Doc On The Run Podcast: Recent Episodes
Dr. Christopher Segler
Running injury tips on self-diagnosis and self-treatment. Simple strategies for rapid recovery of running injuries.
Can you still do your race after breaking a toe?
Many runners assume a broken toe automatically means canceling the event. But that's not always true.
In this episode of the Doc On The Run Podcast, Dr. Christopher Segler shares a real strategy call with a runner preparing to hike the Tour du Mont Blanc after suffering a displaced fourth toe fracture only one week before departure.
In this episode you'll learn:
• The two complications that can permanently affect future running after a broken toe
• Why pain isn't the only thing you should monitor
• How swelling predicts future problems
• Why shoe stiffness matters more than most runners realize
• How to determine whether your toe is stable enough to test
• Why a broken toe doesn't always mean canceling your race
Have you ever felt guilty about taking a day off during stress fracture recovery?
For many runners, the hardest part of getting back to running isn't the injury itself—it's resisting the urge to complete every planned workout.
In this episode of the Doc On The Run Podcast, Dr. Christopher Segler shares a simple mental strategy that can help runners recover faster by changing the way they think about recovery days.
In this episode, you'll learn:
• Why runners often feel guilty about taking a recovery day
• The biggest mental mistake competitive runners make during stress fracture recovery
• How soreness and fatigue can actually become valuable warning signs
• Why your coach wants you close to the injury threshold—but never across it
• The simple mindset shift that can prevent setbacks
• Why "earning" a day off can help you recover faster and race sooner
• How to balance fitness gains with protecting a healing stress fracture
The goal isn't simply working harder.
The goal is getting stronger while protecting your healing bone so you can get back to racing as quickly as possible.
Have you ever felt a strange sensation that seemed like a rubber band squeezing your Achilles tendon, shin, or foot?
It may not be pain…
But it might be one of the earliest warning signs that you're about to make a running injury worse.
In this episode of the Doc On The Run Podcast, Dr. Christopher Segler introduces what he calls the "Rubber Band Sign"—a subtle sensation reported by runners with Achilles tendon injuries, tibial stress fractures, and metatarsal stress fractures that may signal increasing stress before significant pain develops.
In this episode, you'll learn:
• What the "Rubber Band Sign" feels like
• Why runners describe it before pain develops
• How it may relate to Achilles tendinosis and stress fractures
• Why swelling around injured tissue may create this sensation
• What to do if you notice it during your return to running
• Why paying attention early may help you avoid a bigger setback
The goal isn't simply recognizing another symptom.
The goal is recognizing an early warning sign before your injury gets worse.
When your doctor recommends surgery, there is one question most runners never ask.
But it may be the most important question of the entire conversation.
In this episode of the Doc On The Run Podcast, Dr. Christopher Segler explains why runners should not simply accept a recommendation for surgery without understanding how confident the surgeon is that the procedure will actually get them back to running.
Using a recent second-opinion strategy call with an experienced ultrarunner, Dr. Segler discusses how asking for a "guarantee" isn't really about demanding certainty—it's about understanding your surgeon's confidence, expectations, and reasoning.
In this episode, you'll learn:
• The one question most runners are afraid to ask before surgery
• Why "Can you guarantee I'll get back to running?" is really about confidence, not contracts
• How surgeons think differently about different injuries
• Why vague surgical recommendations should prompt more questions
• How to decide whether surgery truly supports your running goals
• Why reassurance and clarity matter before making a permanent decision
The goal is not simply having surgery.
The goal is choosing the treatment that gives you the best chance of getting back to running.
When is the single most important time during the healing of a metatarsal fracture?
Most runners assume the hardest part is waiting weeks to get back to running.
In reality, the most critical period may be the very first week after the fracture occurs.
In this episode of the Doc On The Run Podcast, Dr. Christopher Segler explains why the first seven days after a metatarsal fracture lay the biological foundation for healing, and why seemingly small mistakes during that first week can delay your recovery.
In this episode, you'll learn:
• Why the first week is biologically the most important phase of healing
• What happens during the inflammatory phase after a fracture
• Why bone stability is essential for successful healing
• How movement disrupts the body's repair process
• Why even sleeping without your boot may slow healing during the first week
• How small movements from exercise can delay recovery
• What runners should focus on before worrying about fitness
The goal is not simply surviving the first week.
The goal is creating the strongest possible foundation for the bone to heal so you can get back to running sooner.
If your stress fracture seems to be healing, should you keep repeating the exact same run?
It sounds safe…
But it may actually slow your progress.
In this episode of the Doc On The Run Podcast, Dr. Christopher Segler explains why repeating identical runs can prevent a healing stress fracture from adapting and getting stronger.
Using the example of a runner returning from a tibial stress fracture with a race only three and a half months away, Dr. Segler explains why variability—not repetition—is the key to safely rebuilding bone strength.
In this episode, you'll learn:
• Why repeating the exact same run can stall bone remodeling
• Why soreness beginning around mile two matters
• How cumulative fatigue changes the stress on a healing bone
• Why bone adapts to progressive, varied loading—not identical loading
• Different ways to vary your running without increasing injury risk
• How to build fitness while reducing the chance of another setback
The goal is not simply proving you can repeat the same run.
The goal is helping the bone become stronger so you can safely return to racing.
Are you testing your stress fracture every day just to see if it's getting better?
That simple habit may actually be slowing your recovery.
In this episode of the Doc On The Run Podcast, Dr. Christopher Segler explains why repeatedly testing a stress fracture—especially by intentionally reproducing pain—can keep you above your healing threshold and delay your return to running.
In this episode you'll learn:
• Why runners naturally want to "check" their injury
• How repeated testing can increase stress on a healing metatarsal
• Why pain-testing is different from progress tracking
• How to identify useful recovery milestones without slowing healing
• The concept of your healing threshold—and why it matters
• A smarter way to monitor recovery while preserving your fitness
If you’ve had multiple fifth metatarsal fractures and you also have osteoporosis, can you still run safely?
Many runners assume the answer is automatically “no.”
But that is not necessarily true.
In this episode of the Doc On The Run Podcast, Dr. Christopher Segler explains how runners with osteoporosis can sometimes continue running safely after stress fractures or fifth metatarsal fractures—as long as they understand the specific risks that may have caused the fractures in the first place.
In this episode, you’ll learn:
• Why osteoporosis increases stress fracture risk
• Why repeated fifth metatarsal fractures may not just be about bone density
• How road slope can overload the fifth metatarsal
• Why biomechanics matter in recurrent fractures
• The difference between healing and remodeling
• Why runners with osteoporosis have to be more vigilant about stress management
• The key questions runners should ask before returning to training
The goal is not simply avoiding fractures.
The goal is staying active without re-injuring the bone.
What is the fastest way to calm down extensor tenosynovitis when you are a runner trying to keep training?
In this episode of the Doc On The Run Podcast, Dr. Christopher Segler explains his personal “secret weapon” for reducing inflammation in extensor tenosynovitis and helping runners get back to training faster.
Extensor tenosynovitis happens when the tendon sheaths on the top of the foot become irritated and inflamed. It can become painful with every step, every toe movement, and every run.
In this episode, you’ll learn:
• What extensor tenosynovitis actually is
• Why inflammation inside the tendon sheath becomes so painful
• Why tight shoelaces often trigger the problem
• Why oral anti-inflammatory medications may not help much
• The risks of corticosteroid injections around tendons
• How the contrast bath routine works
• Why alternating hot and cold water may rapidly reduce swelling
• How runners can calm irritation while protecting fitness
The goal is not simply reducing pain.
The goal is calming the inflammation fast enough that you can safely get back to running.
If you have a stress fracture and you’re trying to figure out whether it is safe to run again, should you get an MRI or a CT scan?
Many runners assume there is one perfect imaging test that can tell them exactly when they are cleared to run.
Unfortunately, it is not that simple.
In this episode of the Doc On The Run Podcast, Dr. Christopher Segler explains the real difference between MRI scans and CT scans for stress fractures, what each test actually shows, and why imaging alone often does not give runners the “green light” to return to training.
In this episode, you’ll learn:
• Why MRI is usually better for detecting early stress reactions
• Why CT scans are better at identifying true cracks in bone
• Why inflammation on MRI does not always mean you cannot run
• How bone remodeling can confuse runners and radiologists
• Why repeat imaging can sometimes create more confusion
• How CT scans may help determine whether a fracture is truly healing
• Why imaging findings have to match your symptoms and training goals
The goal is not simply getting another scan.
The goal is understanding whether the bone is actually tolerating stress well enough for you to safely return to running.
What happens when a former professional triathlete and endurance coach suddenly develops a painful plantar plate sprain?
In this episode of the Doc On The Run Podcast, Dr. Christopher Segler speaks with Marcus, a former professional triathlete and current triathlon coach from Brazil, during a real running injury strategy call focused on plantar plate injuries in runners and triathletes.
Marcus had to cancel an upcoming 45K trail race after developing sudden pain under the ball of the foot consistent with a plantar plate sprain. During the call, they discuss how plantar plate injuries develop, why bunions and shoe selection can increase stress on the plantar plate ligament, and how endurance athletes can protect the injured ligament while maintaining fitness.
They also discuss:
• Why MRIs often fail to tell the whole story with plantar plate tears • Whether carbon-plated running shoes can reduce plantar plate strain • How to maintain fitness without worsening the injury • Why boots alone are often not enough • The biggest mistakes runners make during plantar plate recovery • How shoe construction can affect forefoot stress • Why triathletes are uniquely vulnerable to forefoot overload injuries
If you’re a runner or triathlete struggling with forefoot pain, second toe pain, a plantar plate tear, or a plantar plate sprain, this episode will help you better understand the injury and what actually matters during recovery.
If you have popping or clicking around the outside of your ankle, do you actually need peroneal tendon surgery?
Not necessarily.
In this episode of the Doc On The Run Podcast, Dr. Christopher Segler explains the 5 reasons runners might actually consider surgery for painful popping peroneal tendons—and why many runners may not need surgery at all.
In this episode, you’ll learn:
• What the peroneal tendons actually do
• Why peroneal tendons pop or click
• When popping is actually dangerous
• The difference between painful instability and harmless clicking
• Why some split peroneal tendons heal without surgery
• The most important question runners forget to ask surgeons
• How to think about surgery from a runner’s perspective
The real goal is not simply fixing the tendon.
The goal is getting back to running.
How do you know if your stress reaction just turned into a stress fracture?
That’s one of the most important questions a runner can ask—because once there’s a crack in the bone, everything changes.
In this episode of the Doc On The Run Podcast, Dr. Christopher Segler explains the 5 key signs that indicate your stress reaction may have progressed into a true stress fracture.
Understanding these signs can help you avoid making the injury worse and make smarter decisions about training and recovery.
In this episode, you’ll learn:
• The difference between a stress reaction and a stress fracture
• Why that distinction matters for runners
• The 5 warning signs your injury has progressed
• The most reliable sign that you may have a crack in the bone
• Why bruising is a major red flag
• How to think about injury severity when making training decisions
If you want a clearer way to assess your injury, get the free Stress Fracture or Injury Self-Assessment Worksheet at:
https://www.stressfracturesecrets.com/mistake
If you have plantar fasciitis and you’re trying to keep running, you’ve probably been told to stretch, rest, or stop running altogether.
But what if the solution is much simpler?
In this episode of the Doc On The Run Podcast, Dr. Christopher Segler explains the one simple trick he personally used to fix his plantar fasciitis while training for Ironman races—without stopping running.
This episode breaks down how small biomechanical changes can dramatically reduce stress on the plantar fascia and allow healing while maintaining fitness.
In this episode, you’ll learn:
• What the plantar fascia actually does
• Why plantar fasciitis develops in runners
• How road slope changes stress on your foot
• The simple adjustment that reduced strain instantly
• Why small changes can make a big difference in healing
• When this trick will work—and when it won’t
If you have a calcaneal stress fracture and a 100-mile race on your calendar, the question is simple…
Can you still run it?
In this episode of the Doc On The Run Podcast, Dr. Christopher Segler lets you listen in on a real strategy call with an ultrarunner trying to decide whether he can complete a 100-mile race in just over two months after being diagnosed with a calcaneal stress fracture.
This episode breaks down the real risks, the real decisions, and the exact strategy needed to balance healing with maintaining fitness.
In this episode, you’ll learn:
• Why calcaneal stress fractures are especially risky for runners
• The biggest danger that could permanently end your running
• The 3 key signs that tell you if you're getting better or worse
• How to maintain fitness without making the fracture worse
• The most dangerous time before your race (when most runners make mistakes)
• How to find the exact line between healing and training
If you want a clearer way to assess your injury, get the free Stress Fracture or Injury Self-Assessment Worksheet at:
https://www.stressfracturesecrets.com/mistake
What do you do if you’ve been training for months and suddenly get a stress fracture right before your race?
In this episode, I explain the four real options runners have when they don’t want to cancel—and how to think about risk, recovery, and still crossing the finish line.
If you want a clearer way to assess your injury, get the free Stress Fracture or Injury Self-Assessment Worksheet at:
https://www.stressfracturesecrets.com/mistake
If you have been out of running for weeks with a fibular stress fracture and the pain is gone, but you still feel a little pressure at the injury site, should you wait until you are 100% symptom-free before trying to jog again?
That is the question in this episode of the Doc On The Run Podcast.
In this episode, Dr. Christopher Segler explains why the answer is not based on time alone. Just because you have stopped running for four to six weeks does not automatically mean the bone is ready for impact. What matters more is whether your symptoms are improving, whether you can tolerate increasing load without worsening symptoms, and whether you have rebuilt enough strength and stability to run safely.
In this episode, you will learn:
- Why “no pain” does not always mean “fully healed”
- Why a slight sensation does not automatically mean you are not ready
- The 3 key factors to assess before a return-to-run test
- Why the fibula is lower risk than the tibia, but still needs a careful approach
- The biggest mistakes runners make when returning after a stress fracture
- How to know if your recovery progression is actually working
If you want a clearer way to assess your injury, get the free Stress Fracture or Injury Self-Assessment Worksheet at:
https://www.stressfracturesecrets.com/mistake
If your doctor told you that you have a plantar plate injury, did they mean stress, strain, or sprain?
Those terms sound similar, but they mean very different things when you are trying to heal and still run.
In this episode of the Doc On The Run Podcast, Dr. Christopher Segler explains the biomechanical difference between plantar plate stress, plantar plate strain, and plantar plate sprain, and why understanding those terms can help you avoid delayed healing, unnecessary time off, and long-term toe instability.
In this episode, you’ll learn:
- What the plantar plate actually does
- The difference between stress, strain, and sprain
- Why runners often get plantar plate injuries at the second toe
- How to tell whether your plantar plate is irritated or actually injured
- The two biggest mistakes runners make when trying to return to training
- How to modify workouts without making the injury worse
If you want a clearer way to assess the severity of your injury, get the free Stress Fracture or Injury Self-Assessment Worksheet at StressFractureSecrets.com. This description reflects the transcript’s focus on distinguishing load versus actual ligament damage, the signs of instability, and the practical return-to-running decisions runners need to make.
If you have peroneal tendon pain and one doctor says your MRI shows a tear while another says it is just post-surgical change, what are you supposed to do?
That kind of conflicting advice can leave runners completely stuck. You do not want unnecessary surgery, but you also do not want to keep training on a tendon that may actually be torn.
In this episode of the Doc On The Run Podcast, Dr. Christopher Segler explains a practical framework runners can use when MRI findings and medical opinions do not match.
In this episode, you will learn:
• Why peroneal tendon injuries are often difficult to diagnose accurately
• How MRI can sometimes overcall or miss a split tear in the peroneal tendons
• Why different doctors may look at the same scan and reach different conclusions
• Four practical options a runner can consider before making a major decision
• Why diagnostic ultrasound can sometimes add more useful information than another opinion alone
• How to think about a careful test run without masking pain signals with ibuprofen
If you are trying to decide whether your peroneal tendon is healing, needs more imaging, or might need surgery, this episode will help you think more clearly about your next step.
When is it actually safe to start loading a stress fracture again?
In this episode, Dr. Christopher Segler explains how runners can think about progressive bone loading without making the injury worse. He covers why “just rest” is incomplete advice, why pain relief does not equal full healing, the 3 phases of stress fracture recovery, and the biggest mistake runners make when they try to return too soon.
If you have a stress fracture and your doctor starts talking about X-ray grading systems, you may think that grading is the key to deciding whether you can run, cross-train, or still make it to your race.
But for runners, X-ray grading is often not the most useful thing at all.
In this episode, Dr. Christopher Segler explains the two things that matter more than X-ray grading of a stress fracture:
Your goal, and the true severity of the injury.
He explains why most imaging reports do not actually answer the practical questions runners care about most, like whether they can maintain fitness, how aggressive they need to be, and whether they can still complete a goal race. He also explains why tracking measurable symptoms is far more useful than vague descriptions or medical jargon.
In this episode, you’ll learn:
- Why X-ray grading often does not help runners make real training decisions
- How your race goal changes your treatment strategy
- Why injury severity determines what you can still do safely
- Which symptom details are actually useful to track
- Why measurable numbers help you return to running faster
If you want a more practical way to think about stress fractures as a runner, this episode will help.
If you feel an unusual ache in your foot during marathon or triathlon training, you might worry that you have a stress fracture. But many runners actually develop a stress reaction before a true stress fracture occurs.
The problem is that runners often ignore the early warning signs. They experiment with shorter runs, slower workouts, or simply hope the discomfort goes away.
In this episode of the Doc On The Run Podcast, Dr. Christopher Segler explains three critical first aid steps runners should take immediately when they suspect a stress reaction in the foot.
You’ll learn:
• Why stress reactions and stress fractures are closely related
• Why runners often waste valuable training time by “negotiating with themselves” about the pain
• The importance of tracking injury severity
• How comparing photos of your feet can reveal subtle swelling or bruising
• Why reducing stress on the bone is essential to prevent worsening injury
If you act quickly and manage the injury correctly, you may be able to calm the stress reaction down while maintaining your running fitness.
If you suspect a metatarsal stress fracture but your most important marathon is on the calendar, you need a plan—not panic. In this episode, Dr. Christopher Segler explains the only two questions that determine whether you can keep training (or even race) without making the stress fracture worse, plus what you should measure and track starting today.
If you think you have a stress fracture, you’re probably wondering how long it will take to heal — and when you can run again.
In this episode, Dr. Christopher Segler explains the three stages of bone healing, why early protection matters, why pain can disappear before the bone is strong, and how to safely apply stress at the right time so you don’t restart the healing clock.
If you want to heal faster and protect your race, this episode is for you.
If you’re a runner dealing with a stress fracture, you’ve probably been told to “just stop running” and come back in six to eight weeks. But that advice completely ignores the way runners think. In this episode, Dr. Christopher Segler is going to walk you through the crucial questions every runner with a stress fracture should be asking—but that most doctors never do. We’re talking about what might actually be slowing your healing down, what you could be doing right now to maintain your running fitness, and what objective metrics you should be tracking so you know exactly when it’s safe to do more. Because if you want to heal fast and get back to running, you need better questions—and better answers.
When does a metatarsal stress reaction actually show up on imaging? In this episode of the Doc On The Run Podcast, Dr. Christopher Segler explains the difference between a stress response, stress reaction, and true stress fracture—and why timing matters when choosing X-rays, MRI, ultrasound, or CT scans. Learn how early imaging can help you make smarter race decisions, avoid false reassurance from a “normal” X-ray, and protect your fitness without turning a minor stress reaction into a full fracture.
Can you still run a race if you have a stress fracture—or will it permanently set you back? In this episode of Doc On The Run, Dr. Christopher Segler answers the most urgent question injured runners ask when a big event is approaching: can I still run my race with a stress fracture? You’ll learn how to assess risk, distinguish pain from damage, and make a clear decision without sabotaging your long-term recovery.
How much walking is too much when you have a tibial stress fracture? In this episode of Doc On The Run, Dr. Christopher Segler breaks down how runners can safely stay active while healing, explains the key differences between Fredrickson Grade 1 and Grade 2 tibial stress fractures, and outlines the two critical factors that determine how fast you can recover—without making the injury worse.
Today I was on a strategy call with an injured, but recovering runner who is trying to figure out how to organize his workouts to get strong quickly, without re-injuring his stress fracture.
He was headed in the right direction, but was making a critical mistake when trying to do more with split workouts. It’s not about splitting workouts.
It's all about the stressors that are applied to the stress out bone. But this also applies to other overtrain injuries like Achilles tendinitis, perennial, tendinitis, or plantar plate sprains.
If you understand, this basic principle, you will definitely get back to running a whole lot faster!
Today on the Doc On The Run podcast, why any runner with any overtraining injury should focus on making sure there are no big stressors on the same structures.
The Walk-Run Routine is likely the most overprescribed and least understood plan for returning to running after an overtraining injury like a metatarsal stress fracture for a plantar plate sprain.
But the commutative forces that result from that specific routine may put your foot at unnecessary risk of re-injury. Understanding how and why those unique stresses happen may help you make better decisions about your first few runs after you feel your stress fracture or plantar plate sprain has healed enough to resume running.
Today on the Doc On The Run podcast, we're talking about the worst thing about walk run routine after running injury.
Kettlebell workouts can be a great way to maintaining strength, even if you have a running injury.
If you are a runner who has an overtraining injury like a metatarsal stress fracture or a plantar plate sprain, you are probably doing everything you can to keep the rest of your running body strong, while that one injured part heals.
Kettlebell training can help, as long as you don’t let those kettlebell workouts overload that injury to the ball of the foot.
You have to pay close attention to form and technique. Today on the Doc On The Run podcast, we're talking about Kettlebell mistakes and modifications for injured runners.
This morning I was on a webcam call with a runner who had healed a fracture and started running again. He has been running every Monday, Wednesday and Friday, with cross-training in between.
Now he is ready to add a fourth running workout to his weekly training schedule.
The question is:
“What day of the week is best to add an additional run, because I want to make sure I don’t overload the healing tissue and re-injure it.”
Today on the Doc On The Run podcast, we're talking about which weekday is best to add workouts for injured runners.
The half-ass boot routine is no good. Slow improvement with unnecessarily increased risk of atrophy, weakness, stiffness, loss of neuromuscular connections, and destruction of your running form. Your running form, your strength, your flexibility, all protect you from another overtraining injury.
When you wear a fracture walking boot for a long time inconsistently, or a long time walking on it, you're going to get more of those bad things.
The other thing that is good, the sort of polar opposite of that, is a half-ass weight routine.
Whaat is that? And more importantly, why would that be good?
Today on the doc on the Run podcast, we're talking about half boot versus half weight when you're recovering from a running injury.
The biggest enemy in the injured runner’s battle is your desire to run as fast or faster than you were right before you got injured.
This morning I was on a call with a recovering elite Masters athlete and she has been doing great, but she seems to be drifting into dangerous territory!
During our call, I got worried about the way she was thinking about her upcoming workouts. But was thinking was very common, and very dangerous. And that is the reason I decided to record this episode.
Today on the Doc On The Run podcast, we're talking about how you should never let your recovering body compete with your racing body.
This morning I was on a consultation call with a runner at 4:30 a.m. and he's been suffering from a plantar plate injury. But he's been doing pretty well. He actually just finished his first run!
Now, what I asked him about was his plan for his next run. What he said, made me uneasy.
It seemed risky, and I started kind of squirming as he was describing his plan to me. It wasn't really a bad plan. It wasn't really a crazy plan. But based on all the experience I have working with injured runners, I knew it was riskier than it needed to be.
And this is why I decided to record this episode. Because it happens to almost every injured runner! So don't let it happen to you!
Today on the Doc On The Run podcast we’re talking about why runners get re-injured one to two months into healing.
Runners glorify the suffering needed to keep moving in spite of pain, and the payoff is almost always increased fitness, and improvements and mental fortitude needed for running endurance.
No pain, no gain is a terrible approach when you are an injured runner. If you really want to get back to training, racing in full return to running fitness as fast as possible after a running injury you have to stop causing pain in that one injured part. Do not confuse that with stopping running-related exercise. That's the lazy doctor's way.
In this episode, we discuss a different, better approach for runners.
Today on the Doc On The Run Podcast we are talking about Mental Rehab for Recovering Runners with Mental Skills Coach Carrie Jackson.
It may sound dramatic, but in reference to doctors casually telling runners they just cannot run a race (when maybe the runner could run), or worse…they may never run again, Carrie says, “These doctors have no idea the trauma they are causing to the runner by saying that.”
Carrie co-authored “Rebound: Train Your Mind to Bounce Back Stronger from Sports Injuries.” So, she is not just empathetic toward runners, she is 100% qualified to help runners get your mojo back after a serious injury sets you back physically, and the pain of recovery sets you back mentally.
Not only is she a Certified Mental Performance Consultant through the Association for Applied Sport Psychology, but Carrie is also the host of the Injured Athlete’s Club Podcast.
If you have an injury, and you feel down. There is a solution. Listen in to Carrie, and you will find it.
