Doc On The Run Podcast

Do not ask me if you do not know your pain numbers

In the Injured Runners Aid Station, I get questions from injured runners that stop me in my tracks.

“I got this injury while running. I had a stress fracture. It was grade two stress fracture. It's been six weeks. How much longer will it be before I can run?”

Every injured runner wants to know when it will be safe to run. But, I cannot make that decision based on that information. It seems crazy, but "how long until you can run" is never just about "how long since the injury started."

Do not ask me if you don't know your pain numbers. 

That's what we're talking about today on the Doc On The Run Podcast. 

Tall fracture boot vs Short fracture boot, which is better for runners?

It's no secret that I truly believe fracture walking boots are overprescribed, overused and used for way too long for many injured runners with many different kinds of overtraining injuries.

But sometimes I recommend runners use a fracture walking boot for a short period of time. Then teh question becomes which kind? Short boot or Tall boot?

A tall fracture walking boot versus a short fracture walking boot. Which one is better if you're an injured runner? 

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

Do I have to wait for a callus to go away before I can run?

I just saw a woman with an extremely painful callus on the bottom of her foot. She got a type of callus doctors call an "intractable plantar keratosis." When you get one of these calluses, it turns into a tiny rock hard callus embedded deep in the skin on the bottom of the foot.

It hurts. It's like having a little rock taped to your foot. In theory, you can start running as soon as the callus is removed. 

But the real question is whether or not running right away will increase the probability of getting the same callus again. 

Do I have to wait for my callus to go away before I can run? 

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

How can I tell if I should have surgery to remove a big toe fracture fragment?

If you get a fracture in your big toe joint it can be easy to get talked into surgery. Especially if you see fragments on an X-ray. 

Your doctor may call old broken bone pieces by a number of terms:

"Osteophytes"

"Fracture fragments" 

"Loose bodies"

"Surgical targets"

If your doctor points them out and starts talking about surgery, the chances are good that you're going to want to have them removed. But there are times when surgery is totally unnecessary. 

How can I tell if I really need to have surgery to remove a fracture fragment in my big toe joint? 

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

Best imaging study to assess non-union stability

If you get a metatarsal fracture and it does not heal, doctors call it a "non-union." 

Sometimes, even if you have a non-union you can still run. Maybe without surgery.

The single most important consideration with a non-union is stability.

The more stable the bone is, the more likely the fracture will heal.

The more stable the bone is, the less likely it will cause pain.  

The more stable the bone is, the sooner you can start running. 

The more stable the bone is, the less likely you will need surgery.

One of the keys to deciding when it's actually healed enough has to do with that stability. When it comes to assessing it, everybody wants an imaging study.

What's the best imaging study to assess non-union stability when you have a fracture? 

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

Is two weeks on crutches better than one week with a tibial stress fracture?

I just got a great question from a runner with a tibial stress fracture that had been misdiagnosed with shin splints.

She wanted to know how long to use the crutches.

Is two weeks on crutches better than one week when I have a tibial stress fracture?

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

Last chance option to avoid non-union surgery in a runner

Today's episode applies to any injured running pondering surgery. 

I just spoke to a runner who was told she might need surgery to fix a non-union of a metatarsal fracture. 

I said, “Look, you have two choices. You can have surgery or not have surgery.”

We talked about what it meant if she did have surgery in terms of her recovery. And we also talked about how she could potentially get it to heal without having all the risk associated with surgery. 

What is the very last option you can do as a runner to avoid surgery? 

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

 

Minimal restrictive intervention is the goal with runners

If you are an injured runner, you are probably limiting your activity. 

Doctors who don't understand how important it is for you to get back to running tend to limit runner's workouts more than necessary. They're more restrictive than necessary. And it costs you.

You lose more fitness, you get weaker, you get stiffer, you get neuromuscular changes that damage your running form, and disrupts your coordinated firing of muscle units that makes you efficient. 

All of that gets damaged over the weeks that you're not running. So, it's really important that you maintain your fitness.

Today on the Doc On The Run Podcast, we're talking about how the minimum restrictive intervention should always be the goal with injured runners. 

I had a sudden injury but my doctor called it a stress fracture

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I had an interesting question from an athlete who asked, 

“I had an injury, I went to see the doctor and got an X-ray. There was no crack on the X-ray, but my doctor called it a stress fracture. So, I'm confused.”

“I thought that a stress fracture happens when you run too much, too far, too soon, it overloads the bone, and you get a little crack in it. I didn’t do that. It was trauma, a sudden injury, not a bunch of force applied over a long period of time. I wasn't training for anything. I don't get it. Why is my doctor calling this a stress fracture?”

I had a sudden injury, but my doctor called it a stress fracture. 

That's what we're talking about today on the Doc On The Run Podcast. 

Fix the original pain first

I recently did a webcam consultation with an athlete who has had a lot of trouble for a long time. He was very, very athletic. He started having pain and a whole lot of trouble that ensued afterwards that severely changed his athletic picture in only a couple of years. 

After years of seeing experts and not getting any better, he asked me to help him to do a second opinion and help him reassess where he was and what he might be able to do.

The way I think about this is really simple. Many of the bad things that happen after the original injury are because of compensation or your body trying to keep pressure off of that worst injury that happened first. 

So, I always tried to address that first injury, first!

Today on the Doc On The Run Podcast we're talking about why you need to fix the original pain first.