked into myself (the orthopedic doctor has said it was even worse then what I was already doing) in June after 4 months off, I have not had my injuries return so far.
Did they advise you on techniques you could use? Stretches, taping self massage etc.
Nope, because they didn't support me ever running again. The only advice was to stop.
Did they help you plan a graded return to running or advice on strategies to reduce pain when running?
Nope, I read up on this myself. The consultant who ran the scan (the nuclear bone scan) was very nice and offered to see me after the scan was done- I was the last on the list. He told me it would take at least 6 months as it was quite prominant but I had my age and nutrition on my side so guessed at 6 months. The physios just said to rest but not to run again. I am sure they look at running as an extreme sport and do not recognise it as having any benfit or purpose what so ever which is a bit daft because we are built to run. In prehistoric times no doubt if we were not able to run we'd have not continued to exist.
It has been noted that our sporting peak coincides with this prehistoric life expectancy, which is why those of 30 years plus are not considered to have much potential if any.
🙂
I think sometimes the problem with GPs and how long it takes them to take your problem seriously is because day in day out they see unfit and sickly people who come to them straight away with minor twinges. People who are looking for a free prescription because they don't want to go to Asda and spend 32p of their own money on a pack of ibuprofen! So when you say to a GP you've already done all that yourself and it hasn't worked and you now want a referral, I think a lot of the time they're just not used to dealing with stuff like that quickl.
Anyhoo... here are my various experiences of sports related problems and the NHS:
1. A long annoying drawn out experience a few years ago with a very painful shoulder where my doctor just kept prescribing stronger and stronger painkillers despite the obvious fact that my shoulder clunked and crunched when rotated and obviously wasn't going to sort itself out with rest. Only way I got a referral was by saying the pain was so bad I couldn't sleep and was sinking two bottles of wine a night to knock myself out. The physios assumed I had the standard rotator cuff problem that is apparently most common among the 'general population' and gave me cortisone injections for 18 months then finally admitted it wasn't having any effect and sent me for an MRI scan which revealed they'd been injecting steroids into completely the wrong joint and that instead of a rotator cuff injury I had osteo arthritis which could only be rectified by surgery. Which I did get eventually and which did help the problem quite a bit, but overall I'd say it was a poor experience.
2. I went to a different GP with a tennis elbow type tendon strain. Again I was told to take ibuprofen and come back in 3 months if it was still bothering me. His interpretation of my conmplaint seemed to me to to be that I was looking for a sickline from work and that he'd be happy to give me one to make me go away. But I was actually self employed at the time and couldn't afford to take any time off work at all... I looked about online and purchased myself an epicondylitis brace/strap thingy, which sorted the problem after a few weeks of use.
3. An NHS 'sports' physio gave me the wrong type of stretch altogether to treat a calf problem. I had tightness due to a gastrocnemius tear which kept re-tearing itself, she gave me a stretch that worked the soleus. I didn't find that out till very recently and immediately realised why eight years later I still had a problem calf. Three weeks of foam rolling and stretching correctly sorted it out quicker than I could have believed, as I'd ended up thinking it was an unfixable niggle I'd have for life.
4. I developed asthma at age 32. Was advised to stop running altogether. Asked for extra inhalers so I could keep one in my gym locker and one in my backpack and was given a lecture on high risk activities and irresponsible behaviour. Had to go back at a later date with a 'dog ate my inhaler' type excuse so as to get a couple of spares.
Now if I have any running related problems I go either to a private specialist sports injury clinic or a private massage therapist. Or to my local running shop to ask the advice of their expert shoe fitter, whose judgement I have utmost faith in. I don't think I'd trouble the NHS with any sports related injuries again, unless it was something big that required an ambulance and an immediate blood transfusion!
Oh no! I can see now, they were right, I am actually buring out! I never even felt like I got up to speed and already my body is infact in a steadily downwards spiral (and sliding amazingly fast...) Am now wondering how deeply I heed the message before its forced over me.
Been having so many physical health issues in the past year alone, my back is the next thing to go, starting with the lower back and it would seem, be moving upwards, my thorasic back went out last week shortly following a bone density scan (history of weakened and brittle bones). I now have referral pain in my shoulder blades as a result...thats before you get into my depleating energy levels! I was hoping things would pick up but now really thinking about it, I'm wondering if they ever will!
Thanks so much for your messages, sorry to hear some of you have had a really difficult time with treatment on the NHS. Your comments have helped in my aim to improve things where I work. I have discussed a lot of what's been said with my seniors and we are looking into changing the way sports injuries especially running, are treated. For example, if we receive a referral from a runner midway through marathon training seeing them as an urgent due to "exceptional circumstances" rather than them facing a 3 month wait.
It's a complex problem, but it comes down to huge demand for NHS services with limited resources. I'll keep you posted with how I get on!
Thanks again
Tom
Often with running injuries early Physio input can stop a problem becoming more severe and requiring a lot more input from the NHS. In that way it would save the NHS some money and provide a better service for runners. Our aim would be to assess, treat and advise, ideally to help people continue their training rather than miss an event they may have worked hard for. In our private clinic we treated 20 runners in the lead up to Brighton Marathon this year and all of them finished the race.
I see your point though, it's a tricky issue but I think people's comments above show that runners don't get the support they deserve from the NHS. I'm trying to find ways to offer more support for runners without others loosing out.
Tom
Would some kind of mobile walk-in physio surgery for runners be a possibility? It could cover quite a large area as it would only need to visit each population centre at most about once a fortnight -- and could be advertised through running clubs and running shops as well as through GP surgeries. It could refer people to appropriate local services where needed, but could also diagnose straightforward cases and give guidance on how to handle minor niggles to prevent more major problems.
This may be a bonkers idea (it's straight off the top of my head); but with 60% of adults overweight and >20% obese, it surely makes sense to look for innovative ways to support runners. I can't see how something along these lines could fail to be cost-negative over the longer term (just considering the direct cost to the NHS, leaving out of consideration lost economic productivity and other costs of an unhealthy population).
Running comes close to being a free form of exercise. People shouldn't be excluded from it because they can't afford private healthcare.
I do think some kind of specialist service staffed by people with some knowledge of exercise physiology (if that's the correct term) would be a better idea than having runners and other athletes assessed initially by normal GPs who I honestly think are more used to dealing with non-exercisers to the point where they just don't have the sense to deal with patients who are fit and active.
Perfect example: I've been having quite a bit of bother with my asthma recently - it's fine on slow runs but any time I'm running hard and my heart rate goes above 165, it starts to become a problem. I phoned my doc for an appointment at the asthma review clinic and was triaged over the phone. And the doctor I spoke to actually asked: 'So you get short of breath when you're exercising?' And I was like 'Well, yeeeees.... but I mean, so does everyone else I'm running with - that's kind of the point of it!' And she just didn't quite understand what I meant when I tried to explain that it doesn't stop me exercising but it does hold me back from running as fast as I know I can. She was saying things like 'So you can still go running' as if being able to do that meant I didn't really have a problem at all...