Today on the Doc On The Run Podcast we are talking with Dr. Samantha Braun about training fro Ultra’s, running Hell’s Hills and how her training as a Physical and Rehabilitation Medicine Physician helps her avoid overtraining injuries. How do you think you're training in rehabilitation help you understand your own mechanics, physical training limits and overtraining injury prevention while training for Ultra’s? During the 50 mile trail race, what did you do to restore a more positive mindset and keep running to your potential? Knowing what you know now, what would you do differently to prevent that injury from happening? Right now there is some runner listening who is suffering from an over training injury, and very likely of how demoralized they have become as a consequence of not running. If she was sitting there in front of you right now and you knew this about her, what advice would you give her to encourage her to keep healing, working and getting stronger so that she could get back to running?
Over the past couple of months I have done a whole bunch of stress fracture strategy calls with runners who seem to be stuck. I take notes every time I do those calls and there're number of steps that all of them seem to be missing. Let's face it, if they weren't missing some critical steps, we would've never gotten on a call to try to figure out a strategy to get them back on the path to healing and running again.
In this episode I'm going to explain the five critical stress fracture steps every runner should take if they really want to get back to training and back to running as quickly as possible.
Today on the Doc On The Run podcast we're talking about the five critical stress fracture steps for runners.
I just got off of a Stress Fracture Strategy call with a real runner who has been suffering from a stress fracture for 47 days.
Over the past five weeks she has been getting worse, not better.
And she hasn’t even been running for more than a month!
If you have a stress fracture, or a stress reaction and you are:
- worried about canceling race because of a stress fracture
- your stress fracture is not getting better fast enough
- worried you're going to lose your running fitness waiting for the stress fracture to heal
This episode will help you understand the strategies I use whenever I worked directly with runners with stress fractures, and apply those strategies to help you figure out how to speed up your stress fracture recovery.
Today on the Doc On The Run Podcast we are talking with Alexandre Dufresne about his journey and getting back to running after having suffered 2 metatarsal stress fractures at same time!
If you think back about your training leading up to the 2 stress fractures, if you could go back in time, do you think there's any one thing you could have changed in your training routine that might have prevented it from developing into such a serious problem? Listen up to find out!
Today on the Doc On The Run Podcast we are talking with Patrick Durante about Automatic Negative Thoughts and how they affect runners.
Many years ago I was having a discussion about daily stressors with a friend of mine name Maury. He said something I have never forgotten.
“It's not the lions and tigers that will get you. It's the ants and mosquitoes because problems.”
Every single over training injury that afflicts runners as a consequence of developing too much stress. The constant buzzing of mosquitoes and ants may drive you crazy. And Today we are talking about the creepy, crawly kind of ant, but A.N.T. or Automatic Negative Thoughts that buzz through our heads and inhibit our ability to finish races on time, complete training runs in a gratifying way, and may even may inhibit our recovery from hard workouts or over training injuries.
If you're a runner with a stress fracture you're probably trying to figure out everything you can do right now this going to speed up healing of the injured bone, so you can get back to running as soon as possible.
If you have been thinking about bone broth or nutritional supplements like vitamin D and calcium you already know how important it is to get the nutritional building blocks into your system so your osteoblast cells can't start repairing and rebuilding the crack in the bone.
Did you know there's actually a cookbook written specifically to address the nutritional requirements four building healthy bones? Well, there is…it is called The Healthy Bones Plant-Based Nutrition Plan and Cookbook and in today’s episode I am getting to got to sit down with Dr. Laura Kelly who wrote that cookbook.
No matter what injury you have, it could be a stress fracture or it could be tendinitis or it could be a sprained ligament, but whatever you do you have to sure you don't get re-injured, because that could be brutally demoralizing!
Because most runners think jogging is a lot easier than “real running” you might presume it's a lot safer for you to just start jogging to test out your state of recovery.
Today on the Doc On The Run Podcast, we’re talking about why jogging is a terrible way to test the state of healing of a running injury.
Hussein asked me an interesting question. He said,
“I fractured my tibia and fibula. Is it normal after 50 days the fracture is still visible under x-ray, but I am walking with crutches and putting partial weight bearing without any pain or discomfort? My treatment was with a fiberglass cast without any surgery since the bones were not displaced.”
Is it normal for a fracture to be visible on my x-ray after 50 days?
Well, that is a great question and that is what we're talking about today on the Doc On The Run Podcast.
If you have a high arched foot that is prone to getting stress fractures, a podiatrist may have told you that you need cushy running shoes.
I got a question from someone who was given that advice. She said,
“I am so confused, I thought stress fractures were from pounding. I got a stress fracture, and my doc said it was my cushy shoes. I do not understand how this is true.”
How do cushy running shoes cause stress fractures in the foot?
Well, that is a great question and that is what we're talking about today on the Doc On The Run Podcast.
I talk to lots of runners who have been given very bad advice.
If you are reading this, you are probably a runner, and you have probably had to deal with some kind of injury that interfered with your running.
If you have seen a doctor, I am very curious to know what advice you got.
Sometimes I am curious if the "bad advice" is what the doctor said, or if it is just a misinterpretation of what the doctor said to the runner.
Today on the Doc On The Run Podcast, we're talking about the worst advice ever from a doctor.
Today's episode comes from Jordan, who was watching a video called “Proof you do not have to stop running with a metatarsal stress response”.
Jordan wanted to know, “Do you think treadmill at a 5% incline will take some of the stress off the tibia?”
Can a 5% incline on your treadmill reduce the stress on a tibial stress fracture?
Well, that is a great question, and that is what we're talking about today on the Doc On The Run Podcast.
Today's question comes from Priscilla, after she watched the video “Proof you do not have to stop running with a metatarsal stress response.”
She says:
“I am a distance runner, I got a fourth metatarsal stress fracture, I was in the boot 3 months. X-ray is showing some healing but not 100%. I have been walking but I fear it will open up again. Is pain and fear of putting full pressure without the boot normal? I want to run, it is frustrating.”
Is pain and fear normal after a fourth metatarsal stress fracture?
Well, that is a good question and that is what we're talking about today on the Doc On The Run Podcast.
I have heard lots of different things that runners tell me their doctors said...,
"You are not built like a runner."
"You cannot run with your foot type."
"Running just does not work for you.
Decades ago, an orthopedic surgeon who did my reconstructive knee surgery said to me,
"If you ever run, you will have to have a total knee replacement within 10 years."
My knee is still good. And I have been running for decades. I did my first 50-mile trail race when I turned 50. I have done 15 Ironman triathlons. So clearly, my doctor's advice to stop running was wrong.
Did your doctor ever tell you to stop running after a stress fracture?
Well, I hope not, but if so, this episode might be for you because that is what we're talking about today on the Doc On The Run Podcast.
Today's episode comes from a question on the Doc On The Run YouTube channel regarding the video entitled “Proof you do not have to stop running with a metatarsal stress response.”
Brian was clearly frustrated. He commented:
“I wish… I have a big swollen reason under the second metatarsal. It tingles a bit while running. Slight burning. I have to alter my landing to not irritate it. I'm finished. Rest in peace to my running VO2 max. I got to focus on cycling.”
Does a stress response equal "rest in peace" to my VO2 max?
Well, that is a good question and that is what we're talking about today on the Doc On The Run Podcast.
Just this morning I was on a coaching call with a runner who is recovering from a stress fracture.
Almost every runner I talk to can immediately start exercising and start doing stuff to maintain their running fitness if they understand how severe the injury is, and they don't have to just take time off.
It is heartbreaking to me truthfully when I talk to somebody who has been completely off of their foot and on crutches in a fracture walking boot and worse, not exercising at all for two weeks, four weeks, or six weeks before I ever talk to them.
Today on the Doc On The Run Podcast, we're talking about why you should convert your off-season training program to your recovery program when you have a stress fracture.
I got a question from an injured runner, and she wants to know about the amount of time it takes to heal a stress reaction in the sesamoid bone in your foot.
She said:
“I have had a stress reaction in my tibial sesamoid that led to a lot of pain and swelling. I am reading mixed reviews on healing time. I have been off it for three weeks now, either on crutches and taping the toe to immobilize it or in a walking boot with tape on the toe and sesamoid dancing pads to avoid pressure on the bone. I am a 38-year-old healthy female.”
Today on the Doc On The Run Podcast, we're talking about sesamoid stress reactions and the expected healing time.
Today's question comes from someone who watched the YouTube video on the Doc On The Run YouTube channel called “How long before I can run with a stress fracture.”
The comment was:
“Thank you so much for this video. I want to ask if resting for three weeks, complete bed rest and I can afford to do this because I am a student, and it is summer holiday then I can walk to my college to do daily normal tasks. I do not do any physical training or running and my college is about a kilometer away.”
Will three weeks of bed rest heal a stress fracture?
Well, that is a great question and that is what we're talking about today on the Doc On The Run Podcast.
There is nothing worse than being told to stop running, especially when you have no idea how long you're not going to be able to run.
You like your doctor. She is nice. She is smart and helpful. She seems to really care about your running, and even listens to you talk about your last run.
But when she tells you, that you cannot run, there are three questions that you need to ask.
Today on the Doc On The Run Podcast, we're talking about the top three questions to ask your doctor when she tells you, you have to stop running because you have a metatarsal stress fracture.
When you get a stress fracture, the main thing you are trying to do is figure out how bad it is.
How much does it hurt?
How can you get it to heal as quickly as possible?
Although inflammation is an important part of the healing process, it can be very disruptive to two parts of your process of getting back to running.
What are the two worst things about inflammation when you have a stress fracture?
Well, that is what we're talking about today on the Doc On The Run Podcast.
When you get a stress fracture, the main thing you are trying to do is figure out how bad it is.
How much does it hurt?
How can you get it to heal as quickly as possible?
Although inflammation is an important part of the healing process, it can be very disruptive to two parts of your process of getting back to running.
What are the two worst things about inflammation when you have a stress fracture?
Well, that is what we're talking about today on the Doc On The Run Podcast.
One of the most useless obsessions I witness in runners is to focus on the grade a doctor uses to label the stress fracture.
You should care if you can run, you should care if you can work out, you should care if you have to sit around in a fracture walking boot and do nothing.
Most of the time runners call me and they are trying to get an answer from me on what they can do, I know their stress fracture grading is useless.
The reason for that is because I just asked two questions based on it and if you ask your doctor these same two questions, it will help you figure out whether or not you can start working out sooner.
Today on the Doc On The Run podcast, we're talking about two questions that prove to me your stress fracture grading is useless.
Ibuprofen is a very popular medication among runners. I have seen ibuprofen tablets scattered on the course at every marathon and triathlon I have ever done.
Runners take it when they have aches and pains, or to get through races, but I can tell you that there is only one valid reason to take ibuprofen.
To me, the only time a runner with a stress fracture should take ibuprofen is when you have what I call a non-skippable race.
Today on the Doc On The Run Podcast we're talking about the only time a runner with a stress fracture should take ibuprofen.
If you are a runner, it is critical that you do not lose your running fitness while waiting for a stress fracture to heal. Because that puts you at risk of getting another stress fracture once you have recovered and start running again.
I am always trying to think about a way that I can simplify the explanations of what I do with runners when they call me because they are not getting better after a period of being in a fracture walking boot for way too long.
There are really six steps that I follow.
Today on the Doc On The Run Podcast, we're talking about my six-step stress fracture framework.
After you recover from a stress fracture and you are getting back to running, there really are some details you have to pay attention to if you want to avoid a re-injury.
The name of the game is increasing your activity to the point that your metatarsal stress fracture can withstand the stresses you are applying to it.
What are the two most dangerous parts of a run when you have a stress fracture?
Well, that is what we're talking about today on the Doc On The Run Podcast.
When you get a metatarsal stress fracture from running, if you get a crack in the bone, it will eventually start to heal.
If you keep exercising, walking, running, doing elliptical training, and you are aggravating the fracture at all, the bone callus will get larger.
Over time, the bone callus will remodel, and that lump will get thinner. The lump of bone will get smaller.
But if you are having pain because you have a huge lump of bone in your foot, at some point you might want to take a look at it with medical imaging.
Should I get an MRI or an X-ray when I have a large bone callus after a stress fracture, and I want to assess the callus remodeling?
Well, great question and that is what we're talking about today on the Doc On The Run Podcast.
Metatarsal stress fractures are something I talk about a lot because they are one of the most common reasons a runner has to stop running.
One of the reasons you would stop running is that you do not want something called "plastic deformation" of the healing metatarsal.
What is plastic deformation of a metatarsal stress fracture in a runner?
Well, that is what we're talking about today on the Doc On The Run Podcast.
If you get an aching pain in your foot when you are running, and it turns out it is a metatarsal stress fracture, you are not alone. Stress fractures are extremely common.
But the last thing that you need is to stop running, take all this time off, get it to heal, and then get re-injured when you start running again.
There really are only three reasons that I see in runners when they get re-injured after they have fully recovered from a metatarsal stress fracture.
Are there really only three reasons for stress fracture re-injury?
Well, yes, and that is what we are talking about today on the Doc On The Run Podcast.
One of the most common causes of foot pain in runners is a metatarsal stress fracture.
Most of the runners who get a metatarsal stress fracture, complain of an aching pain in the middle, on top of the foot.
This episode is going to explain some of the reasons a runner may have pain after a metatarsal stress fracture has “healed” and you are starting to run again.
What are five causes of foot pain after a metatarsal stress fracture heals?
Well, that is what we're talking about today on the Doc On The Run Podcast.
Imagine you are months into training for an ultra-marathon. You are entering your peak build phase. You feel strong. You're excited about your upcoming race and the possibility of a new PR. Then you get an aching pain in your foot and you're told you have a stress fracture. If you found yourself in that exact situation, and you had to choose one, which would you pick: 1. a doctor who understands running injury treatment 2. a coach who understands training with injuries My personal opinion is that having a coach who understands training through a running injury is actually way more important than having a doctor who understands running injury treatment. Today on the Doc On The Run Podcast we are talking with Isobel and Ron of Peak Endurance Coaching about mindset, training shifts and what ultra-coaching has taught them about avoiding re-injury when training for ultras.
Today's episode comes from a comment posted on one of the videos on the Doc On The Run YouTube channel.
This was on the video that this person watched. It was called, “Can I still run after I heal a fibular stress fracture?” and in that video, I was trying to talk about how you can decide basically whether or not you can run after you have had a fibular stress fracture.
He said:
“Hello, I got a fibular bone crack while running and I have an army physical in 25 days. Please tell me the solution due to which I will be able to give my physical fitness test.”
I got a fibular stress fracture, and I have to run in 25 days. What should I do?
Well, that is what we're talking about today on the Doc On The Run Podcast.
Today's episode actually comes from a comment posted on a video on the Doc On The Run YouTube channel. That specific video was entitled "Best Exercise for Plantar Plate Sprain in Runners."
“Hi Doc, awesome help in all these plantar plate videos. I have been told by my podiatrist that I have a grade one possible border lane, grade two sprain/tear, and I am struggling to get it to heal while I keep running.”
What should a 53-year-old runner with a plantar plate sprain do?
That's what we're talking about today on the Doc On The Run Podcast.
Today's episode comes from a comment posted on a video on the Doc On The Run YouTube channel.
He posted a comment, and he said:
“This happened to me, I got a stress fracture on my right foot in the third metatarsal. I stopped all sports for two months and somehow ended up with two more stress fractures.”
Today on the Doc on the Run podcast, we're talking about somebody who stopped sports for two months and got two more stress fractures.
Tibial stress fractures can be serious, and seriously frustrating if you don't treat them appropriately and aggressively.
Today's episode from a question on one of the Doc On The Run YouTube videos. As you can guess from his question, I am sure Simon must be frustrated.
He asked:
Can a tibial stress fracture still hurt after 11 months?
Well, that is a great question and that is what we're talking about today on the Doc On The Run Podcast.
There really are three steps that I figured out that you need to do if you have a stress fracture but need to start running. Runners call me or ask questions about whether they can run with a "grade 2" or a "grade 3" stress fracture, but many times they do not even understand what that means. Truth is, the runner has not actually figured out how bad the stress fracture is, right now. What are the three steps you need to take if you want to start running with a stress fracture? Well, that is what we're talking about today on the Doc On The Run Podcast.
If you have a second metatarsal stress fracture, and you want to stop stressing the second metatarsal, so it can heal faster, you must take stress off that bone.
If you apply more pressure to all metatarsals (except the second), it will heal faster.
One of the runners who signed up for the metatarsal stress fracture course for runners was doing better and had starting to run.
He asked me a question I had just not thought of before.
He asked:
Should I stop using the metatarsal offloading pads after I start running again and my stress fracture is healing?
Well, that is a great question and that is what we're talking about today on the Doc On The Run Podcast.
One of the most common runners’ injuries I see for second opinion is a plantar plate sprain.
A plantar plate sprain happens usually on the bottom of the second toe. It is a little bitty ligament that gets sprained or partially torn.
Most of those runners with a plantar plate injury want to know how long is it going to take to get back to running.
Recently a few runners told me they asked chat GPT, or some AI program to try to figure this out. So, I wanted to tell you what AI told me when I asked this question of "how long can I run after a plantar plate sprain."
How long before I can start running after a plantar plate sprain?
Well, that is what we're talking about today on the Doc On The Run Podcast.
The navicular bone isn't a big bone, but is a critically important one. A fracture of the navicular is one of the most frightening things that I see in runners.
If you get a navicular stress fracture, there are a few mistakes that I often notice. If you can recognize them, you may spend a lot less time in a fracture boot, or off running.
What are the top five navicular stress fracture mistakes I see in runners?
Well, that is what we're talking about today on the Doc On The Run Podcast.
I get lots of questions from injured runners about stress fractures.
As a consequence, one of the most common questions I get is, "How long before I can run if I get a second metatarsal stress fracture."
So, in this case I decided to ask Dr. CHAT-GPT that question and see what happens!
How long before I can run with a second metatarsal stress fracture?
Well, that is a great question and that is what we're talking about today on the Doc On The Run Podcast.
Today on the Doc on the Run podcast, we're talking with Dr. Ralph Gonzalez about running UTMB Mont Blanc after recovering from a plantar plate sprain and Achilles tendinosis.
Specifically, he's here to talk about his path from injury to crossing the finish line at UTMB and what inspired him to run the challenging race.
From plantar plate sprain and Achilles tendinitis to running UTMB Mont-Blanc.
I was talking with an injured runner who had a stress fracture in the second metatarsal bone.
He was working hard to get it to heal faster. He had gone through the stress fracture course for runners, and he was doing great.
He asked me a question:
When can I walk at home barefoot with a second metatarsal stress fracture?
Well, that is a great question and that is what we're talking about today on the Doc On The Run Podcast.
I have recently had a rash of runners with navicular fractures.
The navicular is a bone that is right on the top of your foot, in front of your ankle and it's also at the apex of your arch.
Navicular fractures are scary because doctors often recommend surgery.
There are four times when you might really need to have surgery for a navicular fracture and in this episode, we are going to talk about why.
What are the four times a navicular fracture might need surgery?
Well, that is what we're talking about today on the Doc On The Run Podcast.
I was on a second opinion call with a runner. She developed a stress fracture in her accessory navicular bone.
If that wasn’t enough, she then started having pain in her arch in the tendon that pulls on her big toe. That tendon is called the Flexor Hallucis Longus Tendon, or FHL Tendon.
Can an accessory navicular stress fracture cause flexor hallucis longus tendinitis in a runner?
Well, the short answer is yes, and I am going to explain how in today's episode of the Doc On The Run podcast.
Jones fracture is a scary injury if you are a runner.
If you have been diagnosed with a Jones fracture and want to start running sooner, you must understand the severity.
Can a bone scan help you tell the difference between a Jones fracture stress reaction and a styloid stress reaction in a runner?
Well, good question and that is what we're talking about today on the Doc On The Run Podcast.
If you get a stress fracture in the fifth metatarsal, there are a couple of reasons why you might want to sleep in a fracture walking boot.
Your goal is to keep the total amount of stress applied to that stress fracture under your threshold for healing, throughout the entire 24-hour period.
Why should I sleep in a boot for a fifth metatarsal stress fracture?
Well, that is a great question and that is what we're talking about today on the Doc On The Run Podcast.
If you get a metatarsal stress reaction or a metatarsal stress fracture your doctor may order medical imaging to figure out how bad it really is.
Your doctor's goal is to really figure out if it is a stress reaction or is it a stress fracture.
What is the difference when it comes to medical imaging using a bone scan versus an x-ray when you are looking for a second metatarsal stress fracture in a runner?
Well, that is what we're talking about today on the Doc On The Run Podcast.
You have a couple of options when you get injured.
One option is to wait so long that you know for a fact it has to be healed enough that it can withstand the forces of running.
The other option is to move that timeline faster and make things happen a lot quicker. The only way to do that is by testing. One of the things you can test with is a test run.
A runner asked me how long her first test run should be, if she had been two weeks since the injury actually had happened.
Let us say you have been injured and you take a couple of weeks off. How long should your test run be?
Well, that is a great question and that is what we're talking about today on the Doc On The Run Podcast.
Whenever you consciously give your brain direction, your subconscious brain will go to work to achieve it.
Your subconscious mind is not just controlling things that you want to happen but it's controlling things that you don't want, too.
If you focus on negativity, if you focus on your injury getting worse, you will probably get worse.
So, the question is can you take this aspect of your brain and controlling your subconscious mind and use it to your advantage when you are trying to heal and get back to running?
Can simply thinking about healing make your running injury heal faster?
Well, that is what we're talking about today on the Doc On The Run Podcast.
Which do you think is worse, a stress fracture or a stress reaction?
Well, since a fracture is a crack and a reaction is just inflamed and irritating, you probably think stress reaction. However, it's not true. Sometimes stress reactions take longer than stress fractures to heal in runners.
Why can a stress reaction take longer than stress fractures to heal in a runner?
Well, that is what we're talking about today on the Doc On The Run Podcast.
I was just on a call with an injured runner who is about to go out for a test run.
She is very excited because she is going to get either a yes or a no on deciding if the tissue in her foot that is been healing is strong enough to withstand a little bit of running at a medium pace for a short distance.
This is an important test because if it hurts, obviously no running, right? You got to wait some more. But because you want to get a yes, you want to make sure that your chances of getting the yes are as high as possible.
The way that you do that is you protect the foot as much as possible. So, the shoes you should use for your test run really do matter a lot.
If you are going to go out and try a test run after you have been injured, what kind of shoes should you wear? Cushioning shoes or stability shoes?
Well, that is a great question and that is what we're talking about today on the Doc On The Run Podcast.
What if you were ramping up for several years to run 100 miles, but then you got tendinitis?
If you start getting pain because you have been doing lots of hill repeats, you could get irritation of the FHL tendon and specifically the tendon sheath that surrounds it where it bends around the back of the ankle. One of the treatment options is to inject it with corticosteroids.
So, this runner called me and wanted to know whether or not it would be a good idea for her to inject the tendon sheath with cortisone before her trail race.
If my FHL tendon is inflamed and irritated, should I inject the tendon sheath before my 100-mile trail race?
Well, that is a great question and that is what we're talking about today on the Doc On The Run Podcast.
If you get pain on the top of your foot because you irritated the extensor tendons, they can be very painful.
A runner asked me recently about using athletic tape to heal extensor tenosynovitis.
Since it seems like athletic tape can help almost any type of musculoskeletal injury, you might be wondering, could taping help the tendons or the tendon sheath on the top of your foot when it gets aggravated.
Should I use tape if I have extensor tenosynovitis?
Well, that is what we're talking about today on the Doc On The Run Podcast.
Yesterday I was at the Twin Cities Foot and Ankle Conference in St. Paul, Minnesota. The reason I was there is I was invited by the Minnesota Podiatric Medical Association to come and give a one-hour lecture, about "What's New in Sports Medicine."
It may not surprise you that most of what I was talking about was how to help injured runners get back to training, full activity, after overtraining injuries, as quickly as possible.
After my talk, another doctor out in the hallway approached me, and she asked an interesting question. What she asked was...
“If you yourself had an overtraining injury, whether it was a stress fracture, a plantar plate sprain, a tear of the plantar fascia, a split in the peroneal tendon, no matter what the injury was, if you yourself were given a deadline of 30 days to healing that thing enough, you could actually run outside without worrying about re-injuring that piece of tissue, what exactly would you do?”
If I had only 30 days to return to full running after an over training injury, what would I do?
Well, that is what we're talking about today on the Doc On The Run Podcast.
Today's episode comes from a running injury from Jamie. He wanted to know about hallux rigidus.
He asked:
“Are there any non-surgical approaches to helping hallux rigidus when you are not a good candidate for a cheilectomy?”
What can a runner do when you have hallux rigidus but you're not a good candidate for cheilectomy surgery?
Well, that is what we're talking about today on the Doc On The Run Podcast.
I often get some questions from listeners I would never imagine.
I just got one of those questions from a runner who has a mallet toe.
Her doctor suggested surgery. The runner was worried because she been researching hammer toes and mallet toes. During that search she learned a lot about the plantar plate ligament as it relates to crooked toes.
She was worried that if she had the surgery, it might cause a plantar plate injury.
Can a percutaneous tenotomy surgery cause a plantar plate injury?
Well, good question and that is what we're talking about today on the Doc On The Run Podcast.
Today's episode comes from a question posted on one of the YouTube videos, specifically on an episode called, “Should I get an MRI to see if I can run now?”
Haitham wanted to know:
“Would you say it is okay to walk if you are pain-free after being non-weight-bearing for two weeks? Does one always have to finish the standard five to six weeks of crutches?”
Does a runner always have to finish the standard five or six weeks on crutches?
