In his latest Fast10 blog Alex Bampton inspects the interesting relationship between an athlete and their GP. 

In many ways, runners and particularly competitive runners, have an advantage when it comes to health monitoring. This mainly stems from the fact that our bodies need to be firing on all cylinders to achieve the adaptations we hope to achieve through training week in, week out.

This means that we tend to clock when things aren’t feeling right earlier than most. Often athletes complain of a lousy session or a few laboured recovery runs a few days prior to the onset of full blown cold symptoms, for example. 

It is because we know how important it is to be fit and healthy, that our threshold for what’s ‘okay’ and thus what we are willing to tolerate tends to be lower.

The athlete can be a little… precious

A random back twinge may be largely ignored by a non-sports person because, rightly or wrongly, they can put up with a few days rest and an extra cushion at night. The same twinge in an athlete is likely to invoke an hour-long YouTube-led self-help session of targeted stretches, foam rolling and intermittent hot and cold treatments in an effort to quickly relieve the issue.

It is not necessarily because an athlete is any more caring towards their body, it’s just that that same twinge is impeding pain-free running which for many athletes is a complete deal breaker for what they consider acceptable.  

If your normal is legging it past the Houses of Parliament with your mates, then you might need to let the doc know. Photo credit: George Russell of Up and Running, Fleet Street).

When the doctor gets involved

Some problems require some form of medical intervention. Those lingering sort of issues that make us miserable, either because of, or-in spite of their impact on our running.

The list for such ailments is of course extensive but generally includes one, two or more of a pic ‘n’ mix selection of chronic pain/discomfort, fatigue, insomnia and low mood. The kind of things that can make us miserable enough to make the hassle of booking an appointment (invariably at an inconvenient time) with a GP, physio or other health care professional seem worth it.

If your problem can be handled by a highly recommended physio or osteopath and you can afford the treatment brilliant. If, like many athletes you do not have this luxury or your issue is not soft tissue-related then you’re likely to have to roll the dice with the local GP.

It is at this point that a conflict can arise. The NHS, for all its brilliance has limited resources. Resources that, quite rightly, are skewed towards emergency treatment and chronic disease management. For the remainder of cases, the GP must make an assessment based on the perceived impact a person’s ailment has on their quality of life before recommending them for a referral to a specialist.

There are other important considerations to be made. They of course have to make a judgement call on whether they believe the patient would benefit from a course of treatment versus rest in the case of physical injuries. But all things being equal this is where athletes can lose out if they have a GP that fails to take a patient-centred approach.

Feeling exhausted but still better than most

For example, a young distance runner comes in complaining of being exhausted after every run.

On the surface, they look fine and their vitals are normal. Young, slim-build, and they say they are able to run 5 miles a day which is far more than the average Joe. Afterall, aren’t most people exhausted after jogging five miles, let alone every day? Maybe they just need to run less?

The issue is of course that they aren’t the average Joe, they are an athlete and the only point of comparison should be themselves. It is far more important to investigate the changes that have led up to this point – their so called ‘loss of function’.

A chess player that complains he can only think 5 moves ahead might sound a bit of a nonentity. But if it turns out 5 years ago they were a grand master capable of thinking 25 moves ahead then there is grounds that this deterioration represents some level of cognitive decline.

By analogy, if our young athlete 6-12 months back could comfortably run 8-10 miles carefree then this is a red flag that needs to be addressed. It could be an early sign of relative energy deficiency in sport (RED-S), anaemia, depression, Lyme disease or even autoimmune diseases like coeliac disease and diabetes that are being partially masked by a patient’s athleticism. 

Talk to and work with your local GP. The NHS is working in extreme circumstances in 2020 and the fact your 5k PB isn’t dropping as quickly as you hoped might not be an alarm bell for them.

Some general advice

I think there needs to be some level of responsibility taken by everyone involved to ensure that athletes’ problems are noted and listened to at the earliest possible stage.

Coaches, an athlete’s wider support network and the athlete themselves have just as much responsibility as the health care professionals in ensuring that appropriate interventions can be made. A doctor of course KNOWS the important of taking a patient-centred approach and should be well-versed in taking a full history from a patient in order to contextualise their problems. But they also need a bit back from the athlete. Athletes need to get across two really important things during these consultations:

  1. That they are an athlete and what their baseline level of health / normality looks like. 

I.e. “I am a competitive distance runner and I would usually be running 60-70 miles a week…”

  1. The impact of their current health problem on their running relative to their own baseline from point 1. It may also be good, if relevant, at this point to explain the impact this is having on your mental health too. For many of us, running is an outlet for neutralising stress and an opportunity to meet up with friends which can be compromised when we are injured or otherwise feeling unwell. 

i.e. Over the last 2 months I’ve been really struggling to summon any energy to run even 3 miles a day and when I do I’m exhausted. It’s also meant I’ve been feeling increasingly lonely as I’m no longer seeing my friends as much…

Communication can be key

Ultimately this will lead to productive discussion between an athlete and physician. It will also ensure that a good, trusting patient-doctor relationship is established from the off.

I think historically, some athletes in a bid to be heard have felt the need to exaggerate or worse invent symptoms. But this can lead to problems of its own.

Being open and honest with ourselves, our coaches and our GP at all stages has got to be the way forward and I think that’s something we can all improve upon going forwards.

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