Doc On The Run Podcast

Is stretching safe with a calcaneal stress fracture?

A runner with a calcaneal stress fracture has a problem. So we got on a call. 

The problem with calcaneal stress fractures is not healing. The heel bone "heals" fast!

Runners with calcaneal stress fractures really have 2 problems:

1. How do I let the heel bone heal fast

2. How can I fix the scarring that happens during step 1?

I was recently doing a call with a real runner who had a calcaneal stress fracture. She was having some issues because she was returning to running.  The problem was not the heel bone.
 
She noticed a lot of stiffness and irritation around the ankle joint, because she'd been immobilized and off of the foot for quite a long time. Anytime you use a boot or crutches, you get lots of indiscriminate scarring. You can't run unless you fix that.
 
Is stretching safe with a calcaneal stress fracture? 
 
Well, that's what we're talking about today on the Doc On The Run Podcast.

MRI essentials for runners, slice size matters

If you recently got an MRI and then looked at the MRI report, it may seem like a bunch of gibberish. 

What you really want to see is a picture of the actual injury.

So you do the most reasonable thing...you try to look at the actual MRI images to see if you can see the stuff mentioned in the report.

You put your MRI disc in your computer, or you go on an online viewing portal and you pull up your MRI images to try to make sense of it.
 
You're trying to figure out if it really picked up your injury or not. 

Did the MRI miss my plantar plate sprain?
Can the MRI show me the actual crack in the bone?
Where is the tear in the tendon or ligament?
 
This episode on the size of the slices might help you. It will also help you a lot if you're going in to get an MRI because you have an injury and your doctor is going to order an MRI.
 
Today on the Doc On The Run Podcast, we're talking about MRI essentials for runners, slice size matters. 

How ankle stiffness can lead to another stress fractures in a runner

Let's say you're out on a run and you start feeling some aching pain in your foot. The next day you wake up, it really hurts when you step out of bed. 
 
You go see a doctor and you're told you have a stress fracture. 

Being told you have a stress fracture is a real bummer because the doctor will probably tell you it will take about six weeks to heal. Then things get worse...

You are told you need to wear a fracture walking boot for about four to six weeks, and of course, you can't run during that time. 
 
After you wallow in tears, you decide to be a "good patient." You go with the plan.

You sit around in the boot.

You don't do anything. 

You don't take the boot off. 

You don't run.

You don't exercise. 

And a month or two later...you finally get clearance to run!

But when you first go for your run, everything feels super stiff! Your running form is terrible. You feel really slow. But more than anything else, you really notice how super stiff everything feels around the ankle.

Today on the Doc On The Run Podcast, we're talking about how ankle stiffness can lead to another stress fracture in a recovering runner. 

I rolled my ankle and foot hurts here. What is it?

An injured runner called me with a problem. "I rolled my ankle and it hurts HERE. The explanation from my doctor didn't make any sense, because the pain on the top of my foot is not where the trouble was on the X-ray." 

I asked for some pictures showing where he felt the pain. And then it started to make sense. 

Ankle ligaments are not the only structures that get injured when you roll your ankle!

If you are a runner with an injury and you want to get back to running you really need to understand what structure could be damaged.  Then you can decide whether or not it's dangerous for you to ramp up your activity.

If a doctor gives you a vague answer that usually tells me that the doctor doesn't know what's going on. 

But if you really think about where the pain is, AND the mechanics of rolling your ankle during an ankle sprain event... you can figure it out!

I rolled my ankle and my foot hurts here. What is it? 

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

MRI essentials for Runners, T1 vs T2 images

If you're a runner who got injured and got an MRI, I'll bet that you've already tried to look at it...but you have simply no idea what you're looking at. 

You see there are more than a hundred images of your foot on the MRI. So, you're not even sure where to start. MRI's can be really overwhelming!

But MRI images are not really that complicated. 
 
In this series on how to read your own MRI, I'm going to break it down and help you understand your own MRI images, especially if you want to see  what was in the MRI report from the radiologist.
 
Today on the Doc On The Run Podcast, we're talking about MRI Essentials for Runners, T1 versus T2 Images.

Injured runners need a Goal Race

If you're injured, you really need to have a goal.

If you were to call me for a private consultation or a house call, I would not accept "I want to get over my foot pain" as a goal.

But interestingly, when injured runners call me, that's often what they say. 

Think about this. When you sign up for a race, it's really easy to get motivated. It's easy to decide on your training plan and just get to work.

But when you are injured, you think the process has to stop.

Today on the Doc On The Run Podcast, we're talking about why injured runners need a goal race.

How to get access to an Alter-G treadmill

Today's episode comes from a recent question from a runner who I advised to begin running on this thing called an AlterG treadmill. 
 
First of all, I do not own an AlterG treadmill. I do not own the company. I don't own stock in the company. I do not get paid a referral fee or anything else if you use one. 
 
I'm not pitching the AlterG treadmill because I get paid for it. 
 
But the AlterG treadmill is a tool that I not only use frequently with athletes who are returning to running, but it is a tool that I teach physicians at conferences to use with their patients as well.
 
How can you get access to an AlterG treadmill when the physical therapy place says no? 
 
That's what we're talking about today on the Doc On The Run Podcast. 

Your brain is your adversary when you first start running

You and your brain are supposed to be on the same team. You work hard with long runs, tempo runs and speed work to get your brain used to the idea of letting you run fast.  

But sometimes your mind can work against you. This is especially true when you first return to running after a foot injury. 

Your brain remembers your pre-injury ability. If not restrained, your brain instinctively wants to get you back to running at that same pace. 

If you just started running post-injury, a little more detail may help you avoid a common trap.  

You need to understand how powerful your mind is when it comes to your pace, your return to running and staying below your threshold for re-injury. 
 
Your brain can be your adversary when you first start running after an over-training injury. 
 
That's what we're talking about today on the Doc On The Run Podcast.

Value of getting an MRI on both feet

There are only a few occasions when you might want to get an MRI on both feet. 
 
Truthfully, getting an insurance company to agree to pay for an MRI on both feet is not easy to do. 

A few years ago I helped a runner who was training for marathons when he got injured. He was super fit. But on a long, super steep run in Yosemite he did some damage to tendons in both of his feet.

He really needed an MRI on both feet. So, I wrote an order for his MRI's. But, when the MRI facility tried to get prioritization, the insurance company denied the MRI request.

That just didn't make any sense to me. 

Is it valuable to get an MRI on both feet?

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

3 variables you can modify when you run after injury

When you're trying to get back to running, you have to think about all of the variables that can increase the stress and strain to your injured tissues.

Your "threshold for recovery" or your "threshold for re-injury," are really the same. 
 
When I lecture at medical conferences, I always tell doctors there are 3 variables you have to play with. 

And you do have to play with the variables if you want to get an athlete back to running as quickly as possible.
 
What are three variables you can modify when you're starting to run after you've had an injury? 
 
Well, that's what we're going to talk about today on the Doc On The Run Podcast.