Well, that is a great question and that is what we're talking about today on the Doc On The Run Podcast.
I was on a call this morning with a former professional Ironman triathlete. This guy is the real deal. He is not lazy.
He is not unmotivated. He is not unathletic. He is a top tier kind of athletic guy, and he is very, very aware of his body. He is also very adept at the process of damaging tissue we call "training" and the need for healing those tissues to make his body stronger.
What he also understands is that the process of healing a ligament sprain (or "injury") is the same thing.
During our call this morning, he pointed out that he barely slept last night. Since his plan was to ride on the trainer today, we were talking about the risk to the sesamoids.
He used a term I had not heard before, calling it "multifaceted negatives."
Should I work out today if I did not sleep well last night?
Well, that is a good question and that is what we're talking about today on the Doc On The Run Podcast.
I got a question from a runner with a fibular stress fracture.
She said her primary care doctor got r x-rays of the fibula bone.
The doctor could not tell from the x-rays if the spot on my fibula that looks odd might be an old stress fracture or a new stress fracture in the fibula bone.
The recommendation from the primary care physician was basically to just wait for four weeks, let it heal, let it calm down.
She asked:
“Is my primary care doctor's advice wrong?"
Should I just wait for weeks to let my fibular stress fracture heal?
Well, that is a great question and that is what we're talking about today on the Doc On The Run Podcast.
I was on a call with a patient who was a professional Ironman triathlete. He had a tibial sesamoid stress fracture.
The sesamoid bones are little bones underneath your big toe joint. They are kind of like tiny little kneecaps that you stand on. And when you are trying to heal one, AND maintain your fitness, it can be a real challenge. But a couple of little tricks can help.
How does taping a tibial sesamoid stress fracture actually help you heal when you are an injured runner?
Well, that is what we're talking about today on the Doc On The Run Podcast.
I was just lecturing at the International Foot and Ankle Foundation meeting in Hawaii.
In the very first talk, I asked one of the doctors sitting on the front row,
"What is your most important question about this patient?”
And he answered, “How did it start?”
I replied, “You do not care about how it started, you do not even care about the injury, you should care more about the runner's goals.”
You probably go to the doctor because your foot hurts, and you want your doctor to fix your foot. If you go there with that approach, that is exactly what you're going to get.
Any doctor can fix your foot, but you need the doctor to focus on your running goals instead.
What is the doctor's job when you have a running injury? Well, I can tell you what it is not. It is not to tell you to stop running.
That is what we're talking about today on the Doc On The Run Podcast.
Today's episode comes from a runner who asked me a very interesting question during a surgical second opinion webcam call.
She seemed to be really confused because the doctor had recommended performing hammertoe surgery in the doctor's office, and not an operating room.
She thought that was weird. She was also confused because the surgery would be performed using only a needle and not a scalpel.
Can a doctor really do a hammer toe surgery using nothing but a needle?
Well, that is what we're talking about today on the Doc On The Run Podcast.
Last week, I was in Hawaii lecturing at the International Foot & Ankle Foundation Medical Conference. meeting.
I had been invited to give several lectures on running injuries. One of those was about stress fractures for physicians, podiatrists, foot and ankle surgeons.
One of the objectives was to help them understand how they can look at stress induced injuries differently, with the intent of teaching the doctors that they really have to consider these timelines.
Timelines, forced decisions and action in injured runners, and that is what we're talking about today on the Doc On The Run Podcast.
Plantar plate injuries in runners are a common topic at medical conferences because they cause a lot of pain in the ball of the foot.
I just spoke to a runner who had an interesting question about plantar plate injuries, which was a question I never would have imagined.
She wanted to know whether or not a "mallet toe" might lead to a plantar plate sprain. She didn't really understand the difference between a "mallet toe" and a "hammer toe." But she did understand that one or both are in some way related to plantar plate injuries.
Does a mallet toe lead to a plantar plate sprain in runners?
Well, that is a good question and that is what we're talking about today on the Doc On The Run Podcast.
Today I was on the call with an injured runner who is trying to figure out how soon she can start running. She had been having pain and she was getting relief by taking over-the-counter medication. She asked me whether not that was good or bad.
Whenever we have pain, we can simply take a pill, and the pain will go away. Non-steroidal anti-inflammatory drugs or NSAIDs are powerful readily available painkillers. I do not just get rid of inflammation they also control or reduce pain.
So, when is it okay or not okay to reduce your pain with NSAIDs if you are in the process of recovering from a running over training injury?
That is a great question and that is what we’re talking about today on the Doc On The Run podcast!
Today I was doing a consultation with a runner who has a thing called an "accessory navicular."
She thought that the bump was much more swollen than normal.
She had basically rolled her ankle and banged that bone into a rock and then she was having some swelling there over the arch.
She did a form of cryotherapy called the contrast bath routine to reduce the inflammation. It suddenly got much smaller. Like the bone shrank.
How can that happen?
If I have an accessory navicular bone in my foot and I do the contrast bath routine, will that fix it?
Well, that is a great question and that is what we're talking about today on the Doc On The Run Podcast.
Okay...I'm just gonna say it...lots of runners get funky toenails. Runners get bruised toenails, black toenails.
But the worst thing is when the nail lifts up off the nail bed and you get fungal filaments that cause athlete's foot underneath the toenail. Then you get toenail fungus or onychomycosis.
If your doctor recommends oral antifungal medications, you may get worried about the side-effects of the medication.
Just today I saw a runner with toenail fungus. He wants it gone!
So I was talking to his primary care doctor about the potential of modifying the normal routine for oral medication for him so that he could reduce his concern for having liver problems as a consequence of taking this medication.
Today on the Doc on the Run podcast, we're talking about a couple of options you have if you are thinking about taking oral medications for toenail fungus.
If you start getting pain in the ball of the foot, especially in the area between the metatarsals, it might be caused by a little fluid-filled sack (called a bursa) that sits between the metatarsals.
Sometimes you get swelling of that little bursa, and it causes pain in the forefoot.
This problem could be misdiagnosed or thought to be caused by a neuroma, an inflamed nerve that runs in that same area.
What is intermetatarsal bursitis in the runner's foot?
Well, that is a great question and that is what we're talking about today on the Doc On The Run Podcast.
I have recently gotten a bunch of questions on one of the episodes I did where I mentioned somebody who had a stress fracture, and I had suggested that she should increase her cadence to try to decrease some of the impact forces through that particular bone when she was running and getting back to training now that she is really started to recover in a meaningful way.
Specifically, what we are talking about here is your cadence.
However, I think that since I have gotten so many questions about it, if you are interested in the idea of cadence and impact forces, this might be useful for you to get some clarification.
Is there any research on running cadence as it relates to impact forces in the foot?
Well, great question and that is what we're talking about today on the Doc On The Run Podcast.
This episode comes from one of the YouTube viewers on the Doc On The Run YouTube channel and he posted a question as a comment on one of the videos, and he wanted to know, how can I tell if I broke the plate and screws on my calcaneal fracture.
But number one, my number one question here is, what is it that this guy could have done that would have made him think that he applied enough force to the broken heel bone that he then could have broken the plate after the surgery?
How can I tell if the plate and screws on my calcaneal fracture broke?
Well, great question and that is what we're talking about today on the Doc On The Run Podcast.
Today's episode actually comes from a comment posted on one of the Doc On The Run YouTube videos.
The viewer asked, and he said exactly, “I dropped a piano on my foot. Will I run again?”
Well, that depends. If you drop a piano on your foot, maybe it would break your pinky toe. Maybe it would completely crush your foot.
I dropped a piano on my foot. Will I run again?
That is s a great question and that is what we're talking about today on the Doc On The Run Podcast.
A runner who has been recovering from a plantar plate sprain was on a webcam call just to follow up and ask me some questions about her first runs now that she is returning to running.
She wanted to know whether or not she should be running on a treadmill or running outside if there was any advantage or disadvantage to either.
Which is better when you are returning to running after an injury, running on a treadmill or just running outside?
Well, that is a great question and that is what we're talking about today on the Doc On The Run Podcast.
I was recently on a follow-up call with a runner who is recovering from a calcaneal stress fracture.
She was doing really well, the stress fracture was healing, and her heel pain had completely resolved. So it was time to start ramping up her running.
Since she wanted strategies to decrease stress on the stress fracture, we talked about increasing her running cadence.
She asked me specifically about the difference between pace and cadence, as she wanted to be absolutely clear on what they were.
What is a method you can use to alter your cadence when you have been recovering from a running injury?
Well, that is what we're talking about today on the Doc On The Run Podcast.
I just got a really obscure question from a runner suffering from chronic stress fractures.
She was asking about a surgical procedure called a tibialis anterior tendon lengthening in order to address a situation where she had the same kind of 5th metatarsal stress fracture, again.
Today on the Doc on the Run podcast, we're talking about tibialis anterior tendon lengthening for chronic fifth metatarsal stress fractures.
If you sprain your ankle, you know that you need to protect it.
The old treatment algorithm used to be R.I.C.E.: rest, ice, compression and elevation.
The newer protocol is P.R.I.C.E.: protection, rest, ice, compression and elevation.
Compression is one of the main things you need to do when you get an ankle sprain. When you sprain the ankle, it swells a lot and it's not going to get better, and you are not going to get back to running until sometime after that swelling goes away.
The point of this episode is that when your ankle is swollen, it is a different size from your non-swollen ankle.
What size compression socks should I get after a bad ankle sprain?
Well, that is a great question and that is what we're talking about today on the Doc On The Run Podcast.
Sometimes runners have to do a whole lot of digging trying to figure out the difference between a couple of different surgical solutions for a recurring injury.
Pain under the big toe joint can be because you are getting a stress reaction or a stress fracture in one of the two little sesamoid bones. It is pressure to that bone that is causing all the trouble.
How can a doctor surgically reduce that pressure?
What is the difference between a sesamoidectomy and a first metatarsal osteotomy for pain under the big toe joint?
Well, if you are wondering, that is what we're talking about today on the Doc On The Run Podcast.
I got a call from a worried runner who had a stress fracture.
The fracture was not healing so he called for a second opinion.
One of the things that he did not understand was this x-ray report that he got. The x-ray report and it said that he had "two millimeters of displacement of the fractured metatarsal bone without angulation."
So, in this episode, I am going to try to explain to you (the same way I explained to him) what "fracture displacement" really means and how it shows up on the x-ray in a runner.
What is metatarsal stress fracture displacement on an x-ray?
Well, that is a great question, and that is what we're talking about today on the Doc On The Run Podcast.
The plantar plate ligament that gets injured in runners is typically located on the bottom of the foot, at the base of the second toe.
It gets inflamed, it gets irritated, it may feel weird at first. The plantar plate may not even feel sprained, or sore, or injured. It might just feel like this weird sort of fullness sensation.
I got a question from a runner who had those same strange symptoms. He was trying to figure out what treatment would best address the "fullness" sensation in and around the plantar plate.
Which is better for an inflamed plantar plate in a runner who wants to run? Icing, cryotherapy, NSAIDs, which one is going to help the most?
Well, great question and that is what we're talking about today on the Doc On The Run Podcast.
I got a call from a runner who had a stress fracture that was not healing, who needed a second opinion.
When we were on the webcam call, one of the things that he did not understand was the specific medical terms on his MRI report. The MRI report said that he had "troughing" of the fractured metatarsal bone.
I just thought that it might be helpful to explain to you what metatarsal troughing really means and how it shows up on an MRI.
Today on the Doc On The Run podcast, we’re talking about what is metatarsal stress fracture troughing.
I was on a call with an active athlete who is recovering from a couple of different injuries and her main goal is to get back to running at high intensity.
But while she has been injured and she cannot really run, what she has been doing is cycling, swimming, and doing a number of different strength training workouts to supplement her running fitness.
She asked me an interesting question and she wanted to know whether or not swimming was really helpful in terms of her cardiovascular fitness more than just her specific running related strength.
Does swimming really help your running fitness improve after an injury?
Well, that is a great question and that is what we're talking about today on the Doc On The Run Podcast.
When you have a plantar plate injury, it can be frustrating. The whole problem stems from a tiny little ligament right at the base of the second toe that is getting irritated, stretched, and strained. If its really bad, you might even have some tiny little tears in the plantar plate ligament.
I was just talking to a runner who asked me about other exercises. Because, she had been told...
"stop running, do other exercises to get stronger."
So, she signed up for a boot camp training class. Although she wasn't running, shewas doing lots of exercises that were potentially harmful to the plantar plate and slowing her recovery, and eventual rturn to pain-free running.
So, which is better for a healing sprained plantar plate, running more or doing exercises that make you stronger like planks, push-ups, and burpees?
Well, that is a great question and that is what we're talking about today on the Doc On The Run Podcast.
I get lots of calls from runners who need a second opinion for running injuries like metatarsal stress fractures. Many times they are confused by medical terminology in their imaging reports.
In this particular case, the runner wanted to know what it meant when her radiology report said that there was "5 millimeters of shortening of the second metatarsal bone," the bone that had the stress fracture.
In this episode, I am going to explain what fracture "shortening" really means and how it shows up on a CT scan.
What exactly is shortening of a fracture when it shows up on a CT scan?
Well, that is what we're talking about today on the Doc On The Run Podcast.
I was just on a call with a trail runner who is recovering from both a sesamoid bone injury as well as a peroneal tendon injury.
Right now she is focusing on working toward running on long technical trail runs in the mountains. To that end she is doing a lot of different forms of activity to supplement her running fitness.
During our call, she asked a great question...
"Should I be adding a lot more time or a lot more intensity to rebuild her running fitness."
Which is more important to increase first, after you have had a running injury, time or intensity?
Well, that is a great question and that is what we're talking about today on the Doc On The Run Podcast.
If you are a runner and you got diagnosed with a plantar plate sprain, you probably already figured that out plantar plate sprains can be frustrating.
The plantar plate ligament is on the bottom of the foot, at the base of the second toe and it helps hold the toe down against the ground.
What is crossover toe deformity?
Well, if you look at the foot from the top, typically crossover toe deformity means the big toe tilts this way and the second toe forms a hammer toe and tilts that way and goes over the big toe. When you have the second toe over the big toe, it causes lots of problems.
Today on the Doc on the Run podcast, we're talking about when a plantar plate tear can cause or contribute to the development of a thing called crossover toe deformity.
Today's episode comes from a question that I got during a second opinion webcam call with a recovering runner.
She is running, she is doing fantastic, and she wanted to know if she should hire a running coach. By the way, this is a very experienced, very fast marathon runner.
After injury recovery, do I need to hire a running coach?
Well, that is what we're talking about today on the Doc On The Run Podcast.
Today's episode comes from a question posted in the comments section of one of the Doc On The Run YouTube channel videos.
Specifically, it came after a viewer watched the video entitled Top Three Clues of a Plantar Fascia Rupture and Davis posted a question.
He wanted to know, does a full or partial plantar fascia rupture greatly increase your risk for a re-tear.
Does a full or partial plantar fascia rupture increase your risk of a plantar fascia tear later?
Well, that is a great question and that is what we're talking about today on the Doc On The Run Podcast.
I was just on a follow-up webcam call with a runner who has chronic ankle instability but wants to get back to running on trails.
She is trying to decide when it is safe for her to make the transition from running on a smooth, flat surface like asphalt to running on uneven technical trails.
Since she had a long time off of running for a long time and she does not want to get re-injured.
She asked me a great question on a recent call.
“Should I be doing this proprioceptive retraining on both ankles or just the injured ankle?”
Well, that is a great question and that is what we're talking about today on the Doc On The Run Podcast.
If you are a runner, and you have pain in the ball of the foot, and you have been diagnosed with a plantar plate sprain, you probably already realize you are in for a lot of trouble.
It is very difficult to get the plantar plate ligament to heal while you are still running.
If you caused a plantar plate injury by hyperextending the toe, then obviously, you need to stop hyperextending the plantar plate by stretching it and pulling on it. At least, if you want to get back to running faster.
Today on the Doc on the Run podcast, we're talking about how hyper extension can lead to a plantar plate injury.
What if I told you that you could skip two days and avoid an overtraining injury altogether?
Well, if you are injured, you would probably go back and skip any two days I picked on your calendar, right?
Overtraining injuries are preventable. You do not get overtraining injuries because you ran too much.
You get overtraining injuries because you did not recover enough before the workout that you were not actually strong enough to withstand.
What are the two most important days you should skip to avoid an overtraining injury?
Well, that is what we're talking about today on the Doc On The Run Podcast.
Today's episode comes from a question that was posted as a comment on one of the videos on the Doc On The Run YouTube channel about the difference between a stress reaction and stress fracture in the fibula in runners.
He said:
“Hey, I really appreciate the video, I go to the gym a lot and I was doing the treadmill at maximum speed and one day my fibula started hurting a lot after the gym in the lower leg on the outside and I found out it was my fibula. I took a day of rest and went back to the gym, and I was running on the treadmill even when my leg was hurting.”
What is this painful bump that might be a fibular stress fracture?
Well, that is what we're talking about today on the Doc On The Run Podcast.
I was just on a follow-up call with a trail runner who has chronic ankle instability. She had some follow-up questions about some of the exercises I gave her to do.
Gluteus medius weakness is known to contribute to ankle instability.
One of the exercises I gave her will strengthen the gluteus medius muscle.
She asked a very specific question about fixing injury when you have identified a weakness, and you are trying to get back to running.
Which is more important, time or range of movement when you are doing the gluteus medius activation exercises and you have ankle instability?
Well, that is what we're talking about today on the Doc On The Run Podcast.
I was just on a webcam call with a runner who had a plantar plate injury.
We were reviewing her MRI. And one of the first things I did was check to see how big the slices were on the MRI.
That's because there can be a wide variation on how tight those cuts are when the MRI imaging machine is taking those pictures.
Believe it or not, there's research that shows how big the plantar plate ligament usually is.
How big is the plantar plate ligament?
Well, great question and that is what we're talking about today on the Doc On The Run Podcast.
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.
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.
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.
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.
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.
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.
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.
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.
Anything the runners does to heal faster will get the runner back to running faster.
Even simple things you can do at home can help change the course of an injury.
On of the oldest treatments for musculoskeletal injury, and one any runner can do themselves, is massage.
A runner on webcam just asked me whether or not it might help her plantar plate injury recover faster. The short answer is:
Yes, massage can help as along as you do not injure the plantar plate ligament further in the process.
How does massage really help when you have an injury? Yes, there are a couple of ways massage can help, as long as that massage does not make the injury worse.
Today on the Doc On The Run Podcast, we’re talking about the good and bad, or the risk vs benefits of massage with a plantar plate sprain.
Runners who have rolled their ankle often have trouble figuring out when to get back to running.
Mostly they seem to be worried about a subtle fracture or delayed ligament healing.
If you think it is no big deal when you roll your ankle, you might be right, and you might be wrong.
What is the number one most important action you can take when you roll your ankle running?
Well, that is what we're talking about today on the Doc On The Run Podcast.
I know if you call me for a consultation, it is not because you want to talk to me because you watched a YouTube video or listened to a podcast, it is because you have a race and everybody else is telling you there is no way you can do it.
Well, that may be my specialty, but today I am going to help you understand how you can figure this out yourself.
It is not really that complicated, it is just that other doctors do not want to tell you how to do it, so I am going to try to explain it to you.
How can you calculate the amount of rest you really need between your running injury and your race?
Well, that is what we're talking about today on the Doc On The Run Podcast.
If you have a pain in the ball of the foot, underneath the base of the toes, that is right where your fat pad cushioning is located.
There is a lot of misunderstanding about what fat pad atrophy really is, particularly when it is related to something like a plantar plate injury.
Sometimes runners have true fat pad atrophy, but that is rare.
More often runners have fat pad displacement that feels like atrophy.
I think that fat pad displacement is more common than atrophy, and I am going to try to explain why.
What is the difference between fat pad atrophy and fat pad displacement in runners?
Well, that is what we're talking about today on the Doc On The Run Podcast.
I know I talk a lot about how necessary it is to reduce the stress and strain on the plantar plate ligament when you are a runner, especially if you are trying to get ready for a race while healing.
It is really difficult to do, but not impossible.
What are the four forms of stress and strain that can affect runners with plantar plate injuries?
Well, that is what we're talking about today on the Doc On The Run Podcast.
I was just on a call with an injured runner who has been healing from a plantar plate sprain. If you have had one of these, you know they're problematic.
The thing was that he asked me a question that really made me stop and think.
What he asked was, “Is stress good or bad for the plantar plate ligament?”
Well, that is what we're talking about today on the Doc On The Run Podcast.
Let me ask you to read 4 words and see how they land on you.
Skinny, weak, atrophy, neglect.
As a runner, would you want any of those words used to describe you?
When the fat pad cushion between the bones and the skin under the heel or the ball of the foot gets thinner, doctors call it “atrophy.” But don’t take it as an insult.
What really causes more atrophy of the fat pad cushion under the ball the foot in runners…inactivity, or too much activity?
Well, that’s what we are talking about today on the Doc On the Run Podcast!
I was just giving a lecture at the 46th annual International Foot & Ankle foundation meeting at the Swedish Medical Center in Seattle.
A foot surgeon in the audience asked a great question during the question-and-answer period following one of my lectures. Specifically, the lecture was medical imaging strategies to avert misdiagnosis in runners.
She asked, “After a runner has been offloaded with crutches and placed in a fracture walking boot or a cast for immobilization, do you incorporate cross training, or only focus on running?”
What is the one biggest mistake any doctor can make with a runner who has been on crutches?
Well, that is what we’re talking about today on the Doc On The Run podcast.
I was recently working with a runner who had really bad sesamoid issues.
She was taping it to try to decrease some of the motion around the big toe joint that could have been irritating the sesamoid bones.
She had a bunch of tape around the forefoot holding everything still. Weird thing was, she did not have swelling there. She had swelling elsewhere.
Is taping the sesamoids good or bad if you have swelling in the foot?
Well, that is a great question and that is what we're talking about today on the Doc On The Run Podcast.
If you get an aching pain under the big toe joint, it might be an injury to one of the two little bones called the sesamoid bones.
The sesamoid bone injuries make me super nervous. If you are a runner and you start getting pain and irritation if the sesamoids, you do not want to ignore it.
I just got off a call with a woman who had sesamoiditis. She wanted to make sure that she was not doing anything to slow the recovery of her sesamoid stress fracture.
With summer coming up, she wanted to know what kind of sandals she might be able to wear.
What summer sandals should I wear if I have sesamoiditis?
Well, that is a good question and that is what we're talking about today on the Doc On The Run Podcast.
I was just on a second opinion call with a runner. He is a triathlete, and he has had a long course of foot trouble. He was diagnosed with a plantar plate injury, but was not getting better.
We figured out some missing pieces of his recovery puzzle and developed a plan of action.
Well, he acted on that game plan and turns out he had been misdiagnosed. What he has is a neuroma (not a plantar plate sprain).
He went back to his doctor and she then wanted to inject his foot with cortisone, but he had a race coming up.
And then he said, “Well, this is the problem. This is why I am calling you again, is that when I saw her, she said you have a neuroma so let's go ahead and inject it with cortisone.”
Can I run a race after a corticosteroid injection for a neuroma?
Well, that is a great question and that is what we're talking about today on the Doc On The Run Podcast.
If you get a sesamoid fracture, you are probably worried. This is a scary injury if you are a runner.
Since stretching is one of the main components of physical therapy after many running injuries, you may think about stretching and why it might help your injury recover faster.
What is the single most important stretch if you are a runner who has had a sesamoid fracture?
Well, that is what we are talking about today on the Doc On The Run Podcast.
One of the most difficult running injuries is a plantar plate injury.
I know, because I have had a plantar plate sprain myself.
Plantar plate sprains are really frustrating because the plantar plate is a very small ligament. It takes very little to aggravate or stress the plantar plate, to irritate it, to stretch it, strain it, or injure it further when you are running.
I had a patient who asked a really interesting question. He said:
“Should I expect to have pain as soon as I start running?”
I basically said, “Well, if you do, you are doing it wrong, because if you are having pain, you are stretching and straining the ligament in the way that is predictably going to re-injure it.”
Should I expect to have some pain when I return to running after healing a plantar plate sprain?
Great question and that is what we're talking about today on the Doc On The Run Podcast.
If you have a fractured sesamoid bone, the biggest concern is that the sesamoid fracture will turn into a fracture nonunion.
"Non-union" means it did not unite. The two broken pieces did not get back together, and the fractured sesamoid bone did not heal.
I was talking to a runner who had a sesamoid injury and she wanted to know whether or not surgery was a good option in her case.
We talked broadly speaking about three different possible kinds of sesamoid surgeries.
Today on the Doc On The Run podcast, we’re talking about surgical options for sesamoid fracture nonunion.
I got an interesting question from a runner who had a plantar plate injury.
This runner had a long course of sort of misdiagnosis, mistreatment and various plantar plate "misadventures."
But when we started working together, he started to do some specific things to improve quickly, and he is doing great now.
He asked:
“Which comes first after my plantar plate sprain heals, will I be running, or will I be wearing dress shoes?”
Well, that is a good question and that is what we're talking about today on the Doc On The Run Podcast.
I had a call from a patient who wanted to know about surgical removal of Morton's neuroma.
She said she went to the doctor. The doctor said, “Well, we can just take the nerve out. It is not a big deal. We do this all the time.”
