Stop Saying Stop

by Mitch Hauschildt, MA, ATC, CSCS

This irritates me with a lot of medical providers.  Their idea of medical treatment for someone is to simply say, “maybe you shouldn’t Crossfit (or run, lift, triathlon, etc).”  That is NOT medical advice and is not good treatment.

This post started as an Instagram “#MaximumMovement Insight” and the more I thought about it, the more passionate I became about the topic, so now it is a blog post.  Let’s start by looking at a few of my recent patients:

Patient #1 is an avid Crossfitter.  She’s a former college athlete who is now 31 years old and has a goal of making the Crossfit games.  I recently watched her endure a grueling workout and collapse into a puddle of her own sweat and lie on the floor for several minutes, trying to recover enough to get up and walk out of the gym.  She’s having some shoulder issues, but wants to keep training hard, day in and day out to reach her goal.  She’s not married and owns the gym where she trains.

Patient #2 loves to run.  She is 41 years old and picked up running about 3 years ago.  She is divorced with no children and relocated to a new city about 2 years ago.  When she started running, she just wanted to get some exercise and do something new with a few friends.  She figured out that she is a pretty good runner and is now about to run 3 marathons in 6 weeks and then add another half marathon and the Disney Goofy Challenge (5k, 10k, half, full marathon is a 4 day stretch) in the next 4 months.  Her goal is to qualify for the Boston Marathon next year.  She has been battling some hamstring issues for the past few months, but her goal pushes her to keep training.

Patient #3 is a 49-year-old business woman who loves to exercise and train.  She developed low back pain and hip pain after a surgery about a year and a half ago, making exercise difficult at times.  Several years ago, she had a health scare and changed her life, losing 60+ pounds before having surgery and developing her subsequent injuries.  Her pain is not gone after a few weeks of therapy and she is wanting to return to working out.

Patient #4 is a 39-year-old male who was diagnosed with multiple sclerosis 5 years ago.  Since that time, his training and activity levels have increased significantly, competing in multiple 5k races, sprint triathlons, and cycling thousands of miles.  His major complaints are that with fatigue, his MS symptoms increase, oftentimes causing him to limp, risking tripping and falling.

All of these patients have had people tell them to just stop what they are doing.  Their theory is that their activities have caused their injuries or expose them to future injuries, so rather than look for solutions they should just stop their activity.

Telling someone to stop isn’t healthcare.

It’s counterproductive and not helpful.

All 4 of these people have been treated by myself because they aren’t getting help from other medical providers.  They are so relieved when I tell them that I’m not going to tell them to stop.  My job is to make sure that they understand the risks of their activities and if they are okay with those risks, then my job is to minimize them and help them to achieve greatness.

Why do I think that telling people just to stop isn’t a good idea?

1. It isn’t going to happen.  Have you ever seen a distance runner not run for one reason or another?  How about an avid Crossfitter? People are going to do what they love.  And, honestly, we need to respect that.  It may not be what we love or think is perfect, but that isn’t our decision to make.
2. Some people just love to do an activity, even though they know it may expose them to injury.  Patient #1 was a college athlete and she loves to compete, but with such a narrow window for her to compete at the college level, she has to look for other ways to fill that void.  Competition is her happy place.  Working towards a competition gives her purpose in life.  She loves the feeling of finishing an intense workout.  She truly loves Crossfit.  Whether I agree or not isn’t my job.  My job is to help her be happy and achieve her goals.  The same is true of patient #2 with her marathons.  Is running 3 marathons in 6 weeks a great decision for her body?  Probably not.  But, it wasn’t really planned that way.  She wanted to run a big race this year, and they can be hard to get into.  Most of them have a lottery system that some people enter year after year and never get selected.  That’s why she applied for 3 different races.  She didn’t expect to get selected for all 3, but that’s what happened.  So, rather than turn 3 different once-in-a-lifetime opportunities away, she’s doing everything she can to train smart and enjoy the journey.  She stated to me when I met her, “I just want to do everything that I can in life.  I’m having a blast and want to take advantage of these opportunities.”  I can’t argue with that and I need to help her reach her goals in a smart, effective way.
3. Some people do things because because of a strong community.  Patient #1 owns her gym and has 110 members that are her family. She has members who open the doors for her early in the morning so she can sleep and recover from her training at times and lots of people that love and support her.  Patient #2 has a similar support system with a local running club.  Taking their activities away from them can have a devastating effect on their mental health because of their support system that exists within their network.
4. Others have had life changing events happen because of their activity (i.e. weight loss) and stripping them of it will create high degrees of anxiety or depression for them.  Patient #3 lost a lot of weight and completely changed her life because of exercise and working out. The mere thought of not being able to work out, brings on anxiety and fear about the possibility of gaining her weight back and going back on medication.  Keeping her working out regularly is important not just for her physical health, but it aids her in handling anxiety and stress.  I don’t want to rob her of that opportunity.
5. Still others have a life changing event that encourages their activity. Patient #4 never wanted to run races or bike distance events until he found out that at some point in the future, his body might not allow him to do those things.  He developed a new-found sense of urgency to take on physical challenges.  Some people would try to argue that his activity level may be an issue with his chronic medical condition, but after research and consideration, I believe that his high activity level is what is keeping his body willing and able to continue his high levels.  Of course that can change with every medical condition and it can be a delicate balance telling him to stop what he is doing because of a diagnosis may actually cause that diagnosis to progress further.  It’s my job to keep him healthy for the next goal in life.

I know some of you may be thinking, “what about that person who has an unhealthy relationship with their activity?  They take everything to the extreme and it has become an addiction for them.  What about them?”

My response is that I believe this happens less than people think.  Just because I think something is crazy excessive, doesn’t necessarily make it so.  And, if someone does have an unhealthy relationship with their activity, that isn’t something that I am going to tackle by myself.  That person needs a team of healthcare providers around them to manage their situation if and when it becomes physically unhealthy.  Telling them to stop won’t make them stop and if it does make that person stop, they likely won’t do well mentally and their issues will show up somewhere else in their life.  Don’t take it away from them until there is a comprehensive plan in place from a team of experts.

Our job as medical providers is to help people achieve greatness.  Don’t get me wrong, it is also our job to educate people on the risks and rewards of their activities so they know what they are potentially risking by doing what they are doing.  But, if someone is educated and aware of everything in place, our role as their providers is to figure out a way to get them to their goals.

I get tired of having people come to me for answers, having been to multiple other physicians, therapists or clinicians who’s answer to their pain or problem is, “just stop doing that.”  That isn’t our job and it gives the health industry a bad name.

You may not love the activity that people are doing that is causing their dysfunction, but for many people, the alternative is a sedentary lifestyle of obesity, diabetes, depression and heart disease.  I’ll take a few shoulder issues and stress fractures over a lifetime of medications and complex health problems
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