Doc On The Run Podcast

How should I ramp up my mileage after injury?

I have a great question from a runner who was injured and is now recovering. 
 
She is getting better, she is back to running, she is advancing her mileage, she is increasing her strength, and her stability. And she asked me during a call whether or not she should follow some specific formula to get back to running. 

She asked me about the "10% rule." 

How should I ramp up my mileage after I have been injured but I am returning to running? Should it be by percentage? Should it be by miles? What is it? 

Well, good question and that is what we're talking about today on the Doc On The Run Podcast.

Should I do proprioceptive retraining exercises before or after I run?

Last night I was on a follow-up call with a trail runner who had chronic ankle instability. She was working hard to get strong enough to run on trails without worrying about rolling her ankle. 

One of the things that she was working on was proprioceptive retraining. 

"Proprioception" just means your ability to tell position and space. 

She called me about a week later and she asked:

“Should I do proprioceptive retraining exercises for my ankle before or after I run?”

Well, that is a great question and that is what we're talking about today on the Doc On The Run Podcast.

How does chronic synovitis lead to plantar plate injury?

I was recently on a second opinion web cam call with a runner who had a plantar plate injury.  One of the things we were talking about as was managing the inflammation in the joint next to the sprained plantar plate ligament.

The plantar plate ligament is basically a thickened plate of collagen that helps hold the toe down against the ground and reinforces the bottom of that joint capsule.

Inflammation in the joint which doctors call "synovitis" can damage the plantar plate.

The chronic inflammatory fluid surrounding the plantar plate ligament is going to slowly degrade the collagen in the plantar plate ligament and make it more prone to stretching out, or worse, getting little plantar plate ruptures.

How does chronic synovitis lead to plantar plate injury? 

Well, that is what we're talking about today on the Doc On The Run Podcast.

Does a stress fracture always hurt when walking?

I just got off a second opinion consultation call with a runner who called because he thought he had a stress fracture, and he asked a great question... 

He said, “Well, I don't get it. It hurts every time I run, but it doesn't hurt when I walk. So, that means I don't really have a stress fracture, right?”

Does a stress fracture always hurt when walking? 

Well, that is a great question, and that is what we're talking about today on the Doc On The Run Podcast. 

#1 most worrisome problem with toenail lost to running

Have you ever had a toenail turn black and blue, and maybe even got so much of a bruise that the toenail fell off?

A lot of runners think of bruised toenails as a badge of honor for doing super long runs and completing marathons.

But you do not want toenails to fall off!

Believe it or not, I have had runners ask me  if I would permanently remove their toenails so that they would no longer get black toenails. But I do not recommend it.

What is the number one most worrisome problem when you lose a toenail from running? 

Well, that is what we're talking about today on the Doc On The Run Podcast.

Should I get an MRI to tell me if I can run now?

One of the questions I often get from runners is whether or not they can get a clear indication that the overtraining injury has healed enough that they can start running. 

This is most common with stress fractures and plantar plate injuries, and things like Achilles tendonitis.

All of these injuries, regardless of which specific one it is, whether it is a tendon, a ligament, or a bone, you want to know if you can start running and if it is healed. And it makes sense that you would want to get an MRI.

Should I get an MRI to tell me if it is okay to run now? 

Well, that is a great question and that is what we're talking about today on the Doc On The Run Podcast. 

What are the 3 types of bone edema on MRI in a runner with stress fracture

I was just on a call with an injured runner who had what she thought was a stress fracture.  We were talking about the way bone stress injury shows up on an MRI. We all would like to believe MRI creates a perfect picture.

It is true that there is a tremendous amount of images and information that you can get from an MRI, but you have to understand that most of the imaging of bone on MRI is not really looking for a crack. 

It's looking for trouble in the form of inflammation or edema within the bone. So, I thought it might be useful to talk about the three types of inflammation or edema that you can see in a bone on an MRI.

What are the three types of bone edema on MRI in a runner with a stress fracture? 

Well, that is what we're talking about today on the Doc On The Run Podcast. 

 

Always closely compare right foot vs left foot with a running injury

Just this morning, I was on a second opinion call with a runner who had an issue.

He said, “It is only going to take a few minutes. I would not even use the entire time because I have a simple problem.”

Every time I do a consultation, I try to see if I can compare the right foot versus the left foot. I wanted to see both of his feet and he just showed me the one that was hurting. 

I told him I needed to see the other one and he said it did not hurt and it did not matter, but it does matter. It is super important. 

Why should you always compare the right foot to the left foot when you have a running injury? 

Well, that is a great question and that is what we're talking about today on the Doc On The Run Podcast. 

Doctor’s job vs. Runners job in healing overtraining injury

Every time a runner calls me who signs up for a consultation and they want a second opinion, they have already seen a doctor and they are often very frustrated. 

They are very frustrated because they were in a boot for a long time and it did not help, or they were told to not run for months, and it did not help. 

I hate to tell you this but almost every time I talk to one of these runners who is justifiably truly upset because the doctor did not listen to them about their goal.

But the problem is that every one of these runners I talk to, there is something that they did not do that they could have done to make this go faster and a lot of that comes down to communication between you and the doctor and it is critical that you understand this.

What is the difference between the doctor's job and the runner's job when you have an overtraining injury? 

Well, that is what we're talking about today on the Doc On The Run Podcast. 

3 ways stress fracture in a runner turns into non-union

One of the most common injuries I see in runners is a stress fracture. 

All overtraining injuries in runners are stress induced injuries and a stress fracture of course implies too much stress applied to the bone. 

A stress fracture is not a problem that you get not because you ran too much, not because you ran too far, or too soon. 

Stress fractures only result when your training exceeds the bone's threshold to recover before your next workout. If you keep doing that, it could get much worse. 

What are the three ways a stress fracture can turn into a non-union in a runner? 

Well, that is what we're talking about today on the Doc On The Run Podcast.