The reason she called me for a second opinion was because the doctor told her we have to cut a ligament to take the painful nerve out.
She wanted to know if that was true, and whether or not that could cause a problem later.
Do you have to cut a ligament in the foot to remove a painful neuroma?
That is what we're talking about today on the Doc On The Run Podcast.
I got a comment from a runner who posted this question on one of the YouTube videos on the Doc On The Run YouTube channel.
He says he had plantar fascia surgery just over 3 months ago.
He said that following the operation, he followed all of the surgeons post-operative instructions "to a tee."
He was feeling great, until he started developing a small pain at the back of the arch right where the heel starts.
He said:
“My whole arch is in pain. Do you think I could have a torn plantar fascia? It was tolerable but in hindsight this has not been ignored.”
Did I tear my fascia after plantar fasciitis surgery?
Well, that is what we're talking about today on the Doc On The Run Podcast.
I was just on a call with a runner who had a plantar plate injury that has been bothering him for about a year and a half.
We did a series of calls to talk about some changes in his treatment that could get him moving in the right direction.
He asked me a great question when I was on a call with him this morning.
He said:
“Can I run in zero drop shoes once it is really healed? Not today, but like when it is really, really healed and it is stronger and all that kind of stuff.”
I said, “You can do whatever you want, you just have to be willing to pay the consequences.”
Can I run in zero drop shoes after a plantar plate sprain heals?
Well, that is a great question and that is what we're talking about today on the Doc On The Run Podcast.
When you have hallux rigidus, the problem is the big toe joint does not want to move.
Many doctors will simply tell you that your big toe joint, or the "first metatarsal phalangeal joint" is getting progressively stiffer and developing arthritis.
If you wear shoes that irritate the joint more, the condition will only gets worse. The question is what sandals won't make hallux rigidus worse?
What sandals can I wear with hallux rigidus?
Well, that is a great question and that is what we're talking about today on the Doc On The Run Podcast.
Today's episode comes from a comment on one of the YouTube videos on peroneal tendinitis. A limping runner asked the question:
“Can peroneal nerve tendinitis cause fifth metatarsal to be tender to the touch and when walking, I am not sure if I have a stress fracture.”
When I read this comment, I became confused because I am not sure what is going on with this runner, but I am going to try to explain and answer the question as best I can in this episode.
Can peroneal nerve tendinitis cause fifth metatarsal pain?
Well, that is what we're talking about today on the Doc On The Run Podcast.
I got a great question from a runner with a sesamoid fracture that turned into a "non-union."
The sesamoid bones are two tiny little bones under the big toe joint. When you break one of the sesamoids, if two pieces of bone do not heal back together, we call a "sesamoid fracture non-union."
In this runner's case, she used a bone stimulator. She wore a fracture boot. She used crutches. But after a year of treatment, the doctor looked at her X-ray and said, “You have a non-union, we should take it out.”
Is it possible to run if you have a sesamoid fracture non-union?
That is a great question and that is what we're talking about today on the Doc On The Run Podcast.
The primary way I help runners is through telemedicine second opinions.
I help runners who are not running, who have not been getting better, who are frustrated, and help them figure out what they need to do to get past the injury and back to running.
Once they are on track and have made lots of progress, they want to know “When should we check in for our next call?”
I feel like I am on track with my running injury, should we book another consulting call or a series of calls to talk about it?
Well, that is a great question and that is what we're talking about today on the Doc On The Run Podcast.
I saw a runner today and I did a cortisone injection to treat her sinus tarsi syndrome. She asked me a great question.
She said, “Is the cortizone injection something I am going to need to do every three to six months?”
She had been reading up on corticosteroid injections and had found that some athletes with certain conditions may have injections scheduled every few months.
Should I have serial injections for sinus tarsi syndrome?
Well, that is a great question and that is what we are talking about today on the Doc On The Run Podcast.
The most important first step with any athlete who signs up for a webcam second opinion or series of coach coaching calls is to ask, “What is your goal?”
I was lecturing at a medical conference in Wisconsin where I was doing a whole morning session on running injury talks and diagnosis of subtle fracture patterns in athletes.
What I told those doctors is they have to ask the athlete, “What is your goal?”
Without understanding your timeline based on your running goal, you cannot make a useful recommendation on treatment on any running injury.
Sitting in that conference room I realized...
Your goal that you have right now could tell me how chronic your running injury really is.
Don't believe me? Well, that is what we're talking about today on the Doc On The Run Podcast.
Today, I had a final follow-up call with a runner who did a series of consultation calls with me to get advice every week. After the series of calls he had improved and was better, but disclosed to me that he felt like he had been depressed.
He thought he might have depression because he realized something had significantly changed in his goal setting.
He said, “I can't even imagine myself doing races anymore.”
Are you depressed because of your running injury?
Well, maybe you are, maybe you are not. I am not a psychiatrist. I am not a psychologist, but that is what we're talking about today on the Doc On The Run Podcast.
This morning, I was on a second opinion call with a runner who had a couple of different injuries in his foot.
The main problem keeping him from running was an injury to the collateral ligaments in one of his toes.
"The toe feels weak and unstable." He is understandably worried that the instability is going to cause a problem if he runs.
He was asking me:
“Well, can we surgically repair the ligaments?”
Should I have surgery to repair the collateral ligaments in my toe if I am a runner?
Well, that is a great question and that is what we're talking about today on the Doc On The Run Podcast.
This morning, I had a conversation with a runner who had an injury. He has been getting a lot better and one of the things that really seemed to help the injury improve was wearing compression socks.
His question was a really good one. He said:
“I had so much improvement with wearing compression socks, but with the injury I have, every time I take the socks off and on, it feels like I am moving the injured tissue now. I am not really sure if I still need the compression.”
Do I need to keep using compression socks until my injury is really healed?
Well, that is what we're talking about today on the Doc On The Run Podcast.
If you get an overtraining injury like a metatarsal stress fracture or a plantar plate sprain or Achilles tendonitis, or peroneal tendonitis, a doctor might prescribe a fracture walking boot.
Well, it is designed to hold you still so that you can hopefully walk on something like a fracture and still let it heal.
The reason for this episode is this morning I was on a call with someone who has been wearing a boot and he is curious why all of a sudden, he is starting to have some aching pain in the boot in the morning when he first gets up and steps on his foot while wearing the boot.
What are the two reasons you might get pain when you have been wearing a fracture walking boot for a running injury?
Well, that is what we're talking about today on the Doc On The Run Podcast.
I was doing a second opinion webcam consultation with a runner who noticed a lump in the calf muscle.
The knot in the leg wasn't limiting his running. In fact, when he was running, this lump in the calf muscle felt better, not worse.
So, you have to wonder, could the knot "not" be a big deal?
There are really 3 things a runner can do immediately after noticing a bump in the leg.
Today on the Doc On The Run Podcast, we're talking about the three steps you should do as the very first thing when you feel a weird lump in your calf muscle.
Today I am about to drive to the airport, get on a plane, fly to Wisconsin to give five lectures on running injuries at a medical conference.
As I was finalizing that talk on medical imaging strategies for athletes, I was thinking about a conversation that I had yesterday with an athlete who had a very frustrating course and actually called me for a second opinion.
He had an injury that hass been going on for a long time. In short, he is trying to get a second opinion from me specifically because I have worked with runners.
Today on the Doc On The Run Podcast we're talking about three things you should not tell your new doctor.
I know. You don't want plantar plate surgery.
But if your plantar plate ligament doesn't repair itself, or your doctor doesn't help it repair itself, you might get talked into surgery.
If you have plantar plate repair surgery, you may spend a lot less time running over the weeks following surgery...because you have to let it heal.
There are really three mistakes that I see runners make when they've had a plantar plate injury. This episode will help you avoid them.
What are 3 big mistakes runners make that lead to plantar plate surgery?
Well, that's what we're talking about today on the Doc On The Run Podcast.
This episode comes from a question posted by one of the Doc On The Run YouTube viewers as a comment on the video “Where to run with plantar fasciitis.”
In the video, I was trying to explain which surfaces can help you the most when you're trying to run with plantar fasciitis. The only way to do that is to make sure you are decreasing the stress and strain on the plantar fascia ligament.
But the question was...
Is the plantar fascia really a ligament?
Well, that's what we're talking about today on the Doc On The Run Podcast.
There are three ways that a doctor might convince you that it's really time to have surgery and fix that plantar plate ligament that's been making you miserable when you've been trying to run.
To you, it may not seem that bad. It kind of aches. It kind of swells. It kind of bugs you. But then the doctor suddenly says, “Look, it's not getting better, let's have surgery.”
Well, how does the doctor convince you that it's time for surgery? What are the things a doctor does, that might actually lead you to believe that it really is time to have surgery?
What are the three ways that a doctor might convince you that you need surgery if you're a runner with a plantar plate injury?
Well, that's what we're talking about today on the Doc On The Run Podcast.
Today's episode comes from one of the YouTube videos and it was specifically a comment that someone posted on one of the videos that was called “Five worst exercises for hallux rigidus”.
This came from Matt and he asked:
"When can you start doing push-ups again, if you have hallux rigidus?"
Well, that's what we're talking about today on the Doc On The Run Podcast.
I'm not going to tell you that any runner should want to use crutches. I'm also not going to tell you that you will enjoy wearing a fracture walking boot.
But there are reasons that you may want to do things a little differently if you're a runner.
The critical issue is that runners must really try to speed up the healing process as much as possible, so that you can avoid losing your running fitness.
What are the three time-sensitive problems solved when you use a fracture walking boot and crutches at the same time?
Well, that's what we're talking about today on the Doc On The Run Podcast!
Most of the runners I see who have pain in the ball of the foot from a plantar plate sprain rarely start out with a completely torn plantar plate tear.
More often, runners ignore the pain from the plantar plate sprain and it evolves into a full thickness plantar plate tear.
Surgery is only needed when the plantar plate is torn in such a way that the plantar plate ligament cannot be expected to heal without surgery.
But there are some mistakes that could lead a runner to the operating room.
Plantar plate surgery is a failure to act quickly.
That's what we're talking about today on the Doc On The Run Podcast.
Sometimes when you get injured and have to stop running, you start to lose your identity.
One of the things that I notice most in runners who have gone weeks or months without running, is they are really bummed out.
These runners seem really grumpy. In some cases, they don't even view themselves as a "runner" anymore...well, because they're "not running."
If you want to heal and get back to running as quickly as possible this can be a real problem.
How can self-judgment actually slow down your injury recovery when you have an overtraining injury as a runner?
Well, that's what we're talking about today on the Doc On The Run Podcast.
I just had a consultation with a runner who had foot pain that she thought might be a stress fracture that had been coming and going for about a month.
She had been increasing her training volume and doing strength exercises that are supposed to build her running fitness.
The pain seemed to be volume related. The more training she did, the more she would notice the discomfort in her foot.
But when we x-rays of her foot, the radiologist suggested this could be an "acute on chronic" stress reaction.
What does that mean?
What is the difference between a chronic stress reaction, or an acute on chronic stress reaction in a runner?
Well, that's what we're talking about today on the Doc On The Run Podcast.
Just this morning, during the live Stress Fracture Masterclass I had an interesting question.
The story went like this. An athlete who is a State ranked high school cross country and track, had to suddenly stop running due to intense pain that started about 15 days ago.
He went and saw a doctor. He got x-rays. He got an MRI, had a physical exam where the orthopedic doctor poked around and tried to figure out what was going on. The Orthopedist gave on diagnosis, but the Radiologist suggested a different diagnosis.
This is where the trouble comes in.
So, the runner was told a couple of different things, 1) a stress reaction, or 2) stress fracture, possibly of A) the third metatarsal or B) intermediate cuneiform bone, at the base of the third metatarsal.
Confused yet?
So was this runner!
What do you do if you think you have a stress fracture, you see an orthopedic doctor and the radiologist who reads your images s disagrees about your diagnosis.
Well, that's what we're talking about today on the Doc On The Run Podcast.
Let's say you had an ankle injury a long time ago.
You sprained the ankle when you were out on a trail run, it got better , and you went right back to running.
But over time, you slowly got more and more pain in the ankle.
In that case, you doctor might order an MRI of your ankle, or a similar imaging study called an MRA (instead of MRI).
What's the difference between MRI or MRA in a runner with an old nagging ankle injury?
That's what we're talking about today on the Doc On The Run Podcast.
I recently saw a runner who thought that he might have a tibial stress fracture. But it turns out, it was just shin splints, which of course is good news. Because you don't really want a tibial stress fracture. Shin splints is much easier to treat.
One of the questions he asked me was about the best running shoes based on his foot type.
This runner really needed more stability than got from the running shoes that he was wearing.
What are two different ways shoes can actually cause shin splints in runners?
That's what we're talking about today on the Doc On The Run Podcast.
If you got pain on the ball of the foot, at the base on the 2nd, and you have been running in a minimalist shoe, running uphill, doing lots of calf raises, or running on steps, you could have an injury to a little bitty ligament called the plantar plate ligament.
If you get an injury to the plantar plate, sometimes your second toe will drift toward your big toe or away from your big toe. The toe drifting sideways can happen for two different reasons.
They are very different causes and so they are treated differently.
Why does the toe drift sideways when you have a plantar plate injury?
Well, that's what we're talking about today on the Doc On The Run Podcast.
If you roll your ankle on a trail run and it turns black and blue and swollen, you may think you just have to take a few days off.
In fact, if you research how long it will take to get back to running, you might find a study that says that if you do early range of motion after an ankle sprain, it only takes 4 days to get back to pre-injury levels of activity.
However, if you do that, you can wind up with a lot of trouble later.
When I lecture at medical conferences on how doctors should treat ankle sprains in runners, I teach 3 phases of ankle sprain injury recovery.
If you are a runner with an ankle sprain, and you understand them, it'll help you get back to training and running without another ankle sprain.
What are the three phases of ankle sprain recovery in runners?
Well, that's what we're talking about today on the Doc On The Run Podcast.
Last night, I was doing a consultation with an athlete who had a fracture when she accidentally kicked a piece of furniture.
Her foot was swollen, it was black and blue. The foot was really painful and she couldn’t walk on it.
She went to urgent care and they took x-rays. She was a little concerned that they told her that it wasn't broken. So, she called me for a second opinion.
My doctor missed a fracture on my x-rays. What should I do about that?
Well, that's a great question and that's what we're talking about today on the Doc On The Run Podcast.
If you're out on a run, and you have heel pain that suddenly hurts a lot, you may have a calcaneal stress fracture, especially if you see bruising and swelling.
If you go see a doctor, they take an x-ray, and they don't see anything at all but they squeeze your heel and it hurts. The suspicion goes up.
If your doctor gets an MRI that shows a calcaneal stress fracture, the doctor is probably going to tell you, "you can't do anything until the stress fracture heels."
Today on the Doc On The Run Podcast, we're talking about calcaneal stress fractures in runners and I have some good news and some bad news.
Last night, I was doing a consultation with an athlete who actually broke one of her toes and her main question was:
Can I compete in four weeks? I have a competition in four weeks, I want to compete. Do you think I'll be ready?
Well, I actually told her, no joke, I actually said, “I'm very sorry, but my crystal ball is broken.”
However, I can tell you how to figure that out because that is what I teach athletes to figure out when they do the Fast Track challenge.
I have a broken toe and I want to compete in four weeks. Is it possible?
Well, that's what we're talking about today on the Doc On The Run Podcast.
Yesterday, I went to an appointment with a friend who had an appointment with an orthopedist.
She had 3 fractures. She wanted to know what she could do in terms of activity while she's healing and recovering from these different injuries.
I just went with her, not as her physician, but to serve as a friend and advocate for her at her appointment. This episode is going to explain why you really need to take an advocate with you to any doctor's appointment.
I went to an orthopedic appointment yesterday and they told me to come back in four weeks. What do I do now?
Well, that's what we're talking about today on the Doc On The Run Podcast.
Yesterday, I was doing a consultation with an athlete who broke one of her toes when she accidentally kicked a piece of furniture.
If you fracture your toe, and you just run and ignore it, it can turn into a painful nonunion (non-healed fracture).
As a runner, you want to speed the healing as much as possible. One of the ways to stimulate fracture healing is with a thing called a bone stimulator.
This particular athlete actually happened to already have a bone stimulator. Her question was pretty obvious:
“Can I just use that bone stimulator for this broken toe since it's a different kind of fracture?”
Well, that's what we're talking about today on the doc on the run podcast.
If you're a runner with heel pain you may think you have plantar fasciitis. But if it is not getting better, your heel pain may be caused by "neuritis."
I was just giving a lecture to a group of physicians getting their continuing medical education credits at the International foot Medical Foundation medical conference in Lake Tahoe.
I was giving a lecture called “When Heel Pain is NOT Plantar Fasciitis in Runners.” One of the conditions I was talking about was "medial calcaneal neuritis."
One of the doctors in the audience asked a really great question...
He said, “I see a lot of people that have Baxter’s neuritis, and it's down on the bottom of the heel it's plantar , it’s not on the side of the heel, it’s not medial neuritis, it's different. What would you do to tell the difference between these two conditions in a runner, given the circumstances you just explained in the talk?”
Today on the Doc On The Run Podcast we're talking about medial calcaneal neuritis versus Baxter’s neuritis in a runner.
I recently did a consultation with a runner who had gotten a plantar plate injury. He had been getting better by using some of the tricks I teach in the Plantar Plate Course For Runners.
He got better, he was protecting it, he reduced the stress and strain on the ligament, and he got back to running. He was doing great.
But then he had a setback when he went to the synagogue. He was dressed up and wearing some fancy dress shoes, and he started to get plantar plate pain again.
Today on the Doc On The Run Podcast, we're talking about how dress shoes with a long toe box can actually work as a lever against your plantar plate.
I was just at the International Foot & Ankle foundation meeting in Lake Tahoe listening to a lecture given by a Professor of Biomechanics and Podiatric Medicine at Barry University.
He said that a cortisone injection can be used as a "stop gap treatment" in heel pain caused by plantar fasciitis.
The idea is that some runners may need pain relief sooner than would normally be expected. It is true that corticosteroid injections can reduce the inflammation in and around the plantar fascia and quickly reduce pain.
When I had "normal practice" with "normal patients," I used to treat plantar fasciitis with corticosteroid injections pretty much daily.
But I almost never do plantar fascia cortisone injections now.
Can a corticosteroid injection serve as a stop gap for runners with heel pain?
That's what we're talking about today on the Doc On The Run Podcast.
I just had a conversation with a runner who has a plantar plate injury.
He got the plantar plate sprain trying to build his uphill running strength in preparation for a trail race.
This is no rookie mistake. He is a longtime ultra marathoner with lots of experience. But he made a common mistake determined runners can make.
Today on the Doc On The Run Podcast, we're talking about one of the worst exercises you can do if you have a plantar plate sprain and you've been trying to build your uphill running strength for a trail race.
Taping is one of the oldest and simplest ways to treat foot pain and injuries to the toes, feet and ankles.
There is a specific way to take your ankles after an ankle sprain so you can start running earlier.
If you have a plantar plate sprain you might try taping the toe to decrease some of the stress and strain on the plantar plate ligament when you run.
If you have a broken toe, buddy-splinting with tape can really help hold the broken bone still so it can hurt less and heal faster.
But if your skin gets irritated, and you are forced to stop using it, the tape can't help you at all.
Today on the Doc On The Run Podcast, we’re talking about how to patch test for tape allergy.
I recently saw an elite runner who had what he thought was shin splints. One of the findings on the MRI report was something called "hyperemia."
He asked me:
“What does that mean? Does that mean I have a stress fracture? Does that mean I have shin splints?”
What does hyperemia mean when you see it on an MRI report or an ultrasound report and you have something like shin splints or a tibial stress reaction?
Well, good question and that's what we're talking about today on the Doc On The Run Podcast.
I believe the most commonly prescribed and most overprescribed treatment for injured runners is probably a fracture walking boot.
The big question for your doctor is...
Is the fracture walking boot really necessary or not, given my stage of injury recovery?
When is a fracture walking boot really necessary for a metatarsal stress fracture?
Well, that's a great question and that's what we're talking about today on the Doc On The Run Podcast.
When you get an overtraining injury from running, it's not because you did too much, because you were too strong or too motivated.
You got injured because you were too weak.
You were too weak to sustain the stress applied to that piece of tissue, that one injured piece of tissue that got injured when you did one workout.
That's what really happened.
If you get injured, you have to understand how to correct that specific weakness.
Understanding this is crucial.
Overtraining injuries in runners are actually caused by weakness.
And that's what we're talking about today in the Doc On The Run Podcast.
There are a lot of confusing things you can see on an MRI report, on an x-ray report or an ultrasound report when you're a runner with pain that you think might be a stress fracture.
One of those findings that may be reported on your medical imaging study is a thing called "cortical thickening."
I want to explain what that is so you can better understand it in case you happen to see it on an MRI report, x-ray report or in your doctor's notes.
What is cortical thickening that precedes a stress fracture?
Well, that's what we're talking about today on the Doc On The Run Podcast.
I just had an interesting call with an elite runner, who's a high school cross country runner.
He developed a tibial stress fracture, or stress reaction.
But he thought it was shin splints.
When I looked at it with ultrasound, I saw some stuff that made me really worried about it. So, I got an MRI to confirm.
The first question he had was, what's the grade?
Grading scales cause confusion.
Today on the Doc On The Run Podcast we're talking about why stress fracture grading is BS for runners.
When you get a stress fracture, one of the earliest visible indications on an X-ray or an MRI or a CT scan is a thing called periosteal elevation. Your doctor might see it on ultrasound, x-rays or MRI studies....way before your ever see a crack in the bone.
Since it's one of the earliest changes in the bone when you start to get a stress fracture, I thought it might be useful to talk about the term "periosteal elevation" really means.
What is periosteal elevation in a stress fracture in a runner?
Well, that's what we're talking about today on the Doc On The Run Podcast.
I got an interesting question in the Injured Runners Aid Station, “Should I run without my custom orthotics to strengthen my feet?”
It seems logical that stronger runners are less prone to injury. The premise behind this question is whether or not orthotics may cause weakness in your feet or legs.
Never ignore your doctor's advice. But you have to ask your doctor the right questions about treatments like custom orthotics. You also have to understand when a little variety might help you become a stronger runner.
Why variety makes you stronger as a runner?
That's what we're talking about today on the Doc On The Run Podcast.
If you're a runner and you get a stress fracture, the number one most important thing that you do is get it to calm down while you maintain your running fitness.
Based on those ideas, I built a framework that I've been using for years with injured runners who want to heal and want to get back to running.
In this episode we will go through my stepwise process of how I do it.
Today on the Doc On The Run Podcast we're talking about my stress fracture framework simplified.
Pain is the most useful and likely most underutilized tool available to any runner who is tired of waiting for doctors to give them permission to run.
How you track your pain is important.
One of the critical components in the running injury secrets framework that I discussed in the first episode of the members only podcast in the Injured Runners Aid Station is about pain caused from damage in the tissue versus pain caused by inflammation around the tissue.
You cannot run without understanding the difference, at least not safely.
Is the pain from injury or just inflammation?
Well, that's what we're talking about today on the Doc On The Run Podcast.
Pain is the most useful and likely most underutilized tool available to any runner who is tired of waiting for doctors to give them permission to run.
How you track your pain is important.
One of the critical components in the running injury secrets framework that I discussed in the first episode of the members only podcast in the Injured Runners Aid Station is about pain caused from damage in the tissue versus pain caused by inflammation around the tissue.
You cannot run without understanding the difference, at least not safely.
Is the pain from injury or just inflammation?
Well, that's what we're talking about today on the Doc On The Run Podcast.
If you get a plantar plate sprain, it can take a long time to heal, particularly if you're not paying close attention.
And because of that, many runners get frustrated.
I see 2 responses to that frustration:
1) go to the doctor and hope for some kind of quick fix.
2) just ignore it and run on it because it doesn't really hurt that bad.
Both of those are bad ideas with plantar plate injuries in runners.
What are two ways capsulitis can actually lead to a plantar plate rupture?
Well, that's what we're talking about today on the Doc On The Run Podcast.
When you get a stress fracture, you need the little bitty crack in the bone to heal.
How do you do that?
First, you have to stop bending or torquing or twisting the bone in a way that led to the crack in the first place.
Second, you have to let the healing process take place.
After the inflammation goes away, and after you get some collagen sealing up the healing crack, you start to get "ossification" of the bone where it turns into hard solid bone that you can run on.
That happens through a combination of two different types of cells in the bone called osteoblasts and osteoclasts.
Osteoblast versus osteoclast, the battle that’s rebuilding bone after a stress fracture.
That's what we're talking about today on the Doc On The Run Podcast.
How long does it take you to get fit enough to run a 3 hour marathon?
Well, that depends on what? It depends on what you would actually do. Not how long you wait.
How long it takes for you to heal your overtraining injury all depends on what you do, and which variables you choose to control. Not how long you wait.
Believe it or not, every injured runner who calls me for a consultation has control over far more of these variables than they think.
How long will it take my overtraining injury to heal?
Well, that's what we're talking about today on the Doc On The Run Podcast.
If you're a runner with a plantar plate sprain, I can understand why you're frustrated.
You have some minor vague aching pain in the ball of the foot, and you're trying to get back to running, but you're getting lots of conflicting advice.
In my experience, it's very rare that a runner gets a plantar plate injury from what I call "overtraining."
