Nikki Kimball ruled the women ultra running scene from the early 2000s to the mid-2010s, winning everything from national trail championships to Western States, Leadville, UTMB and many more. Besides being ubiquitous on ultra podiums, and a board member of Hardrock 100, Kimball, now 49, has always been open about her depression. While she works as a physiotherapist in Bozeman, Mont., with a couple of mental health professional friends, she’s also set up a regular running clinic dedicated to helping local people fight depression.
We sat with her and talked about how and why the COVID-19 situation can bring psychological distress to some of us runners. She elegantly analyzes the situation and gives her perspective on ways to cope with it all. Forcing yourself to remain active and running is, of course, one of them.
PR: What sort of training have you been able to log in lately, and how often?
Nikki Kimball: I have been fortunate enough to manage to be doing either cross-country skiing or running every day with my dog. I also backcountry skied late in the season in a couple of couloirs around Bozeman that are Northeast- or North-facing. One holds its snow until about mid-July, and the other is still accessible now. These are narrow couloirs where you don’t want to fall. It’s sketchy, but doable.
Earlier, cross-country skiing has been ideal this season because it has allowed me to be more isolated than if I was running on the roads or some of our famous trails. I felt reasonably safe like this. But of course, not being able to car-pool is also not great because it is not environmentally friendly. I guess you can’t have it all, can you?
PR: I know you’ve been working a lot lately, even during the shutdown. Tell us why physical therapists are frontline workers and how you are generally feeling about this pandemic situation.
NK: I’m not super worried, but I’m not relaxed either. I’m sort of on guard.
We have to socially distance ourselves as much as we can, but we also have to treat people with severe medical problems. Those may not be direct life-threatening situations, but if you never get your ankle back, for example, you’re never going to be able to run again. And it becomes a more severe problem. Also, if you get hooked up on opioids because you can’t get pain relief, that also becomes a huge deal. My work is about keeping people out of hospitals and doctors’ offices. PTs need to work right now because we are keeping people off narcotics. A lot of our patients have chronic pains. And if they’re not moving, they automatically need more meds, more drugs. Since there aren’t [many] proper pain medications out there on the market that are not addictive, one of our tasks is to help people with their pains so they won’t need as many drugs.
PR: What about the ones you coach? I bet you have runners in psychological distress directly because of COVID.
NK: Oh absolutely! A few of the athletes that I coach struggle emotionally now. Some are having real problems because they trained for a race that ends up not happening. Having raced for over 40 years, I’ve had events that have been canceled on me for various reasons. I’ve been through that. I’d been training my whole life for a US team race and then 9/11 happened. And suddenly I couldn’t get to the competition. And I lived. I did just fine. I guess sharing those experiences with my athletes can be very helpful to them.
PR: You’ve been very successful at some of the hardest ultra races around the world, which all required extreme mental strength as well as resilience. All ultra runners know that. But you’ve also been subject to clinical depression from time to time and have always come out victorious. I would imagine that is why people would want to turn to you to get the help they need. Do you agree?
NK: Well, being an ultra runner helps. In a 100-miles race, one goes through so many different emotions. Sometimes there is pain. Sometimes it’s beautiful, and everything feels fantastic. Then suddenly another switch goes off, and you feel like you don’t want to run at all, and you’re never going to run again. The emotions and the difficulty, and the challenges, the mental flexibility required for somebody to successfully have an ultramarathon career are skills that can make you better at handling some of the terrifying things in life, like a pandemic.
PR: The synergy between running and depression is a very natural one. In psychiatric literature, it is now well established that aerobic exercise is incredibly helpful in mitigating symptoms of depression.
NK: Absolutely! But it took a while. It’s only in 2010 that the American Psychiatric Association added supervised regular exercise as a first-line treatment for major depressive disorder. What it means is that the scientific evidence is strong enough that one of the clinical recommendations for the treatment of depression is exercise.
From my end, I think that the mix between physical therapy and psychological counseling or psychiatry works well with runners. When a healthy runner gets injured, he will be quite miserable. And when somebody uses running to help their mental health, it’s even worse. It can lead to death. So it’s an emergency situation. As physical therapists, we are good at finding alternative exercises for, say, somebody who sprains their ankle and can’t run. We will find other activities that give the person that same cardiovascular stress that helps their depression.
PR: This is true with other sports as well. Many sports can teach people skills that will eventually help them later in other aspects of their lives.
NK: Yes, but running can be different in that some of us don’t do so well when we’re not running. Because, let’s put it this way: some are using running to make themselves mentally sane, whether it’s part of their treatment for depression or whether they’re just a better person when they run. It can be problematic in a time like now, especially if you are in an area where you cannot run. Imagine someone living alone, losing a job, and who, on top of that, cannot go run like before. It’s a dire and sad situation. Suicide has hit us hard in Montana, more than it usually does, directly because of COVID. We are also being turned away from emergency departments that are only taking COVID patients. So yes, I am worried about the mental health of some runners in this country right now.
PR: Because we’re all struggling through those uncertain times, there must be runners who never had an anxiety disorder in their lives, people who had not previously been depressed, and who are today showing significant symptoms of depression. What advice would you give those people? What tools would you recommend they use?
NK: Because of COVID-19, we may not be willing to run as much as we used to, or enjoy life as before. I understand that all of life may be up on the air right now. I’m not a psychiatrist or a psychologist, so I can’t diagnose people. I can only rely on those feelings and agree that isolation is scary. My only advice would be to see a doctor. It’s all about getting support. Whether it’s depression or addictions, you can’t survive them without support. We have to remember that we are a social species. I’m personally doing pretty well because I have been going out hiking, and most generally being outdoors every second that I can.
PR: Counseling is a support you can easily get online now, through Zoom meetings and other types of cloud-based video conferencing services. Are you using those yourself in your line of work?
NK: We’re using online video services to treat some of our patients, yes, so they don’t have to leave their homes. But it’s not ideal because the results sometimes won’t be as good as if we had treated them in person. Physical therapy is essential for some post-operation patients to get a range of motion back. One of my patients had significant ankle fracture-dislocation. If I were not doing manual therapy on her, she would end up having a permanent disability.
The sum of stuff happening right now is overwhelming. All of my friends who are counselors or psychiatrists are incredibly busy these days. A Zoom running group created locally is an excellent idea. I’m terrified of people’s future mental health as it gets colder and darker this coming fall. Since people are at least surviving right now, I think such a running group may even be a better idea in the fall.
Gaël Couturier is a French journalist living in Los Angeles. He’s an avid marathon runner (8 NYC, 6 Paris, 4 Médoc, 3 LA and 1 Honolulu marathon in Iraq during the war), countless ultra running events finisher (including 4-times UTMB and 7 Marathon Des Sables), not to mention 17 Ironman triathlons.