Plantar plate ligaments don't get sprained because you ran way too much, or ran too many miles. It doesn't really happen that way. But they do get injured by workouts designed to support your running fitness.
What are three running drills that might lead to a plantar plate sprain?
Well, that's what we're talking about today on the Doc On The Run Podcast.
If you're trying to improve and you don't improve, whose fault is it?
Before we talk about running injuries, let's talk about when you're not injured. You hire a coach. You know the coach is qualified, You know your coach has given you a valid training plan, and you know that you can execute.
But then something goes sideways. Your baby gets sick. You get an additional work project. You are sent away out of town on work. Something happens, and you miss some workouts.
If you don't communicate that to your coach, and you just skip workouts, or inadvertently stack workouts together to make up for missed workouts, and then you get injured, whose fault is that?
Whose fault is it if an injured runner is not getting better?
Well, that's what we're talking about today on the Doc On The Run Podcast.
I often get nutrition questions from runners who have overtraining injuries involving tissues made of collagen like the plantar plate ligament.
At the heart of these questions is what is the most important ingredient to add in their diet to speed recovery.
In this episode we are briefly discussing the key ingredients your body needs to repair collagen. If you are missing these, you might have a slower repair process if you have a partial tear of the plantar plate ligament itself.
What is the most important ingredient to a runner after a plantar plate sprain?
Well, that's what we're talking about today on the Doc On The Run Podcast.
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.
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.
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.
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.
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.
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.
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.
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.
Please change the podcast descriptions, Aweber email and Clickfunnels email to:
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.
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.
I saw a runner who had a traumatic fracture, but she had been told it was a stress fracture. This did not make sense to her, because her injury wasn't from training for a race.
She was trying to understand the difference in healing between a stress fracture with a crack when compared to the healing time of a traumatic fracture with a similar crack.
It's important to understand they were talking about similar cracks in similar bones that remain in a similar position. We're not talking about broken bones that are displaced.
If you jump off a ladder, you break the bone and it's moved out of position, that is a completely different story. Stress fractures don't generally get displaced as much as traumatic fractures.
If there's a crack in the bone because of a stress fracture, the bone is not displaced. But how does that compare to similar (non-displaced )traumatic fracture?
Is there any difference in healing between a stress fracture versus a traumatic fracture?
Well, that's what we're talking about today on the Doc On The Run Podcast.
A metatarsal fracture "non-union" is what doctors call it when you broke the bone, it started to heal, but then the fracture kind of quit healing. Usually it means you got a bunch of scar tissue between the ends of the bone.
Sometimes that happens without you or your doctor realizing it. The problem gets worse if you start running on it.
The question is, "should I take non-steroidal anti-inflammatory drugs (or NSAIDs)?
NSAID's are medications like ibuprofen and naproxen. These drugs are not steroids, but they stop inflammation. Many runners take them for all kinds of aches and pains after training. The question is, is it a good idea or not when you may have a metatarsal fracture non-union?
Should a runner take non-steroidal anti-inflammatory medications for a non-union?
Well, that's what we're talking about today on the Doc On The Run Podcast.
If you get a metatarsal stress fracture, the first thing that you're going to notice is not that you have a broken bone in your foot.
You are going to notice pain.
Typically, the feeling starts as a little vague discomfort in your foot that progressively gets worse as you continue to train and run on it.
The soreness gets worse the longer you run, feels worse when you walk barefoot on hard surfaces and becomes more notable going up and down wooden stairs.
As I explained this to a runner in the Injured Runners Aid Station, she asked "What really causes the pain?"
What causes most of the pain when you have a metatarsal stress fracture?
Well, that's what we're talking about today on the Doc On The Run Podcast.
A stress fracture in your tibia, or shin bone, is a bad injury. You definitely don't want the crack to grow to the point where it could break.
The big question is what will make a tibial stress fracture better, faster...crutches or a fracture walking boot?
When is a fracture walking boot better than crutches for a tibial stress fracture if you're a runner?
That's what we're talking about today on the Doc On The Run Podcast.
This episode comes from a discussion I called with a runner who called me for a second opinion. She had a stress fracture non-union and somebody had remained recommended that she have surgery.
I was looking at her CT scan and she asked me an interesting question.
She said,
“Does it look stable?”
And I said, “Can't tell.”
It looks like a non-union. It looks like it’s broken and never healed.
What are the three ways you could tell whether or not a metatarsal fracture non-union is stable without getting an imaging study?
Well, that's what we're talking about today on the Doc On The Run Podcast.
50% of your body weight goes through the big toe joint when you run. So, If you get a fracture in the big toe joint, it can be a serious problem.
One type of fracture in the big toe joint is called an avulsion fracture.
I was just doing a consultation with a runner who had a phalanx avulsion fracture in the big toe joint. I wanted to show you what it really is and so that you can understand it better and what it might actually mean in terms of your returning to running.
What is a phalanx avulsion fracture in the big toe joint?
Well, that's what we're talking about today on the Doc On The Run Podcast.
Non-steroidal anti-inflammatory drugs (or NSAIDs for short), like Ibuprofen and Naproxen, what we call are extremely popular with runners because they get rid of lots of aches and pains.
We often think inflammation results from hard exercise, so it stands to reason a non-steroidal anti-inflammatory will actually help after a long run.
I don't normally recommend runners take NSAIDs as a part of a training routine.
But there are a couple of alternatives that I would recommend over non-steroidal anti-inflammatory drugs.
What's better to take than non-steroidal anti-inflammatory drugs for a stress fracture in a runner?
Well, that's what we're talking about today on the Doc On The Run Podcast.
I had a call with a runner who asked me an interesting question about the difference between a mild stress fracture and a serious stress reaction in a runner. She wanted to know if the difference was based on the amount of tenderness or pain that she had.
Although it stands to reason that the more tenderness, the more pain you have, the worse it must be. However, that is not really what differentiates a mild stress fracture from a serious stress reaction.
What's the difference between a mild stress fracture and a serious stress reaction in a runner?
Well, that's what we're talking about today on the Doc On The Run Podcast.
If you get gout, it's going to be painful. It hurts because you get so much uric acid buildup in your bloodstream that it starts to crystallize, forming little bitty needle shaped crystals in the joint.
They are pointed, they're sharp and they are poking the tissue on the synovial tissue inside of the joint, and it hurts.
When is the worst time to check for gout with a blood test?
Well, that's what we're talking about today on the Doc On The Run Podcast.
Every runner who has heel pain wants it fixed.
A lot of us think about this in the way that we fix automobiles. The alternator goes out in your car, you go get a new one put in. Your battery dies, you go get a new battery. But your foot doesn't work this way. So unfortunately, when you have surgery, you're trading one problem for another.
I have done endoscopic plantar fascia release surgeries, but not on any runners for more than a decade. Why do you think that is?
Can an endoscopic plantar fascia release surgery get me back to running faster?
Well, that's a great question and that's what we're talking about today on the Doc On The Run Podcast.
If you have a tear in the plantar fascia, you probably know what a frustrating injury it can be. If you think it's better, and you're going to start running, one of your big questions is probably,
“How do I avoid a second tear in the plantar fascia?”
That's a great question and that's what we're talking about today in the Doc On The Run Podcast.
If your doctor said you have gout, you might have heard about a gout specific diet.
A gout diet is not a specific diet in terms of a plan. It's avoiding foods that are high in purines that can contribute to high blood levels of uric acid.
What is the most ignored part of a diet for somebody who's a runner and thinks they have gout?
Well, that's what we're talking about today on the Doc On The Run Podcast.
Don't ever forget that when you get a running injury, the goal is not to heal the injury. The goal is to get back to running.
If you heal the injury and you get so weak and so stiff, that you wind up getting another overtraining injury, that is a failure.
The thing you have to really think about as you're returning to running isn't just about the possible other injuries you could get but incomplete healing.
The goal is to always strengthen everything as much as possible without obviously causing a real injury to the specific injury that got you in the fracture walking boot, on the crutches or thinking about canceling your race.
Today on the Doc On The Run Podcast, we're talking about partial credit versus pass or fail with running injuries.
Why would you want to add stress?
We're not talking about psychological stress. We're not talking about the stress of a screaming baby or a boss yelling at you.
We're talking about stress on the tissues that will actually stimulate a healing response that makes them stronger later, just like working out.
If you're an injured runner who's getting back to running, you need to add stress systematically.
And that's what we're talking about today on the Doc On The Run Podcast.
One of the problems with the plantar fascia is that you may think you have plantar fasciitis, but eventually you find out that it was not really fasciitis at all.
It's actually a partially torn plantar fascia ligament. That can be a problem since it is the largest ligament in your foot.
When somebody says:
“Can I run with a small tear in the plantar fascia?”
I say that depends.
Is it a big deal if I run with a torn plantar fascia?
Well, that's what we're talking about today on the Doc On The Run Podcast.
When you have a running injury and you know what your goal is you are halfway there. But if you're trying to get back to running, you've really got to do three things.
You have to start moving, not make the injury anything worse, and you've got to get fit as fast as possible.
Every day is a test run after you've healed a running injury.
That's what we're talking about today on the Doc On The Run Podcast.
One of the problems with being a runner is that you have a higher pain threshold.
If you have a minor attack of gout, it may not bother you as much as it would other people and what Gout is, is that you get painful crystals forming within a joint like the big toe joint.
If you have what we call sub-acute gout, meaning it's not really killing you, it's just kind of a minor thing that's building up gradually, then the condition might actually sort of fly under the radar.
You might be gradually building up crystals in the joint that you're not really aware of at all.
How can gout lead to hallux rigidus?
Well, that's what we're talking about today on the Doc On The Run Podcast.
A runner called me to follow up and asked:
"I've been doing the routine that we discussed during our first call and I've got no pain, I’ve got no tenderness. How can I tell if I'm really ready to run now without hurting it?”
You have to realize that if you run and you are weak and unstable, you are at higher risk. Those gaps in recovery create unnecessary risk.
You have to figure the pieces you haven't really considered that could put you at risk of re-injury.
Find the gaps between where you are and your running.
That's what we're talking about today on the Doc On The Run Podcast.
Your doctor might recommend custom orthotics if you're an athlete, and you happen to be pregnant.
When you get pregnant, you have lots of hormones going through your systems that can cause ligamentous laxity.
The reason that's a problem if you're a runner is that you have rapid weight gain during pregnancy. That weight combined with additional relaxation in your feet can accentuate mild foot problems and even cause deformities that persist later after the pregnancy is over with.
When does a pregnant runner need custom orthotics?
Well, that's what we're talking about today on the Doc On The Run Podcast.
Today we're talking about the Yasso 800's developed by a guy named Bart Yasso.
I was lucky enough to meet him after he gave a talk before the Salt Lake City marathon back when I was in residency about 20 years ago.
In any event, this workout is a useful way to analyze your fitness and determine your marathon pace. Yasso 800's can be really helpful to an injured runner who's returning to running when trying to figure out how fast you should run your post-injury marathon.
Today on the Doc On The Run Podcast we're talking about how to use the Yasso 800s to test your marathon fitness after you've recovered from a running injury.
Today's episode comes from one of the YouTube viewers who was watching a video called "Can I run with a split peroneal tendon?"
I was trying to explain the circumstances when you can run with a split tendon, and when you really shouldn't.
He wanted to know if his doctor could tell whether or not he needed surgery just by looking at his ankle.
“The MRI tells me I have a split tear. So, presumably as a tear in the peroneal tendon, but I don't know which one."
Can my doctor tell me if I need surgery on my peroneal tendon just by looking at my ankle?
Well, that's a great question and that's what we're talking about today on the Doc On The Run Podcast.
This episode comes from a consultation call on webcam with a runner with a sesamoid stress fracture.
Interestingly, his doctor wasn't even sure what it was, if it was really a crack in the bone that wasn't healing, or if it was what I call a "sprain" of the bipartite sesamoid.
Today on the Doc On The Run Podcast we're talking about how big toe positioning can actually help a medial tibial sesamoid stress fracture or bipartite sesamoid disruption.
Today's episode comes from Benda, who was watching a video called "12 steps to healing and running with a metatarsal stress fracture" on the Doc On The Run YouTube channel.
She asked a question,
“I'm so confused. I don't have a stress fracture. It was an acute injury. I have a half marathon in early December. Is there hope for me?”
I got injured five weeks out from my half marathon. Is there hope?
Well, that's what we're talking about today on the Doc On The Run Podcast.
I recently got a comment from Michael on a video on the Doc On The Run YouTube channel which was about how fracture walking boots are one of the worst treatments for an injured runner.
He posted an interesting comment which is really a valid question. He said,
“What is the boot for? Is it for protection? Is it for immobilization? Is it to keep weight off?"
What does a fracture walking boot actually do?
Well, that's what we're talking about today on the Doc On The Run Podcast.
I recently got a great question from someone who was watching one of the videos on sesamoid fractures.
Underneath the big toe joint, you have two little bones called sesamoid bones.
Sometimes you can get a fracture or crack in the bone that doesn't heal. Then it turns into what we call a non-union.
Some people have sesamoids called "bi-partite" sesamoids. It looks like a fractured sesamoid. But its' normal. The two pieces are connected by soft tissue. But that soft tissue connection can become injured or sprained.
What's the difference between a sesamoid fracture non-union and a disrupted bipartite sesamoid sprain?
Well, that's what we're talking about today on the Doc On The Run Podcast.
Stress fractures are the most common overtraining injury I treat in runners.
If you're a runner with a stress fracture, your first question is probably "When can I run?"
Since the answer is always, "When it is healed enough to withstand running..."
Your second question is likely “What can I do to heal a stress fracture as quickly as possible.”
But if you heal it, get back to running and then get another stress fracture, a recurrent stress fracture, your number one question should be “why”.
What is the number one question for a runner with a second stress fracture?
Well, that's what we're talking about today on the Doc On The Run Podcast.
If you are a runner struggling with a plantar plate sprain, it is probably going to be extremely frustrating trying to get it to heal so you can get back to running.
The plantar plate a very small ligament. It does not have a great blood supply. Every time you take a step, you put pressure on the plantar plate. Every time your heel comes up off the ground when you walk, you stretch the plantar plate.
Because it is so difficult to heal, runners typically have frustrating setbacks.
That state of discouragement makes it pretty easy for a doctor to talk you into plantar plate surgery.
When should a runner just give up and have plantar plate surgery for a plantar plate sprain?
Well, that's what we're talking about today on the Doc On The Run Podcast.
Just last week, I was giving a lecture at the International Foot and Ankle Foundation meeting in Hawaii. The lecture was on Conservative Management of Ankle Sprains in Runners Who Want to Run.
One of the worst things that can happen to a runner with an ankle sprain is that you can lose what we call proprioceptive ability. But that is preventable.
What would you do if I told you, you can reduce your risk of the number one most common musculoskeletal injury by 35%?
Well, that's what we're talking about today on the Doc On The Run Podcast.
In today’s podcast episode we're talking about fracture healing versus skin healing.
This talk comes from a discussion I had at the International Foot and Ankle Foundation meeting in Hawaii where I was recently giving a lecture on Runner's Heel Pain to a whole roomful of doctors.
A doctor asked me a question about how to get a runner back to running as quickly as possible after injury.
What do injured runners do that makes about as much sense as picking at a healing skin incision?
Well, that's what we're talking about today on the Doc On The Run Podcast.
If you get a fracture of one of the metatarsal bones in your foot, you are not going to be able to run until it heals.
But as soon as it's healed, you will want to start running again.
You may have recently seen the episode that I did where I was talking about how ultrasound may show signs of healing sooner than X-rays.
How much earlier can ultrasound show healing of a fracture as compared to X-ray?
Well, that's what we're talking about today on the Doc On The Run Podcast.
I was just lecturing at the International Foot and Ankle Foundation meeting in Hawaii. One of the podiatrists came up to me and asked me a question after one of the sessions.
He said that he was going to be working with a local high school cross-country team.
He wanted to know what I thought would be the most important things to share with cross-country runners to try to reduce their risk of injuries amongst the team throughout their cross-country season.
What information would I want to share with a high school cross-country team?
That's a great question and that's what we're talking about today on the Doc On The Run Podcast.
If you're a trail runner or a marathon runner or an ultra-marathoner, well, the last thing you want to do is get a fracture.
If you break something, you have to sit still until it heals, and that can take a long time.
What is a common cause of fracture in a trail runner?
Well, that's what we're talking about today on the Doc On The Run Podcast.
Bruised toenails are extremely common in runners. Many consider black and blue toenails a rite of passage when training for your first marathon.
However, if a bruise under the toenail appears without any trauma, it can be worrisome.
A solitary dark linear streak is alarming to dermatologists and podiatrists. Because if you get a solitary linear bruise that doesn't drift out like a typical bruise under the nail usually does, your doctor might be concerned that you have something called acral-lentiginous melanoma.
If your doctor performs a tissue biopsy of the nail matrix to make sure you don't have cancer, well, you might be worried that your nail is going to be deformed.
Can the toenail grow back normally if you remove part of the root of the nail because you had a biopsy?
Well, that's what we're talking about today on the Doc On The Run Podcast.
If you get a fracture of the metatarsal, you have to make sure that it's healed before you start running on it.
It doesn't matter if it's a stress fracture, or a traumatic fracture where you stepped in a hole, tripped or fell off a ladder.
Deciding when it appears to be healed enough to withstand the forces of running is the key.
The most common way doctors decide when the fracture is fully healed is by taking an X-ray.
When can I start running after a metatarsal fracture if I have no healing on the X-ray?
Well, that's a great question and that's what we're talking about today on the Doc On The Run Podcast.
Plantar plate injuries are one of the most difficult injuries for runners.
The reason is that they can take a long time to get better. Every time you take a step, you're applying direct pressure to the plantar plate ligament.
Every time your heel comes up off the ground, you bend the toes, and you're stretching the plantar plate ligament.
The plantar plate ligament doesn't really have a great blood supply, and they can be extremely frustrating for runners. So the big question is:
When can I start working out if I have a plantar plate sprain?
Well, that's what we're talking about today on the Doc On The Run Podcast.
I was on a call with a marathoner who had a cuboid fracture.
He was getting better, and he was trying to figure out how he could start running.
The cuboid bone is an irregular bone at the base of the metatarsals, and it's sandwiched in between the fourth and fifth metatarsal bones and the heel bone. It is a bad bone to break. So he had a valid question:
Is it risky to run with a cuboid fracture?
Well, that's a great question, and that's what we're talking about today on the Doc On The Run Podcast.
I don't like it when I hear a doctor said, "Don't run."
What the doctor should say is, "Let's figure out how you can run."
And if you're injured, that's what you should be thinking about too.
Not, "When can I run?"
But, "How can I work out right now?"
When can I run if my doctor says "don't run" because of an injury?
That's a great question, and that's what we're talking about today on the Doc On The Run Podcast.
Today I got a great question from a runner who had a 4th metatarsal stress fracture while training for a marathon. He wanted to know how likely it was to get a setback, or re-injury, if he is running while the stress fracture heals.
How likely is a setback if I run while my stress fracture heals?
Well, that's a great question and that's what we're talking about today on the Doc On The Run Podcast.
Today's episode comes from the question-and-answer session at the International Foot & Ankle Foundation meeting in Las Vegas. I was lecturing on Medical Imaging Strategies in Runners to Avert Misdiagnosis.
At the end of this talk that I was giving, one of the doctors, Dr. Brad Hayman, asked a great question,
"A lot of us doctors who are not runners have a very difficult time relating to some of these runners because we don't necessarily get why it's so important that they're doing a particular race."
What can doctors do to relate to injured runners?
Well, that's a great question, and that's what we're talking about today on the Doc On The Run Podcast.
Today's episode comes from the question-and-answer period when I was lecturing at the International Foot & Ankle Foundation Medical Conference in Las Vegas. The talk was Conservative Management of Ankle Sprains in Runners Who Want to Run.
During that talk, I explained to the doctors everything that I do with runners who have ankle sprains. Afterward I got a great question from Dr. Bryan Markinson, who is a prominent physician from New York.
He said:
"Okay. Is this stupid or is this not stupid? Because, I get runners who really want to run. I figure when they're in good shape, it's okay for them to run in an ankle brace. Is that really a thing that you recommend or not?"
Can I let runners run in an ankle brace after they've had an ankle sprain?
Well, that's a great question, and that's what we're talking about today on the Doc On The Run Podcast
All injured runners realize it's a problem.
You're not working out when they get an overtraining injury. You're told to sit still. But the problem is not that you're going stir crazy because you feel like you need to exercise.
The problem you notice is that you're getting weaker, you're losing your fitness. And although I know that you're worried about losing your fitness, there is another problem you may not see.
You should work out while you're waiting to heal.
And that's what we're talking about today on the Doc On The Run Podcast.
I just got a great question from a runner with a cuboid fracture. He signed up for four weekly coaching calls as he was returning to running.
He just wanted to make sure that he didn't make the fracture worse as he was actually getting back to activity.
He asked, “Once I start running outside, can I use the Alter-G treadmill to add miles and speed while lowering overall tissue stress?”
Can I use the Alter-G treadmill to add miles and speed while lowering overall tissue stress after recovering from an injury?
That's a great question and that's what we're talking about today on the Doc On The Run Podcast.
I got a question on one of the Doc On The Run YouTube channel videos about insertional Achilles tendinitis.
Kevin asked:
“For a few weeks, I had insertional Achilles tendinitis. I have read that doing heel raises over a step could make the situation even worse. Some suggest doing it on barefoot in a flat zone. What do you think?”
Can heel raises make insertional Achilles tendinitis worse?
Well, that's what we're talking about today on the Doc On The Run Podcast
When I see a runner who's had a sprain or a trip or a fall or something, the #1 concern is to make sure no bones are broken.
Most of the time, what I do is I take a portable ultrasound unit with me so that I can look at the foot on the spot and try to figure out whether or not there is a fracture.
I had a question about this as a comment on one of the Doc On The Run YouTube video episodes where I was talking about ultrasound imaging in the foot when you're a runner.
The question was, “Can you get a false negative? Can you get a false positive?”
Can you get a false negative if you're looking for a fracture with an ultrasound unit?
Well, that's a great question and that's what we're talking about today on the Doc On The Run Podcast.
Today's episode comes from a question on the Doc On The Run YouTube channel. We were talking about how bone callus shows up as evidence of healing after a fracture in a runner.
Her question was:
“If there was no visible gap in between the bones where the fracture is, will the callus still be visible on the X-ray ? How will the callus show for non-displaced fractures on imaging? Thank you so much for creating this channel and for sharing all your expertise to the world.”
How does callus show healing on non-displaced fractures?
Well, that's what we're talking about today on the Doc On The Run Podcast.
I was just on a webcam call with a runner who signed up for an initial consultation and then decided to get a few weeks of additional coaching where we just check in every week to make sure that he's not making any big mistakes that are going to cause a re-injury.
We were talking about how the whole goal is to keep running without slowing down the healing.
The way you do that is that you stay below your threshold for re-injury or re-fracture of the bone.
Today on the Doc On The Run Podcast, we're talking about how you should audit your stress level to avoid re injury when you start running after you're recovering from an overtraining injury.
Plantar fasciitis is the most common cause of foot pain that might keep you from running.
But some treatments that help "normal" patients may cause lingering trouble in runners.
It seems like most of the runners who call me for help have made at least one, if not two of the three biggest mistakes runners can make with plantar fasciits.
Today on the Doc On The Run Podcast we're talking about the top three mistakes runners make with plantar fasciitis.
Today's episode comes from Olivia who asked a question on the Doc On The Run YouTube channel:
“I believe I'm dealing with an interstitial tear. Would supplementing collagen help the healing process?”
An interstitial tear just means you have little bitty tear on the inside of a tendon or ligament.
You can get these types of injuries in the plantar plate ligament, the plantar fascia, or any tendon. All of those tendons and ligaments are made of collagen.
So, it seems reasonable that collagen supplementation might help the healing process. But is it proven to work?
Would collagen supplementation help an interstitial tear and a runner?
Well, that's what we're talking about today on the Doc On The Run Podcast.
Compression socks are a useful tool when recovering from a running injury. Just a little compression can gently squeeze all that inflammatory fluid out of your foot, your ankle and your leg.
I was talking to a runner yesterday who asked me about the best compression sock sizing. She was worried that if the socks were too tight, they could hurt her fracture when she was pulling the socks on. That is a totally valid concern!
If it hurts when you're pulling on compression socks, you might actually be stretching, straining, and stressing the injured tissue. All that added stress could prolong your recovery.
But if the compression socks are too loose, then you don't get much benefit. Size matters.
What size compression socks should I buy if I have a running injury?
Well, that's what we're talking about today on the Doc On The Run Podcast.
If you got injured, but you're trying to get back to running, one of the most important decisions you can make is which doctor you choose to see.
And it is entirely your choice.
I just got off a call with a runner who had a really serious issue.
She rolled her ankle. She treated it like a normal ankle sprain.
But about six weeks later, it was still a little bit puffy. It still hurts. It was still bugging her, and she wanted to get a second opinion.
She did the right thing. She went and saw an orthopedic surgeon to get a second opinion.
When we were on the call yesterday, there were three things that I saw as definite red flags and definite signs that this woman was seeing the wrong doctor.
What are the top three ways you can be sure you're seeing the wrong doctor?
Well, that's what we're talking about today on the Doc On The Run Podcast.
Today's episode comes from one of the Doc On The Run YouTube viewers.
Casey wrote in and he said,
“This year I suffered from this problem after switching to zero drop running shoes and I was finally running pain free. The zero drop running shoes made me into a forefoot runner instead of a heel striker. I was doing great but then I started having pain in the ball of my foot from a callus. I then started having this pain and I did exactly what you said to do in this video and it worked great and specifically this video showing how to remove a callus in a specific way with a specific technique.”
He also said, “Great information here, everything I was researching kept saying it was metatarsalgia but my pain was different. Thank you for the great video.”
Many runners get unfairly stuck with a metatarsalgia diagnosis.
What is the intractable dubious metatarsalgia diagnosis?
Well, that's what we're talking about today but the Doc On The Run Podcast.
I get lots of questions about "sinus tarsi syndrome" in runners.
It seems like most runners who call me don't even really know what it is.
The sinus tarsi is not a structure, so much as a space.
That space contains some structures that can cause pain after an ankle sprain. The sinus tarsi may also ache in flatfooted runners as well.
The sinus tarsi confuses many runners because it is kind of in the ankle, but kind of in the foot as well.
What is the sinus tarsi?
Well, that's what we're talking about today on the Doc On The Run Podcast.
I had a question on one of my YouTube videos in which I was trying to explain the procedure for broken toes called "closed reduction." That's the fancy term for popping the broken bone back in place or "re-setting the fracture."
You may have heard someone say, “Well, I had a fracture and the doctor had to "set it" or the doctor had "put the broken bone back in place.”
There is a risk and a benefit to everything. Even with non-surgical fracture treatment.
Putting a fractured piece of bone (in a broken toe) back where it belongs is more likely to make it heal in the right position, because you put it back in the right position.
If you leave the broken bone in the wrong position, it may heal and then cause problems later because it's crooked.
Today on the Doc On The Run Podcast we're talking about the biggest danger with popping a broken toe back in place.
Today's episode comes from a second opinion discussion with a runner suffering with a nagging plantar plate ligament injury.
She was considering surgery for a plantar plate sprain.
Truth is, her plantar plate sprain was not really that bad.
It's pretty common when runners have trouble healing a plantar plate sprain, the doctor may recommend a number of different surgeries.
One of those surgeries is where we actually shorten a bone in an attempt to decrease the tension and pressure on the plantar plate ligament.
Should a runner have surgery to shorten a long second metatarsal bone?
Well, that's what we're talking about today on the Doc On The Run Podcast.
Today's episode comes from a question from one of the Doc On The Run YouTube channel viewers about fibular stress fractures.
There are only tow bones between your knee and your foot: The Tibia (or shin bone) and the fibula bone, which is much smaller.
The fibula bone supports very little of your weight when you run. Your knee is at the top of the tibia bone, and the other end of the tibia sits on top of the talus bone at the top of your foot.
The tibia is the bone that really takes the pressure from your knee and redistributes it to your foot. The fibula bone is a stabilizing bone on the outside of your leg, it is not a weight bearing bone and it really does not support your weight or hold a lot of vertical force.
Understanding the leg bone anatomy can help you understand the stresses that may cause a stress fracture in either one of the leg bones.
Can I still run after I heal of fibular stress fracture?
Well, that's what we're talking about today on the Doc On The Run Podcast.
I was just speaking with a runner who scheduled a second opinion consultation. He asked, "what is the best way to tell if my foot is broken."
I said, "Well, there's the fast and easy way and then there's the fast and cheap way.”
Today on the Doc On The Run Podcast, we're talking about fast and easy versus fast and cheap ways to tell if your foot is broken.
Today's episode comes from a comment on Doc On The Run YouTube channel.
Colin watched the video explaining: “Bone bruise vs stress reaction in a runner.” He posted a question asking what he should do after a frustrating 10 months off from running, without improvement.
I've had a bone bruise for 10 months and I'm still not running. What does that mean?
Well, that's what we're talking about today on the Doc On The Run Podcast.
I just had a conversation with a runner who signed up for one of the self-help courses. She booked a short call just to get a jumpstart, prioritize and figure out what she really needed to do first, so she could get better as quickly as possible.
She asked me a really interesting question at the end of our call and she said,
“Okay, based on what we talked about, are you sure that my ligament is not going to just rip apart if I start running?”
I said,
“No, I'm not sure of that at all. In fact, we didn't even talk about your injury. You told me that you think you have this injury. But you (and your doctors) are not even 100% certain you have a ligament injury. You don't even know what's really wrong. Right now, you don't know where you are, because you have no reliable data."
You cannot run early without data.
And that's what we're talking about today on the Doc On The Run Podcast.
Perhaps the most nagging injury, and most difficult to deal with if you're a runner, is something called a "plantar plate sprain."
The plantar plate ligament is on the bottom of the foot, usually at the base of the second toe.
I got a question from a runner who actually had a plantar plate injury. She also happened to have bunions. So, she asked:
"Do bunions cause plantar plate sprains in runners?"
That's a great question and that's what we're talking about today on the Doc On The Run Podcast.
Today's episode comes from Janet ,who posted a comment and question on the Doc On The Run YouTube channel.
She said,
“I got a healed stress fracture, returned to running. I got into cross country and it started to flare up and hurt around the tibia again, is this normal or should I be concerned?”
Is returning pain normal when returning to running after a healed stress fracture?
Well, that's what we're talking about today on the Doc On The Run Podcast.
The peroneal tendons help stabilize your foot. They're kind of your landing gear when you run. They keep you from wobbling or swaying out of control.
When you start to roll your ankle, the peroneal tendons pull your foot back under you.
If you ignore irritation and aggravation of those tendons, they can get weaker, tear or split apart.
The sudden trauma of suddenly rolling your ankle can cause them to split as well.
If you see a doctor when you suspect a split peroneal tendon, one of the first things you may find is that the doctors say this is a surgical problem. You may hear that you must have surgery to repair a split peroneus brevis tendon.
That's not always true and I will explain why.
Does a split peroneal tendon always mean you have to have surgery if you're a runner?
Well, that's what we're talking about today on the Doc On The Run Podcast.
Today's episode comes from a discussion I had with a runner who is only five weeks out from a marathon.
She has been injured and super-aware that she could lose her fitness fast!
Her main goal on our call was to make sure that she is ready for the starting line, but more importantly, make it to the finish line fast enough to qualify for Boston.
Maintaining your running fitness when you're injured is a delicate dance.
And that's what we're talking about today on the Doc On The Run Podcast.
There really are three basic steps that doctors use when you have a broken toe.
The medical term for this procedure is called "closed reduction."
We don't cut the broken toe open, look at the bones and put them in place.
Instead, we leave the skin closed and manipulate the toe to pop the fracture back in place.
This is a very common procedure doctors do. I even have done it many times in people's homes, most often with a runner who has a broken toe that really hurts.
I am going to explain the basic steps...but do not do this on your own!
What are the basic steps if you have a broken toe, it's crooked and you want to put it back in place?
Well, that's what we're talking about today on the Doc On The Run Podcast.
One of the questions I get most often from runners with stress fractures is...
"How can I get it to heal better? How do I get back to running faster?"
The best way is to remove the stress so that the stress fracture can actually heal as fast as possible. That sounds obvious, but most runners aren't doing that.
I talked to a runner just a couple of days ago who was not running on it, but she was walking on it...a lot.
She told me, “Well, I have a fracture walking boot, but I'm walking in it and my foot hurts."
My first response was, “Why aren't you using crutches to take the stress off of it? If walking is making it hurt, you're not going to get better quickly. It'll get better eventually, probably, but certainly not as fast as possible.”
Do I have to use crutches if I have a fibula stress fracture?
Well, that's what we're talking about today on the Doc On The Run Podcast.
Plantar plate injuries are very common, and they are extremely annoying.
I get lots of questions and comments both from the podcast and from the Doc On The Run YouTube channel about plantar plate sprains.
Today's episode comes from a question posted by Jason on the Doc On The Run YouTube channel. He asked...
"Can MRI miss a plantar plate strain?”
The short answer is yes, and I'm going to try to explain why.
Can an MRI miss a plantar plate strain?
Well, that's a great question and that's what we're talking about today on the Doc On The Run Podcast.
Almost all runners who call me for a consultation have one thing in common.
The number one thing they want to get out of their discussion with me is “How can I start running sooner? I want to get back to running so I don't lose all my running fitness.”
There is one free and highly effective tool you can use as an injured runner, but most of the runners I talked to seem to be completely neglecting and ignoring it.
What is the single most effective but most often neglected tool injured runners can use to get back to running sooner?
Well, that's what we're talking about today on the Doc On The Run Podcast.
If you have ankle pain and you push around on that lump of bone on the outside of your ankle, you may realize that you have pain on the bone specifically.
If so, you might become worried that you have a thing called a fibular stress fracture.
If you start trying to figure out what to do, one of the first things you may find is a lot of discussion about something called a "stress reaction" instead of just a "stress fracture".
What's the difference between a fibular stress reaction and a stress fracture in a runner?
Well, that's what we're talking about today on the Doc On The Run Podcast.
This may seem like a strange episode, but I just had a conversation with a runner who is not just a forefoot runner, but she is really a forefoot runner. Like running-on-your-tiptoes kind of forefoot runner.
One of the things that I brought up in our discussion were some research studies that have actually calculated the amount of pressure in the forefoot when a woman is wearing high heels.
What does an elephant, a woman in high heels and a forefoot runner have in common?
Well, that's what we're talking about today on the Doc On The Run Podcast.
If you've been running, training for a marathon or an ultra-marathon and you start to get pain on the outside of your ankle, you do have a reason to be concerned.
There are really four things that seem to cause pain on the outside of the ankle the most. We're going to talk about those today.
What are the four main causes of lateral ankle pain in runners?
Well, that's what we're talking about today on the Doc On The Run Podcast.
If you have been told you have a plantar plate sprain, you're probably already really frustrated.
Even minor plantar plate tears can be nagging injuries that are very difficult to get better while you're running on them.
The bottom line is, you've got to make sure that the plantar plate ligament improves because (in general) plantar plate sprains are either getting worse or they're getting better.
One of the questions I get all the time from runners is what is really the best study for a plantar plate injury.
What's the best imaging study for a runner who is suspected of having a plantar plate injury?
Well, that's what we're talking about today on the Doc On The Run Podcast.
If you're out on a run and you roll your ankle, you need to know how you can test the ankle to figure out what is wrong.
More importantly, what tests can tell you how likely it is that you're actually going to get back to running and not have an ankle sprain again.
There are several tests doctors use in evaluating injured ankles. Some are more important than others.
What is the single most important test for a runner with an ankle sprain?
Well, that's what we're talking about today on the Doc On The Run Podcast.
There are times when you might have a suspected stress fracture in your foot. If so, your doctor may order an X-ray.
There are other times when it's extremely unlikely that you have a broken bone at all, but it is almost certainly just a soft tissue injury.
One of the questions I get a lot from runners with plantar plate sprains is how to make sure the pain is not from a stress fracture.
I have only seen one case where somebody had fracture pain in the exact same spot you would have pain when you had a plantar plate injury.
Can a fracture in the metatarsal seem like a plantar plate sprain?
Well, that's what we're talking about today on the Doc On The Run Podcast.
If you are running with foot or ankle pain, and you're trying to figure out what's wrong, the first step is deciding if it is a bone injury or soft tissue injury.
It might be useful to talk about the thought process I use when trying to figure out whether or not you have bone versus soft tissue injury.
How do you rule out soft tissue versus a bone injury when you're a runner and you've rolled your ankle?
Well, that's what we're talking about today on the Doc On The Run Podcast.
I recently did an episode where I was talking about Lister’s corns.
If you missed it, a "Lister's corn" is really just a callus or thick skin that looks like the pinky toenail or the little toenail has a split in it.
That edge of the nail that looks like a completely separate piece of nail.
But it's not a nail at all, it's callus.
I just saw a runner who had this problem where his Lister's corn was really painful. It hurt so much he thought the nail might be ingrown. He asked,
Why does a lister’s corn hurt when I run?
Well, that's what we're talking about today on the Doc On The Run Podcast.
All overtraining injuries are difficult.
The problem is that you're trying to not lose your running fitness while giving the injured part enough of a rest so it can actually heal.
A runner asked me an interesting question the other day, he actually said, “Okay, if I have bruising and swelling, does that mean I'm more likely to have a bone injury or a soft tissue injury?”
What are the key differences between a soft tissue injury and a bone injury in a runner?
Well, that's what we're talking about today on the Doc On The Run Podcast.
I was recently doing a second opinion consultation with a runner over a webcam to review the MRI of his foot.
What we found was that he had what looked to be attenuation and a partial tear in the plantar plate ligament on his MRI.
There was a lot of inflammation in the foot around the ligament, not just within the ligament itself.
He asked me was really good question:
“Could my plantar plate ligament been have injured long before I ever got an MRI?”
Well, that's what we're talking about today on the Doc On The Run Podcast.
Every runner who gets injured is in a race against time.
It is a race to not lose your running fitness.
You know you are going to get weaker. You know you're going to get stiffer. You're probably really concerned that you're going to lose all that aerobic fitness that took months or years building up.
Running injuries are like compound interest but in reverse.
That's what we're going to talk about today on the Doc On The Run Podcast.
I just saw a runner who sprained her ankle. It's been about a month and she's still having pain. Pain and swelling persisting a month later, are not good. There are a couple of reasons that that can happen.
Anytime doctors see persistent swelling and pain after an ankle injury, they become concerned there might be a fracture.
When should a runner who rolled an ankle be concerned that there might be a fracture like a lateral process fracture?
Well, that's what we're talking about today on the Doc On The Run Podcast.
If you are a runner with pain in the ball of the foot at the base of the second toe and start researching online, you may become concerned you have a thing called a plantar plate injury.
If so, you may be wondering whether X-rays or MRI imaging may be needed to tell what is wrong. Before seeing a doctor, it may be helpful to understand which are helpful, and which imaging studies are a waste of time.
What is the worst possible medical imaging study you could get if you're a runner with a suspected plantar plate injury?
Well, that's what we're talking about today on the Doc On The Run Podcast.
Just this week, I got a call from an injured runner about a new problem. I've seen him before for some other issues, but in this case.
He said that he thought maybe he actually had an ingrown toenail on his pinky or that the toenail itself had split in half and it was bugging him a little bit.
I said “Well, send me a picture. I'll take a look and see.”
My pinky toenail split in half. Is that a problem?
Well, that's what we're going to talk about today on the Doc On The Run Podcast.
Today's episode comes from a YouTube viewer who posted a question,
“I have a low risk grade stress reaction in my posterior tibia. Interestingly, there is some research discussing the benefits of weight bearing bone building exercise once tolerated pain free, like hops jumps and step ups. Do you have any advice on when and how to integrate these types of exercises into a rehabilitation program?”
When is it okay to add weight bearing exercises when you've had a bone injury like a stress reaction?
That is what we are talking about today on the Doc On The Run Podcast.
Today's episode comes from a YouTube viewer named John, who wrote in with a question about nerve pain vs. peroneal tendon pain.
He said ”I'm experiencing discomfort in my fifth metatarsal/peroneal tendon below the ankle. There is no swelling. However, upon hamstring stretch, especially in a downward dog position, this area feels like it's on fire. The fact that I cannot do downward dog right now, with my right heel down. I'm starting to think this may be a nerve. It's been hurting for about 10 days.”
Could peroneal tendon pain really be a nerve problem?
Well, that's what we're talking about today on the Doc On The Run Podcast.
Today's question comes from one of the YouTube viewers. Tasnim, wrote in and wanted to know whether or not "stress reaction" is the same terminology that is used in the UK for the term "metatarsalgia".
This question points out how confusing these two terms can be when you have forefoot pain that might be a stress fracture, might be a plantar plate sprain, or could even be a neuroma.
Are stress "reaction" and "metatarsalgia" the same terms?
Well, that's what we're talking about today on the Doc On The Run Podcast.
You're out on a run, and you suddenly start having extremely sharp heel pain.
You think it's plantar fasciitis.
But when you look at your foot, you see a huge bruise.
That's not plantar fasciitis. That's where you ripped something.
Is there always bruising with a partial rupture or a tear in the plantar fascia?
Well, that's what we're talking about today on the Doc On The Run Podcast.
One of the most powerful ways to reduce stress and strain on any piece of injured tissue is to get completely off of your feet. Bedrest can do that.
I was talking with a runner recently who asked a great question,
“Should I just do bed rest?”
I answered,
“Bed rest is like chemo for runners.”
With chemotherapy, we're basically giving you a powerful drug.
But is it going to kill the tumor first, or is it going to kill the patient first?
Bed rest is like chemotherapy for runners, and that's what we're talking about today on the Doc On The Run Podcast.
Today I was on a call with an injured runner who was told she had plantar fasciitis.
She was confused and she started doing some research. She enrolled in the Runner's Heel Pain Course because she was trying to figure out why her "diagnosis" didn't seem to match her gut instinct.
She suspected her diagnosis was wrong.
If you have heel pain, and you call for a ride instead of finishing your run, it's not plantar fasciitis.
And that's what we're talking about today on the Doc On The Run Podcast.
I was just on a call with a runner who has had this condition called "hallux rigidus." and it's where your big toe joint starts to get stiff, becomes rigid, and it doesn't move as much.
Hallux rigidus is a progressive condition, especially if you continue to irritate the joint. You can damage the joint cartilage. The stiffer the big toe joint gets, the more pressure on the cartilage when the big toe is trying to fight that stiffness. Sometimes that movement hurts.
He was asking me about the options on different injections.
What are the risks between an injection like a PRP or platelet rich plasma injection versus something like a cortisone injection when you have hallux rigidus?
Well, that's what we're talking about today on the Doc On The Run Podcast.
Have you ever been to the doctor and heard this, “You must be allergic to running because you get injured every time you go running.”
A recovering runner and I were on a call talking about how she could get back to running and how to "just go for a run" without getting re-injured.
We were talking about this approach of getting her running fitness back now, and returning to running faster without just sitting around waiting.
She told me something I had never heard.
Today on the Doc On The Run Podcast we're talking about running allergies and injury recovery.
Plantar fasciitis is one of the most common conditions that affects runners.
In fact, foot pain consistent with plantar fasciitis accounts for about 40% of all visits to the podiatrists in the United States each year.
Unfortunately, just because you think that you have plantar fasciitis, and you started doing some simple things to treat it, it doesn't necessarily mean that it's going to get better.
If you are a runner, and you think you have plantar fasciitis, you must realize there are some avoidable mistakes you could make when trying to self-treat runner's heel pain.
Today on the Doc On The Run Podcast, we're talking about the top five reasons runners heel pain doesn't get better.
I just had a discussion with a really interesting patient. He was a pro triathlete. He had some difficulty getting past a particular injury.
We were talking about all of the ways that you can encounter barriers to healing. And how you can start making progress in spite of them.
We were talking about two different things, logical and psychological barriers.
What's the difference between logical versus psychological barriers to healing injuries in runners?
Well, that's what we're talking about today on the Doc On The Run Podcast.
Every runner with a stress fracture wants to know "when can I run?"
How soon you can start running after a foot fracture really depends on when you have enough strength in the bone so that the healing fracture will withstand the forces applied during running without breaking the bone again.
It all depends on what you do to speed up (or slow down) the bone healing process. The rate of fracture healing depends on your physiology, and it depends on stages of bone healing.
But it does NOT depend entirely on generic timelines.
How long is each stage of fracture healing when you have a broken bone?
Well, that's what we're talking about today on the Doc On The Run Podcast.
The first thing any runner should do when you roll your ankle is protect the ankle from further injury. In fact, the algorithm doctors use to treat ankle sprains is P. R. I. C. E.
P stands for Protection, meaning don’t roll it again. Don't make it worse. Then, Rest it. Ice it. Use Compression to keep it from swelling. Elevate it to get the fluid out if it's really swollen.
So, what happens is, you're a runner, you're out on a trail and you roll your ankle. What happens if you don't follow the PRICE method?
]It just might take a whole lot longer before it gets better.
What are the most common three ways I see runners lose all their fitness after they get an ankle sprain?
Well, that's what we're talking about today on the Doc On The Run Podcast.
There are three key indications that tell me that somebody may not have plantar fasciitis, but probably have something else.
If you think you have plantar fasciitis, you may have a different form of runner's heel pain. Treating the wrong condition will not get you back to running. Understanding the ways plantar fasciitis shows up can help you make sure you don't have something else causing your heel pain.
What are the three best signs that your heel pain is not Plantar fasciitis?
Well, that's what we're talking about today on the Doc On The Run Podcast.
I got a specific question about a recent episode on calluses in runners.
The question was, “Well, if you have that pattern of callus, and reduce the thickness of the callus so the callus is going away, does that mean there is less pressure there?”
You may have checked out the episode on the three callus patterns that I see in runners at high risk for getting a plantar plate injury.
Does callus reduction reduce your risk or decrease the risk that you're going to get a plantar plate sprain?
Well, that's what we're talking about today on the Doc On The Run Podcast.
I was just on a call with an interesting elite athlete, and he's been injured.
He had one particular injury in his foot and then started having a completely different injury, as soon as that injury in his foot was starting to heal.
We were talking about how disappointment can lead to more and more setbacks.
The phrase he used struck me.
He said, “I think it might be traumatic disappointment.”
What is traumatic disappointment and what kind of effect can it have on delayed healing in an injured runner?
Well, that's what we're talking about today on the Doc On The Run Podcast.
Yesterday I called a recovering runner, just to check in and see how he was doing, because he had done the Fast Track Challenge 2 months ago.
He's doing great. He has recovered and gotten past his injury.
He said he learned a lot in the Challenge and has applied it to his training.
He's on track for running ultra-marathons this year. He has a coach. Training is in full swing with no limitation from the injury and got him into the Fast Track challenge.
Something he said on that call actually kind of shocked me.
I asked him, “Is there anything that you wish you could have done differently if you went back?”
He answered, “Yeah, I would have called you sooner for a consultation.”
If you ever run into injury many times, your first step is to sit still and wait. Sometimes that's a problem and that's what we're talking about today on the Doc On The Run Podcast.
If you are a runner and you get pain in the ball of the foot, particularly at the base of the second toe right. It could be a plantar plate sprain.
Whenever I see a runner on webcam who has pain that sounds like a plantar plate sprain, the first thing I do is look for any callus pattern in the skin that suggests they have too much pressure and friction at that area that could injure the plantar plate ligament underneath the skin.
This episode will help you understand how certain callus patterns relate to some basic foot mechanics when you're trying to figure out what is causing your ball of foot pain.
Today on the Doc On The Run Podcast we're talking about three callus patterns I often see that can suggest you have a risk for getting a plantar plate sprain if you are a runner.
Everybody's short on time. This is true for runners in training, but it's also true for injured runners.
If you're trying to make progress as fast as possible, you really have to do the things that will give you the most progress in the least amount of time.
Many runners I talk to on a second opinion consultation webcam call really want to know which stretches will help them. Specifically, which two or three stretches will help the most.
What are the most valuable stretches you can do after a running injury?
Well, that's what we're talking about today on the Doc On The Run Podcast.
If you have a condition called "hallux rigidus" or "hallux limitus," the name tells you what's wrong.
"Hallux" means big toe.
"Rigidus" means the big toe joint doesn't move at all.
"Limitus" just means the big toe joint movement is limited and stiff.
There are three problems with hallux rigidus, which are: 1) damage to the cartilage, 2) bone spurs around the joint and 3) restriction of the soft tissues such that the toe doesn't move up and down the way it should.
Those three reasons that cause the condition are the same reasons that can fail if you have a cheilectomy surgery.
Today on the Doc On The Run Podcast we're talking about three reasons for cheilectomy failure after hallux rigidus surgery.
Let's say you have a nagging tendon injury that's really been painful. It's been bugging you a lot when you run.
You have had persistent pain either on the side of the ankle that just won't seem to go away, even if you run less.
You see the doctor and she says, “Look, we tried everything. We should do surgery. Your tendon is not really torn, but we should do this surgical procedure called a "synovectomy" to get it to calm down so it will finally stop hurting.”
What is a tendon synovectomy surgery?
Well, that's what we're talking about today on the Doc On The Run Podcast.
Let's say you're out on a trail run, you roll your ankle and sprain it. So what do you do?
You limp home, you get back to the car, you ice it, you take some pressure off of it, you elevate it, you do all the right stuff. But, it's really painful and swollen the next few days.
Then, maybe a day or two later, it's black, it's blue and swollen. But even worse, you look down and you're kind of dismayed because your toes are swollen like sausages.
Believe it or not, I have had a number of patients who called me, not because they sprained their ankle, but because they were actually worried they may have broken toes as well.
Is it possible to break your toes at the same time you get an ankle sprain?
Well, that's what we're talking about today on the Doc On The Run Podcast.
Today's episode comes from a discussion I just had yesterday with an athlete. He had a metatarsal fracture non-union.
A "fracture non-union" can develop when there is a crack in the bone that moving a little bit too much and doesn't completely heal.
Non-unions can happen if you get a stress fracture, and you keep running on it and you're tough and you're strong and it doesn't really hurt that bad.
If you keep running and repeatedly stress that crack, it can't heal.
Should I get a CT scan or should I test walking to see if my fracture is healed?
Well, that's what we're talking about today on the Doc On The Run Podcast.
When you get an injury to a bone like a metatarsal stress fracture, you can develop a thing called a "bone callus."
You might even see it as a lump visible on the x-ray in your doctors office.
Whether the lump is made up of hard bone, fibrocartilage or something in between, it may help you to understand the significance of that lump in your foot.
When the bone callous appears, and the size of the bone callous itself, can tell your whole lot about your progression of healing, and whether or not you might get other problems in the future.
What is a bone callus in a metatarsal stress fracture? Well, that's what we're talking about today on the Doc On The Run Podcast!
Achilles tendon injury on one leg and a calf muscle strain on the other leg?
Talk about a bummer: 2-for-the-price-of-1 overtraining injuries! Yes, it is possible to get similar running injuries on opposite legs, at the same time.
Today I had a conversation with a runner who has developed both of these injuries from running. These are actually just opposite ends of the same biomechanical spectrum at work. During the call I was explaining to him how it can happen, and how he could make some simple changes to prevent it from happening again in the future.
How can running on the road cause Achilles tendinitis in one leg and calf strain on the other? Well, that's what we're talking about today on the Doc On The Run Podcast!
What would be worse than not being able to run because you had foot pain that didn't get better for a year or two?
I know one thing that would be worse... Having foot surgery to treat a problem that was not actually even located in the foot.
Think about that. You had pain in your foot for two years. Then some doctor convinces you to have surgery, only to find out there was no problem with the tendon.
You stop running. You have surgery. You wait for your stitches to heal. You have to stay off your feet until the incision is all healed.
And your foot pain does not change at all.
Sounds crazy, but this can happen. And it's most likely to occur when you have something called referred pain. The pain in your foot might be actually caused by nerve compression deep to your glues maximus...that' right...in your butt.
Today on the Doc On the Run Podcast we are talking about foot pain that is truly a pain in the butt!
If you just got injured, your number one goal is to not lose your running fitness as your running injury heals.
If you were diagnosed with a running injury a while ago, you stopped running and now you’re just getting back to running after taking some time off, in that case your primary goal is to resume running without sustaining another overtraining injury. Especially right when you start running again.
What I teach runners in the Fast Track Challenge is how to find their unique fastest path back to running. The process is all about methodical testing.
Methodical testing is the key to running after injury.
And that’s what we're talking about today on the Doc On The Run Podcast.
This morning, I was on a call with a recovering runner who signed up for a series of coaching calls to get back to running after a long-standing injury.
This is an elite athlete who had multiple setbacks, and encountered difficulty getting over the hump a number of times.
If you're going to get back your fitness, and if you're going to get back to training as fast as possible, you're going to have to endure some discomfort, some risk, and frankly, a little bit of anxiety every time you bump up against your limits. But that is part of the recovery process.
Are you scared of re-injury after trying to build strength when you've had a running injury?
Well, that's what we're talking about today on the Doc On The Run Podcast.
Let's say you have been injured. You've been a good little patient. You waited around, you have done nothing. You have endured a frustrating period of boredom. And you finally started running again. That’s great!
Today's episode came from a webcam call I did with a recovering runner. She has a stress fracture but her foot was good enough to run outside.
The question was about whether or not an injured runner should keep using something like an AlterG treadmill to maintain running fitness while continuing to heal and recover from a stress fracture.
After healing a stress fracture, should I use the AlterG treadmill even after I've started running outside?
Well, that's a great question, and that's what we're talking about today on the Doc On The Run Podcast.
Today I was out on a run and I was thinking about treadmills versus running outside. To be fair, I was actually running outside during this run.
It seems like most of the runners who sign up for the Fast Track challenge, or who call me for a second opinion, the majority of them like to run outside.
I have a question for you.
If you got an overtraining injury like a metatarsal stress fracture, calcaneal stress fracture, or a tibial stress fracture, plantar plate sprain, the question is... Are you running on a treadmill to ease back into running, or are you just running outside, to see how running feels after your injury?
Are you using a treadmill for returning to running after an injury?
Well, that's what we're talking about today on the Doc On The Run Podcast.
Let's say you're out on a run and you start getting some aching pain in the ball of the foot. It persists for a while.
It's not really that bad. Your foot is not killing you. But it starts to bother you more and more over the course of a few weeks.
Being proactive, you see a podiatrist. The podiatrist tells you that he thinks you have something called a Morton's neuroma. So he does an x-ray of your foot and what do you see? Well, nothing. Why is that?
When are x-rays useful for a runner with a Morton's neuroma?
Well, that's what we're talking about today on the Doc On The Run Podcast.
Have you ever had black toenails after a long run?
Have you ever lost a toenail after a marathon?
Have you tried using goopy skin lubricants, or worn bigger shoes that make you feel like you're wearing clown shoes?
If you have, but you're still having problems beating up your toenails in your running shoes when run, I've got a simple solution that may actually help.
Today on the Doc On The Run Podcast we're talking about the best way to file your toenails if you're a marathon runner.
If you're a runner with plantar fasciitis, you probably have heel pain when you get up and step out of bed.
If that's gone on for months, you tried icing, you've tried stretching, and you've become frustrated, it starts to become pretty easy for your doctor to talk you into surgery.
If you've had plantar fasciitis for a long time and your doctor is trying to convince you need surgery, you should listen up!
When is plantar fascia surgery really necessary for runners?
Well, that's what we're talking about today on the Doc On The Run Podcast.
If you get aching pain in your ankles when you're running, and it seems to lag and doesn't just go away, you might not have ankle pain at all.
There's a thing that I see often in runners complaining of ankle pain, but when I actually look at the runner's feet, it's a different condition altogether.
That condition is something called "sinus tarsi impingement."
Today on the Doc On The Run Podcast, we're talking about ankle pain versus sinus tarsi impingement when running.
Plantar plate ligament sprains are a tough injury for runners. Plantar plate tears can cause a lot of pain in the ball of the foot. Unless you treat them correctly, that pain can persist for a long time. As a result plantar plate injuries can be super frustrating.
Unfortunately, plantar plate tears are often diagnosed when you get an MRI of the foot. I often get questions from runners asking me whether or not they have to wait for another MRI before they can run.
Does the plantar plate ligament need to heal on an MRI before I can run?
Well, that's what we're talking about today on the Doc On The Run Podcast.
Today's episode comes from a question posted as a YouTube video comment.
That video was explaining how using crutches for a short period of time can help injured runners.
I wasn't talking about months of crutches, not many weeks, but a short period of time to try to accelerate the process of healing over-training injuries.
In the comments someone posted and said, "How long would you use crutches for this...?"
How long should I use crutches?
Well, that's a million-dollar question! And that's what we're talking about today on the Doc On The Run Podcast.
WARNING: You may not want to listen to this topic while you're eating.
I'm going to tell you a story that goes along with dinner.
Believe it or not. One time we went out to a restaurantwith a bunch of friends.
A member of our dinner party took off his shoes and he said, "Hey, what do you think of this?" He was literally showing me warts on the feet right there in the restaurant.
Plantar warts are on the bottom of the foot. Warts on the feet can be difficult to treat because the skin is so thick.
To make matters worse, he had a more severe type of warts called mosaic warts. They were all over the feet. That makes treatment even more difficult.
Today on the Doc On The Run Podcast, we're talking about plantar wart treatment options in runners.
Whenever I speak to a runner who wants to know if they can run with a bone bruise, I get confused. If you were "diagnosed" with a bone bruise, you should be confused, too.
A bruise is a very simple thing. You fall down and land on your knee and you get a bruise. You get a bruise because your kneecap crushes the skin against the ground and you get bleeding in the skin that you see as discoloration that we call a bruise.
You can't see that in a bone. When you get diagnosed with a bone bruise, you have to think of it in terms of bone injury, like a stress fracture. The continuum of bone injury includes stress response, stress reaction and stress fractures.
You have to understand the severity of the bone injury before you can decide whether or not to run.
What is the difference between a bone bruise and a stress reaction in a runner?
Well, that's what we're talking about today on the Doc On The Run Podcast.
If you have pain at the bottom of the big toe joint, up along the arch, just above the plantar fascia, you may have been told that you have this thing called FHL tenosynovitis.
"Tenosynovitis" just means that you have inflammation of the tendon sheath or tube that carries the flexor tendon down to your big toe. It helps you pull your big toe down when you push off while running. When the tendon sheath gets inflamed, it can be painful.
If you have tenosynovitis, your doctor may recommend a cortisone injection, or a Platelet Rich Plasma (PRP) injection.
So what's the difference between these two injections and why would you want one versus another?
Today on the Doc On The Run Podcast we're talking about FHL tenosynovitis injections, corticosteroids versus PRP injection.
It's no secret that I enjoy Ironman triathlons. I did 15 of them, and the last one I did was the Ironman World Championships. That doesn't mean I'm fast. It just means I'm stubborn.
But when I was a kid, I was obsessed with Ironman Hawaii and I decided that I was going to do Kona.
You never know what good or "bad" things can happen to help you fulfill your dreams.
Long story short, the day before I was going to leave for Hawaii, literally the day before I was getting on the plane, I was in my doctor's office and he said that I could not possibly do Ironman Hawaii because I had pneumonia.
But it turns out the Universe is always conspiring to make dreams come true.
Today on the Doc On The Run Podcast, we're talking about how pneumonia made my Kona dream come true.
If you're a runner you may be wondering what in the world something like "subungual melanoma" has to do with running injuries.
There are a couple of reasons.
Subungual melanoma is commonly mistaken for a bruised toenail. What runner has never had a dark spot under the toenail?
Subungual melanoma is actually extremely deadly. You're not necessarily likely to get it, but there is a reason that this might be pertinent to you as a runner.
Repeated trauma from running and beating up your toes could possibly increase your odds of getting this form of cancer.
What is subungual melanoma?
Well, that's what we're talking about today on the Doc On The Run Podcast.
If you have pain under the big toe joint, it could be an injury called sesamoiditis. Sesamoid bones are like a pair of tiny little kneecaps under the big toe joint. They are about the size of kidney beans. If irritated enough, sesamoid can develop stress fractures.
Any inflammation of the sesamoid bones is called sesamoiditis.
But pain in the sesamoid area can also result from inflammation of the tendon sheath that goes around the flexor tendon. The flexor tendon sheath is just a tube around the tendon that actually helps the tendon glide as your big toe moves up and down.
The flexor tendon sheath is very close to the sesamoids. Sometimes it is hard for a runner to tell the two conditions apart.
There's a big difference between the two conditions and a big difference between the way that you would treat them.
What's the difference between flexor hallucis longus tenosynovitis and sesamoiditis?
Well, that's what we're talking about today on the Doc On The Run Podcast.
One of the worst questions you can ask any doctor is, "when can I run?" Believe it or not, I get these questions every single day...from total strangers. They get injured and go to the doctor. The doctor says, "You can't run." Then they will call me and ask, "When can I run?"
Why am I going to give you the magic answer, if I don't even know you?
There is a better way.
The best questions that you can come up with are the ones that direct your doctor to start thinking about how to help you get back to running a whole lot faster.
If you got a running injury and you're trying to figure out how to run and you go to the doctor, don't ask them when you can run, ask them how you can run.
That's what we're talking about today on Doc On The Run Podcast.
An interesting runner called me for a second opinion. He had a couple of things going on that created a pretty confusing picture.
He had a plantar plate sprains (at least he was told he had plantar plate injuries) because his MRI showed evidence of injuries to the plantar plate ligaments of toes two, three, and four.
He also had some nerve type symptoms. But on the bottom of the foot, he also had this very interesting ridge of callus.
So what was REALLY causing all of his trouble when he ran?
Today, on the Doc On The Run Podcast, we're talking about a runner with a plantar plate injury and deep perineal neuritis.
I got a great question from a runner who wanted to start running on an Alter G Treadmill. What she said was:
"I've been getting out of the boot. I started running on an Alter G Treadmill, and everything's been going great. I feel good. I feel like a million bucks because I'm finally moving again. Is it okay for me to run every day?"
What if you had a friend, who was not fit at all, who wanted to run a marathon? Imagine she wanted to do her very first marathon, and you were going to help her train? Would you tell her to run every single day?
Can I run every day on an Alter G Treadmill?
Well, that's what we're talking about today on the Doc On The Run Podcast.
Today's question actually comes from Elizabeth who explained she rolled her ankle, and sustained a fracture of the fibula bone. She wanted to see if she could get some advice.
She said, "I'm a 27-year-old female. I twisted my ankle and I was rushed off for x-rays and discovered a spiral displaced fracture of my fibula in my ankle joint. I'm dying to get back on the road and going a bit stir crazy. It's been 10 or 11 weeks post-break now. I want to know if I will do damage by starting to run in increments to gain back some fitness and cardiovascular fitness or if it'll be okay.”
Can I run after a spiral fracture of the fibula?
Well, that's what we're going to talk about today on the Doc On The Run Podcast.
One of the worst injuries you can get when you're a runner is a plantar plate sprain. It's a stretching, a straining, a tearing of this tiny little ligament at the ball of the foot called the plantar plate.
Every time I do a second opinion consultation over webcam for a runner with a suspected plantar plate sprain, I ask them to do one simple thing.
I want to look at the insert in their running shoe: "Go get it, right now, preferably one you've been running in for a long time, not a brand new one."
Pull out the insert and let's see what the wear pattern shows us.
Today on the Doc On The Run Podcast, we're talking about how your running shoe insert can actually show whether or not you're at risk of a plantar plate sprain.
During a recent call with a runner who signed up for a series of phone calls, we were trying to figure out exactly what happened to cause his foot pain.
The way that doctors are taught to think goes something like this: Come up with a particular name called a "diagnosis" and then do a "procedure" that the insurance covers.
Doctors focus on making sure the diagnosis code matches the insurance requirements so they will send a check.
This process does not serve runners well. Runners need to focus on how they got injured...so they do not do it again.
How an injury happened is much more important than what happened.
Does that make sense?
Well, that's what we're talking about today on the Doc On The Run Podcast.
One of the most common nerve related running injuries is a thing called Morton's neuroma. A "neuroma" is just an irritated nerve. A "Morton's neuroma" occurs specifically in the foot between the 3rd and 4th toes.
When a neuroma first starts, the nerve is just a little bit irritated, and it may feel a bit weird.
In one of the original descriptions of Morton's neuroma, it described a sensation or feeling of wet leather being stuck to the bottom of the foot. That odd sensation is the result of the nerve getting aggravated. It starts to send little erroneous signals to your brain. If the nerve is getting irritated, you want to make sure your running shoes are not making it worse.
What are the four worst traits of a running shoe if you have a Morton's neuroma?
Well, that's what we're talking about today on the Doc On The Run Podcast.
If you have a soft tissue injury in your foot related to overtraining, you (or your doctor) may be thinking about getting an MRI.
If you have a ligament injury, plantar plate sprain, partial tear of the plantar fascia, an Achilles tendon partial rupture, Achilles tendinosis, or peroneal tendinitis, the timing of the MRI is extremely important.
MRIs can be really useful tools. They give you over a hundred images of your foot. Because you have so many pictures, the detail can fool you into believing the MRI is a complete picture, but it is not.
When is an MRI most reliable for a soft tissue running injury?
Well, that's what we're talking about today on the Doc On The Run Podcast.
I was just on a call with a runner who has a plantar plate sprain. A plantar plate sprain is an injury to a very small ligament right at the base of the toe, usually the second toe, right where it attaches to the metatarsal at what we call the metatarsophalangeal joint.
That sprain typically causes aching in the ball of the foot.
These are tough injuries to get better.
I have had one myself, and when you get them, they're really annoying.
It seems like they get better very, very slowly, but you can make them worse very, very quickly.
It's really important when you get a plantar plate sprain to identify the one thing that caused the injury so you stop doing it.
Today on the Doc On The Run Podcast, we're going to talk about my advice for a flat-footed runner who has a plantar plate injury that started from running on a treadmill.
I just got off the phone with an elite athlete recently who asked a great question.
He called me and said, "I have custom orthotics and I know they support my foot better. So the question is, can I use a broader range of shoes?"
What he really wants to know is whether or not he can ONLY use motion control shoes.
He was really asking, "Since I have an unstable foot that's now stabilized by the custom orthotic supporting the foot, does that mean that I can wear shoes other than something like a true motion control shoe?"
Can I wear softer shoes when running with a custom orthotic?
Well, that's a great question, and that's what we're talking about today on the Doc On The Run Podcast.
One of the things about getting an MRI has to do with timing of the injury.
What do I mean by that?
Well, it means timing in terms of when the MRI is done relative to how long it has been since you actually beat it up and injured that structure.
When is an MRI most reliable for a bone running injury like a stress fracture?
Well, that's what we're talking about today on the Doc The On Run Podcast.
Every time I talk to a recovering runner who is trying to figure out how to run, and help figure out what's causing all their trouble, I ask them to keep a pain journal.
Why do you think that is?
Pain is the lowest cost, most abundant, and most underutilized diagnostic resource available to help an injured runner guide the recovery.
Imagine a contest between doctors trying to get injured runners back to running faster.
If I could only use pain as a diagnostic tool, but other doctors could use MRIs, X-rays, CT scans, and all the medical imaging they wanted (but could not track the runner's pain), I bet I would get runners back to running faster.
Find the one thing that causes the most pain when you're running.
That's what we're talking about today on the Doc On The Run Podcast.
When you get a stress fracture, you have to remember that it is a stress related injury.
That's why it's called a "stress" fracture.
It is not a "run-too-much" fracture. It is not a "ran-too-far" fracture. It is a "too-much-stress" fracture.
So, if you want to know whether or not you're at risk of getting one as you ramp up your training, one of the simplest things you can do is look at your running shoes. More specifically, your running shoe insert.
How can your running shoe insert show you whether or not you're at risk for a metatarsal stress fracture?
Well, that's what we're talking about today on the Doc On The Run Podcast.
If you get an overtraining injury and your doctor tells you to stop running, so you sit still doing nothing, lots of bad things happen.
If you stop running, you will feel terrible physically. Zero exercise makes athletes feel worse.
Additionally, you're probably going to get super grumpy.
Don't be surprised if your spouse, your kids, and your friends start to think you're being a little bit of a jerk. That is because you're in a really terrible mood all the time... because you're not running.
You also start to lose your identity as a fit runner.
We all feel good when we run. We feel good when we accomplish goals. We feel good when we do a long run at a good pace.
But all that gets washed away when you're sitting around recovering from an injury.
Your identity needs to be that of a recovering runner.
That's what we're talking about today on the Doc On The Run Podcast.
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:
-
How do I let the heel bone heal fast
-
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Yesterday it started to snow. So I decided to go out on a trail run on the trail in this picture.
I only saw one deer and two people.
As I ran around a corner under a cliff two climbers approached wearing jackets, with fleece hats under their helmets and all their climbing gear.
I stopped, looked at them and I asked, "Isn't it too cold for climbing?"
One of the climbers smiled and said, "Isn't it too cold for a trail run?" We all started to laugh.
The reality is that it is never too cold to go for a trail run. But excuses for getting stronger abound.
This is true when you are injured, too.
You got injured because you were too weak.
That's what we're talking about today on the Doc On The Run Podcast.
One of my Elite Access patients sent me a message. He was having pain from an inflamed Tailor's bunion bursa at the base of the pinky toe.
He got a bigger shoe with a wider toe box that decreased the pressure. But when he was running, his foot was sliding around in the shoe, and it was still causing a problem.
He asked me if there was any solution. And yes, there is...
Today, on the Doc On The Run Podcast, we're talking about how you can lace your running shoes differently when you have bursitis pain from a tailor's bunion.
When you get injured, a lot of things go wrong.
-
Because you have pain, you suspect you have to stop training.
-
When you see a doctor, they confirm your fear and tell you that you really need to rest.
You translate that into really strict rest, doing nothing basically. You stop exercising. You stop training.
All kinds of bad stuff starts to happen. It is a lot more than just losing aerobic fitness.
Today on the Doc On The Run Podcast, we're talking about how it is that the longer you wait, the more pain you can expect when you actually return to running after you get an over-training injury.
Today we're talking about metatarsal fracture, nonunion surgery versus no surgery.
I know some people will think that I probably should have gone straight from #665 to 667 because frankly, there are some negative connotations surrounding those three letters, 666...the number of the beast.
But I decided to do this episode anyway. And, I decided to dedicate this one to a buddy who is a beast.
He's tough, he's active, and he happens to have a metatarsal nonunion that hasn't stopped him from doing a whole lot of fun, active things.
I'm hoping in this episode you can learn a little bit about the different options you have when you get a metatarsal fracture nonunion.
A calcaneal stress fracture is a terrible injury.
What is a calcaneal stress fracture?
"Calcaneus" is the medical term for heel bone. When you get a stress fracture in the heel bone, doctors call it a calcaneal stress fracture. When you run with a calcaneal stress fracture there is a risk the bone can actually shatter and break apart.
That obviously would be bad.
But there are three really interesting facts about the heel bone that you should think about.
Is a fracture walking boot the best thing when you have a calcaneal stress fracture?
Well, that's what we're talking about today on the Doc On The Run Podcast.
Today I went out for a run, but truthfully I wasn't really excited about it. It was cold, it was pouring rain, and I had a lot of stuff to do. I could have easily justified not putting on my running shoes, not going out and slogging through a bunch of mud puddles.
I also hate to admit that part of the truth is, I had new running shoes. I just didn't want to get them all nasty and dirty running in the rain, because they were brand new.
But I did run.
I enjoyed that cold wet run more than I thought that I would. But that's almost always the case when you're not really wanting to go out and workout, but you do anyway. Right?
When you're injured, and you're not exercising, you may wonder, "When should I start to exercise?"
Remember, the best time to plant a tree was 100 years ago.
Today on the Doc On The Run Podcast, we're talking about how runners who recover faster workout before the perfect time.
I just got a great question from a runner who had been using a thing called a dancer's pad.
A dancer's pad is sometimes used to help an injury to these little bones under the big toe joint called the "sesamoid bones."
If one of the sesamoids is painful and irritated and you're trying to take the pressure off of it, an easy way to do that is to place a dancer's pad in your shoe.
How can a dancer's pad lead to a plantar plate sprain?
Well, that's what we're talking about today on the Doc On The Run Podcast.
If you're a runner and you are listening to this, you probably have some kind of injury that's doing one of two things.
Either it's keeping you completely off of your feet and you're not running at all, or you are basically running in a halfway fashion. You are not really doing your full workouts. Your workouts are not really gratifying. And you don't really feel like you're making progress.
You have to remember here, the enemy is time.
Today on the Doc On The Run Podcast, we're talking about how uncertainty costs injured runners.
In this episode of the Doc On The Run Podcast we have a real treat for you. Kate is someone I met through the Grand Canyon R2R2R Run Group and she has an amazing story!
If you are not familiar with what running the Grand Canyon entails, you start at one side, run from the rim of the Grand Canyon Down treacherous trails all the way to the bottom, then run across the bottom of the canyon and back up out of the canyon on the other side. Then you turn around and run back.
Kate has agreed to come on the show today to talk about running the Grand Canyon.
More specifically she is here to talk about running Rim-to-Rim-to-Rim with a calcaneal stress fracture!
Today on the Doc On The Run Podcast we are talking with Kate Stopa, about calcaneal stress fractures, running the Grand Canyon Rim to Rim to Rim, giving up a kidney.
I just got a call from an ultra-marathoner I have seen a number of times over the years.
He is not a wimp. He's a tough guy. He's very smart. He knows his body really well, and he got what we suspected was a partial tear in the plantar fascia.
He didn't get better. He took weeks off. He couldn't run. He couldn't even hike! it was killing him, so I ordered an MRI.
I diligently prepared the order for his MRI. I sent it to the facility. I wrote up all the various details which basically proved that his MRI study is medically necessary and completely justified...and they should pay for it.
Well, the insurance company denied prior authorization for his MRI.
You won't believe this, but the insurance company said he had to have heel pain FOR 6 MONTHS before they would allow him to get an MRI.
What would you do if you're a runner and you were told you're going to have to wait six months to get an MRI in order to make a decision about what you would do for treatment?
Well, that's what we're talking about today on the Doc On The Run Podcast.
Imagine this scenario. You are out on a long run. You have been training hard for your race. But near the end of your run, your foot starts to ache a little bit.
The next day when you wake up, it hurts. So maybe you take a day off, you don't run that day, and you skip a workout.
The day after that, you go for a run and predictably it gets worse.
You call your local podiatrist. You make an appointment and when you're in the doctor's office, the doctor hands you a pre-written sheet (that is not designed for runners,) but designed for anybody that comes in with a metatarsal stress fracture or with plantar fasciitis or with Achilles tendonitis, or whatever. Those instruction sheets are not written for runners.
They're written for anyone and everyone who has that injury. It's supposed to fit everybody. Does that make any sense?
Today on the Doc On The Run Podcast, we're talking about how to get tailored treatment instead of some cookie cutter treatment plan when you go to the doctor with an overtraining injury.
Achilles tendinosis is one of the worst injuries you can get as an injured runner. It is chronic, it's hard to get rid of, and the tendon feels noticeably different.
The tendon gets thicker and it becomes constantly painful. Every time you run on it, you may worry that it might rupture or rip apart.
There are lots of different ways to treat Achilles tendinosis. Two of those options are PRP or platelet-rich plasma injection or a procedure called "dry needling."
Yesterday in a live Runner's Aid Station call, an injured runner asked me to explain the specific differences between these two treatments. I thought it might be helpful to try to explain it to you the way I explained it during that call.
What's the difference between dry needling and PRP injection when you have Achilles tendinosis and you're a runner?
Well, that's what we're going to talk about today on the Doc On The Run Podcast.
If the top of your foot hurts because you have extensor tenosynovitis, it can cause a lot of pain. But the condition is not complicated.
The extensor tendons run down across the top of your foot. The extensor tendons continue all the way out to the toes. The function of the tendons is to pull your toes up when you swing through in the swing phase of gait, so you don't trip over your toes when you run.
If you start running and your shoelaces actually push on the tendons with just a tiny bit too much force, the tendon sheath surrounding the tendons can get irritated. With continued aggravation, you get inflammation within the tendon sheath. A big painful spot right on the top of your foot is the result.
So, there's a simple way you can decrease the irritation of the tendon sheath when you have extensor tenosynovitis.
Today on the Doc On The Run Podcast, we're talking about how you can alter your running shoe lacing pattern if you have this condition called tenosynovitis.
All of us want to get better when we have a running injury.
We just want to run. But when you go to the doctor, things can start getting confusing. The doctor may tell you what you need to do, but it doesn't always jive with what you really want to do.
I thought it might be helpful for you to understand a little bit about the difference between true wants and needs when you go to the doctor. This may help you get your doctor to focus on what you really do need so you can get back to running sooner.
Today on the Doc On The Run Podcast, we're talking about distinguishing your wants from your needs and your running injury recovery.
Any time you get a running injury you are facing a tremendous task.
You might think that your job is to get help and heal the injuries quickly as possible.
But that would only be partially correct.
Your real job as an injured runner is to seek the full solution.
Today on the Doc On The Run Podcast, we're talking about how injured runners need the full solution.
If you are a runner who thinks you have a tendon tear, ligament tear or other overtraining injury, you may want an MRI. In fact, you may be convinced an MRI will give you a crystal clear picture of what may be wrong inside your foot or ankle.
But, I believe many many runners and doctors rely way to heavily on MRI for running injuries.
Today we are going to talk about a study published in Foot and Ankle International in 1998.
The research study was led by Dr. Matthew Rocket (a well-respected foot and ankle surgeon) in Houston Texas.
This was a great study comparing the effectiveness of MRI and diagnostic ultrasound when trying to decide whether or not there is an actual tear in a tendon around the foot and ankle.
Is an MRI best way to check for a tendon tear in a runner?
Well, that's what we're talking about, today, on the Doc On The Run Podcast.
I got a call recently from a runner with a torn plantar fascia. It was a unique situation, but truthfully really not that rare.
Any time you have an injury and you want to run, you have to make some really important key decisions, based on only a few important factors.
This case will be instructive in helping you figure out how you can make that decision, and decide if (and when) it might be safe for you to run.
If you just had an injury, but you have a really important event you want to run, you gotta check out this episode!
"I think I tore my plantar fascia. Can I run this weekend?"
Well, that's a great question, and that's what we're talking about, today, on the Doc On The Run Podcast.
Most runners understandably feel like a victim of an over-training injury.
They say something like, "Well, I was feeling strong, I was feeling ready for my race, I was really feeling great, and then this happened to me. I got a stress fracture, I got Achilles tendonitis, I got peroneal tendonitis, got plantar fasciitis, something happened to me and now I feel like I've lost all my fitness and I can't run my race."
Well, most of the time we just reflexively think that things happen to us, but sometimes things really do happen for us.
What do I mean by that? Well, sometimes the bad thing actually has a silver lining that you can't even see.
Today on the Doc On The Run Podcast, we're talking about how if you PR with an injury, the injury happened for you and not to you.
Today's episode actually comes from a comment and a question sent in by one of the viewers of the Doc On The Run YouTube channel.
This was Jean, wrote in and she said,
"Hello, Dr. Segler. I had a fifth metatarsal fracture repair surgery five weeks ago. I was started to walk without crutches and a knee walker or a scooter as of yesterday, but my foot feels achy, though. Well, as a runner, when can I possibly resume running after my metatarsal surgery?"
This is what everybody wants to know.
I didn't do the surgery and I don't know all the details, but I can tell you that depending upon when you're going to run after a surgery depends upon several things.
How soon can I run after fifth metatarsal fracture surgery?
Well, that's a great question, and that's what we're talking about today on the Doc On The Run Podcast.
I was just talking to a runner over webcam who had been researching metatarsal stress fractures, but heard something about a "malunion" and knew that a fracture malunion was a really bad thing.
He had been diagnosed with a stress reaction in one of his metatarsals.
If you continue to stress a metatarsal stress reaction enough, it can progress to a full-on metatarsal fracture.
So, he wanted to know, "If I run on my stress reaction, is it going to turn into a malunion?"
How can a bone stress reaction turn into a malunion, from running?
Well, that's what we're talking about today on the Doc On The Run Podcast.
Many years ago when I was first in practice, I met someone who was a doctor, and who was a runner herself. She liked to treat runners and she happened to make a lot of money. A whole lot of money!
I was very impressed with her, so I actually flew across the country to spend one day in her office following her around to see exactly what she does to make so much money working with runners.
There was one particular visit with one runner, which really struck me.
Right before we walked into the treatment room, the doctor spun around, looked at me and said, "Okay, this guy's a runner. He has plantar fasciitis. I'm going to show you how to treat plantar fasciitis in a runner in under a minute."
The encounter was nothing like I expected...
Treating injuries is fast, but treating runners is slow.
Well, that's what we're talking about today on the Doc On The Run Podcast.
Today's episode comes from one of the YouTube viewers Doc On The Run YouTube channel who had watched one of the videos on fractures. He asked a great question.
This is from Saif. What he said was,
"Thank you for such a short and effective, informative video. My question was, does displaced fracture heal naturally without medical treatment? And the thought process was that how did our ancestors and primitives heal without medical care or deal with these displaced fractures?"
How does a displaced fracture heal naturally without medical treatment?
Well, that's what we're talking about today on the Doc On The Run Podcast.
Today's episode actually comes from a question sent in by Melissa.
She signed up for the Plantar Plate Masterclass and she asked a very specific question.
She asked:
Should I run with a pad for a plantar plate sprain?
Great question! And that's what we're talking about today on the Doc On The Run Podcast.
What if you could be out on a run, sun on your face, running two weeks ahead of schedule, faster than what you thought, or what some doctor told you?
That would be amazing, right?
Let me tell you that neither me, nor anyone, can promise you that a bone stimulator, snake oil, or fairy dust is going to make that happen.
However, it is true that bone stimulators have been shown to actually speed up fracture healing significantly, particularly problematic fractures.
The question I get all the time from runners with metatarsal fractures is, "Well, okay, if a bone stimulator might help, will my insurance company pay for a bone stimulator to speed up a metatarsal fracture, stress fracture, or some other fracture that's really inhibiting a quick return to running?"
When will an insurance company pay for my bone stimulator to help my metatarsal fracture?
Well, that's what we're talking about today on the Doc On The Run Podcast.
Everyday I help runners who are stuck by giving them a different perspective during a second opinion call.
When we get on the call, we do a couple of things to get focused in the right direction and get them unstuck.
1) We figure out what their real goal is with running, not with injury. What race did you sign up for? How fast do you want to run? What are your long term goals with running?
2) If those are the goals you really want to achieve, how is your present injury interfering with those goals?
What astonishes me is that many of the times when I talk to these athletes and I ask them what they're doing to work toward those goals, they are doing nothing. They tell me they are not running. They are losing all of their fitness. They are very frustrated.
Today on the Doc On The Run Podcast we're talking about two ingredients for recovering from any overtraining injury faster.
Ankle sprains are probably the most common musculoskeletal injury affecting runners. It is really easy to roll an ankle and find yourself limping, unable to run.
You might have sprained your ankle tripping on a root or rock when you're out running on a trail.
Maybe you were wearing some fancy shoes going out to dinner and you stepped on a little reflector on a crosswalk, twisting your ankle.
No matter how you injure the ankle, if your ankle is painful and swollen it is definitely going to interfere with your running.
What are the three biggest mistakes runners make with ankle sprains?
Well, that's what we're talking about today on the Doc On The Run Podcast.
In this episode, we're talking about three mistakes I see almost every runner make when they call me for help.
Let's be clear, runners do not call me when they are on their run and first start getting foot pain.
More often, aching runners go see a doctor, talk to a running buddy, or seek information online to get a rough idea of what's going on.
When those steps don't help, it is my job to help them figure out which mistake they are making.
What are the three steps every injured runner is missing when they call me and ask for help?
Well, that's what we're talking about today on the Doc On The Run Podcast.
A couple of weeks ago, I was invited to give some lectures at the Heartland Podiatry Conference in Des Moines, Iowa. The conference organizers asked me to give an entire "Doc On The Run session" during which I presented five lectures back to back...all on how doctors could approach treatment of injured runners differently.
During the attendee question and answer session, a doctor asked:
"Do you use ankle braces for ankle sprains, and under what circumstances would you recommend braces for recovering runners?
This question came out of what's called Conservative Management of Ankle Sprains in Runners Who Want to Run.
Do I recommend ankle braces for runners?
Well, that's what we're talking about today on the Doc On The Run Podcast.
If you have trouble with your Achilles tendon and a doctor told you that you might actually rupture it and tear completely if you continue to run, you should probably be worried.
If you are anxious about your Achilles, stay with me.
I have some good news and some bad news.
A recovering runner in the Runners Aid Station asked me...
“If I rupture my Achilles tendon, if I just ignore the tendinosis, if I just block out the pain, continue to run, continue to train, and then it does rupture, would I be able to run after it heals?”
Great question...
Will I be able to run after a ruptured Achilles tendon?
Well, that's what we're talking about today on the Doc On The Run Podcast.
Today's episode comes from a question from one of the YouTube viewers. The specific question was, are calcified Achilles tendons more prone to tendon rupture in runners?
That's a great question.
I think if you ask most doctors, their answer is probably going to be yes.
But since I got this very specific question, I actually wanted to see if there is any research that truly proves whether or not Achilles tendons that have calcification or ossification within them, whether or not they're actually more prone to rupture in runners.
Are calcified Achilles tendons more prone to rupture in runners?
Well, that's what we're going to talk about today on the Doc On The Run Podcast.
What would happen if you did this?
Walk into your doctor's office and say,
"Hey, look, I'm a runner. My situation is complicated. I really want to train. I really want to get back to running. I would like you to take an hour, sit down with me and let's really work through this so that I can get back to training."
Right now when you picture yourself going into your doctor's office and asking for a full hour, how does that make you feel?
If you don't think you could walk in and ask the doctor directly, what if you called the office in advance and tried to explain you have a complicated situation and you would like an hour of the doctor's time.
What do you think would happen?
Ask for an hour and tell your doctor you need more time because you are a runner.
That's what we're talking about today on the Doc On The Run Podcast.
If you're a runner and you have pain in the ball of the foot, especially around your second toe joint where the toe attaches to the foot, you may be suffering from a plantar plate sprain.
Many years ago, if you had this kind of pain, it would probably have just been called "capsulitis" by your doctor.
But a plantar plate injury is something that has become more recognized as a distinct pathology in the last 10 or 20 years. Plantar plate injuries do not get misdiagnosed nor ignored as often as before.
Plantar plate injuries are very difficult to heal in runners because the ligament gets stretched and strained every time you stand on your foot or bend your toe.
But the joint capsule can also get injured. Joint capsule injuries and plantar plate injuries are not the same.
Capsulitis vs. plantar plate sprain. What's the difference?
Well, that's what we're talking about today on the Doc On The Run Podcast.
Every time a runner calls me who has a plantar plate sprain, they're trying to figure out how they can know for sure they actually do have a plantar plate sprain. They often also want to know how bad the plantar plate injury really is.
When you're a runner, the problem with plantar plate sprains is that many doctors will offer a standardized cookie cutter approach.
I most often help runners get better without surgery.
That's not because I'm a better doctor. It is because I really put a lot of attention into educating injured runners about how to do all of the additional things to get the injury to heal quickly...so that they can skip the surgery.
One way to start healing faster is by imaging the plantar plate to determine the extent of tissue injury.
Plantar plate imaging, MRI vs. Ultrasound.
That's what we're talking about today on the Doc On The Run Podcast.
After years of doing the Doc On The Run Podcast and making YouTube videos to explain overtraining injuries that can interfere with running, I have gotten a lot of interesting questions.
We've had over a million views on YouTube, and over 300,000 downloads of the podcast which all equal a lot of questions.
Mostly overtraining injury questions center on a search for a shortcut. Many injured runners also think the solution is in only one action.
Don't search for less than what is needed.
That's what we're talking about today on the Doc On The Run Podcast.
If you are a runner and you have an injury, my guess is that you are most worried about how long you will need to stop running.
When people call me for a webcam consultation or an in-person second opinion evaluation, I see runners making the same mistakes over and over.
If you've made one of these mistakes, don't beat yourself up too much.
There is not that much you can do about the past.
But you can take action today, change course and get focused on what you need to do right now to get back to running faster.
Dwelling on what you have done incorrectly will only slow you down.
But if you don't identify mistakes, you can't fix them.
Today, on the Doc On The Run Podcast, we're talking about how mistakes mean the most time off running.
Last week I was lecturing at the International Foot & Ankle Foundation medical conference in Hawaii. Specifically, I had been asked to give a couple of talks on treating running injuries.
During the day I was moderating the surgery and sports medicine session, Dr. Gary Labianco was giving a lecture on Metatarsal Fractures.
He said something that led us to today's episode. It was genius!
"If you want to heal a metatarsal fracture, you have to break bone faster than you break it down."
What he means is that you have osteoclasts and osteoblasts, not just repairing bone, but also removing bone throughout the healing process.
That is true. But let's think about the other side of that equation.
Not just physicians pulling your activity back to stop breaking bone down so fast, but all of the things you as a patient could do to make bone faster.
Wanna heal a stress fracture faster? Make bone faster than you break it down!
Well, that's what we're talking about today on the Doc On The Run Podcast.
Growth happens outside of your comfort zone. This is true for both emotional growth and physical growth.
Very few patients who call me for help with a stress fracture are not really upset.
They all feel like they wasted months of time with treatments that either didn’t help, or made them worse. They are still not running.
All of these runners seem to express the same concern, the fastest path back to running seems just as mysterious as that supposedly invisible crack in the bone.
Is your doctor pushing you out of your comfort zone?
And is that discomfort going to help you heal that stress fracture so you can run?
Well, that's what we're talking about today on the Doc On The Run Podcast.
I just did a consultation call with an injured runner who had a really interesting history with his heel pain. There was some concern that he might actually have a calcaneal stress fracture and not a plantar fascia issue.
In case you don't know, "calcaneal stress fracture" is just the medical term for a stress fracture in the heel bone.
The heel bone is the largest bone in your foot, and runners can sometimes develop a stress fracture in the heel bone.
They are relatively rare, but there are a couple of ways that you can get these stress fractures.
The good news is calcaneal stress fractures heal pretty quickly. But if you have one, you really don't want to run on it.
How can a runner tell a heel bone stress fracture from plantar fasciitis?
Well, that's what we're talking about today on the Doc on the Run podcast.
If you have this pain on the outside of your foot near the cuboid bone, you might start worrying you have a cuboid stress fracture.
Cuboid stress fractures are rare.
In fact, cuboid stress fractures account for less than 1% of all the stress fractures that happen in the foot in athletes.
But there is something more common that can feel like a cuboid stress fracture.
Doctors call it "capsuloligamentous strain."
How can a runner tell the difference between a cuboid stress fracture and this thing called capsuloligamentous strain?
Well, that's what we're talking about today on the Doc on the Run podcast.
If you have been running with a nagging aching pain on the outside of your foot, just in front of your ankle, you might think you have a cuboid stress fracture.
If you then get an x-ray of the foot and it shows a tiny little extra bone sitting just next to the cuboid, well that bone has a specific name and it is called an Os Peroneum.
Sometimes you can get pain from the Os Peroneum, sometimes you can get pain from the cuboid bone that's right next to it.
If you're a runner and you have Os Peroneum pain, how do you tell the difference from a cuboid stress fracture?
Well, that's what we're talking about today on the Doc On The Run podcast.
If you call me and you tell me, I think I have a cuboid stress fracture, the first thing I'd say is...pretty unlikely.
In fact, cuboid stress fractures are less than 1% of all the stress fractures that happen in the foot in athletes.
So they really are very rare.
One thing you can get that's actually much more common is arthritis within the joint. That's also pretty rare, but you can tell the difference.
How can a runner tell the difference between a cuboid stress fracture or calcaneocuboid joint arthritis?
Well, that's what we're talking about today on the Doc On The Run podcast.
"Subluxed Cuboid" is just a cuboid sitting slightly out of position.
Stress fracture of the cuboid is very different from a subluxed cuboid.
If you have this aching pain on the side of your foot, and you've been told maybe it's "cuboid syndrome" or a "subluxed cuboid," but it's not getting better, you could have a thing called a cuboid stress fracture.
The reason you probably weren't told it was a cuboid stress fracture is that, first of all, those are really rare. Cuboid stress fracture is less than 1% of all stress fractures in the foot.
If you're a runner and you call me, say, "Hey, I really need to do a webcam call because I think I have a cuboid stress fracture," the first thing I would think is...probably not.
But you might and, if you do, you do not want to ignore it because a cuboid stress fracture, when ignored, gets worse over time.
What's the difference between a cuboid stress fracture and a subluxed cuboid, and how can you tell the difference if you're a runner?
Well, that's what we're talking about today on the Doc on the Run podcast.
If you are a runner and you've had pain on the outside of your ankle or the outside of your foot, kind of near the heel you may have been told that you have peroneus longus tendinitis.
Sometimes peroneus longus tendinitis is the wrong diagnosis. You might actually have a cuboid stress fracture.
Which one's worse?
Well, I'll tell you that in terms of really destroying your ability to run, definitely an ignored cuboid stress fracture is worse.
How can you tell the difference between a cuboid stress fracture and peroneus longus tendinitis?
Well, that's what we're talking about today on the Doc On The Run Podcast.
If you're a runner who has been told that you have a cuboid stress fracture, you might be worried that there's an actual crack in the bone.
A visible crack on x-ray is what I think of when I picture a truly fractured cuboid bone. There is a huge difference between a cuboid bone with a crack, vs. without a crack.
The cuboid bone is an irregular bone. It's small, but it's important. It sits right in between your heel bone and the fourth and fifth metatarsal bones.
When you roll your ankle and your foot rolls under you, you can compress the cuboid and crack it.
Repeatedly compressing the cuboid can lead to a stress fracture in the bone.
What's the difference between a cuboid stress fracture and a truly fractured cuboid bone?
Well, that's what we're talking about today on the Doc On The Run Podcast.
If you are a runner and you get an aching pain on the top of the foot, and it's not getting better, you might have this weird thing called a cuboid stress fracture.
Cuboid stress fractures are often misdiagnosed as an "ankle sprain" or "foot sprain."
The cuboid bone is positioned in a way that it can get squished in between the other foot bones.
Cuboid stress fractures can cause a lot of trouble if you ignore it, because it can get worse and turn into an actual fracture.
Even worse, the weakened cuboid bone can get crushed completely if you ignore it.
Today on the Doc On The Run podcast we're talking about cuboid stress fracture fundamentals for runners.
Just today I was seeing a runner during a house call and he had a neuroma. So, understandably, he put a neuroma pad in his shoes.
When he was running, his neuroma suddenly got way worse!
I asked him what happened.
He said, "I moved it a little bit. I moved it from where you put it before and I thought it would take more pressure off, but I think it actually made it worse and it really flared it up."
What happens if you run with a neuroma pad in the wrong place?
Well, that's what we're talking about today on the Doc on the Run podcast.
I was just speaking at a medical conference in Las Vegas, and of course I flew on a plane to get there.
To me, as a podiatrist, the most dangerous two spots in the airport are in the security screening line.
I don't like standing on those yellow footprints in the security scanner spots because I think it's a little gross to stand without shoes, where thousands of people a day step barefoot.
I see people in airports with fungal toenails and with athlete's foot infections. I can see the skin on their feet peeling, and I know exactly what's happening.
When that skin is peeling they are shedding live fungal filaments and fungal spores everywhere they step.
And I worry that travelers are depositing, sharing and spreading foot fungus on those yellow footprints.
Want a foot fungus pro tip? Well, I'm going to give you one. Wear old socks to the airport.
It might be kinda gross, but that's what we're talking about today on the Doc On The Run podcast.
If you are a runner with a painful tendon or ligament issue like chronic plantar fasciitis, Achilles tendonitis or plantar plate sprain that just won't get better, you might have done some research into injections and found a thing called a PRP or "platelet-rich plasma injection."
The way that PRP injections are marketed by some doctors, you might think that it's mostly unicorns and fairy dust, but there is some actual science behind platelet-rich plasma. and the effect that it can have on these tendons and ligaments that aren't healing very well.
Corticosteroid injections have also been around for a much longer time.
Both types of injections can be used as treatments for tendon and ligament sprains in runners.
The question is whether or not there is any real scientific evidence to support Platelet Rich Plasma injection or Corticosteroid injections for chronic tendon or ligament injuries. Is one injection any better than the other?
PRP science explained. Is there a difference between PRP injections, corticosteroid injections, and placebo?
That's what we're talking about today on the Doc On The Run Podcast.
The #1 concern all injured runners face is time.
How long will I have to use crutches.
How long will it take the surgery to heal.
How long will I have to wear a fracture walking boot.
How long will I have to stop running.
How much running fitness will I lose in that time.
I feel like most of the runners who call me for a second opinion over webcam are making a critical mistake. They are hiding from the injury.
Are you an injured runner who's hiding from your injury?
Well, that's what we're talking about today on the Doc On The Run podcast.
If you have ever run with a rock in your shoe, you know just how painful a little pebble can be.
Sometimes a callus forms in a way that it gets rock hard and starts to get embedded in the skin.
Painful calluses can literally feel like a rock taped to your foot. The problem is that callus removal pads don’t work.
Using a pumice stone to shave down the surface of the callus doesn’t really help much either.
But you can fix them the same way I do using what I call the Strawberry Stem Technique.
Let’s talk about how they form and how this technique works.
Today on the Doc On The Run podcast, we're talking about how you can fix painful calluses in a runner with what I call the Strawberry Stem Technique.
The whole key to rapid running injury recovery is to proceed with confidence.
If you are using a fracture walking boot or crutches, you must do so confident the boot is necessary...and not based on guesswork.
If you are starting range of motion exercises for a torn tendon, you must be confident you can work past pain, without worrying you might cause a re-injury.
You need to make sure that you know that the present action in your recovery is necessary.
You also need to understand how you can gain confidence in your next step in recovery.
Today on the Doc On The Run Podcast, we're talking about how injured runners must proceed with confidence.
One time at a medical conference, an expert lecturing on biomechanics said,
“When a runner develops Hallux Rigidus, he becomes a swimmer instead of a runner.”
Most of the doctors in the audience laughed.
I really didn't think that was very funny. I actually have hallux rigidus myself, and it doesn't disrupt my running.
It is true Hallux Rigidus can cause pain and swelling in the big toe joint. If you aren't careful the joint can get destroyed.
If you understand a little bit about the mechanics of the joint, it may help you understand how to avoid the arthritis that can hamper your ability to run in the future.
How can pronation cause hallux rigidus in a runner?
Well, that's what we're talking about today on the Doc On The Run podcast.
I was just giving 3 lectures on running injuries at a medical conference in Las Vegas.
As is often the case, after one of my lectures one of the physicians in the audience approached me in the hallway to ask a question.
What do you do with activity level when somebody has an old fracture where the bone was broken long ago?
The runner recently had a re-injury at that spot. It has been painful, it's been swelling, and he's trying to figure out what to do.
What's a bone bruise at an old fracture site? Is it a big problem or a little problem?
Well, that's what we're talking about today on the Doc On The Run podcast.
When you have two painful problems in different parts of the same foot, things can get complicated.
I recently had a call with an injured runner with a couple of different problems.
On the outside of his foot, between the third and fourth toes, he has a painful neuroma. The other problem is that he's got bursitis. The inflamed bursa is in a completely different place, no where near the irritated nerve.
When a runner has two injuries, like a neuroma on one side of the foot and bursitis on the other side of the foot, which one is worse?
Which one should you pay attention to first?
Well, that's a great question and that's what we're talking about today on the Doc On The Run podcast.
I just got off a call with a runner who needed a second opinion with his running injury recovery.
He had a fracture and it has been improving. But because it was painful and swollen, he was still icing it daily.
At his last follow-up appointment, the doctor actually said, "I think you're good enough to actually start cycling at this point, to get back a little of your running fitness."
So, the question is, should I stop icing?
Do I need to keep doing that? If my injury is good enough to start cycling can I stop icing?
Does a release to cycle mean you're good enough to stop icing your foot?
Well, that's what we're talking about today on the Doc On The Run podcast.
Sometimes a doctor really needs to touch your foot to make the diagnosis. But not always with runners.
Since the pandemic pushed so many of us into Zoom meetings, we all know it's pretty easy to get on a web-cam call when it's really difficult to meet someone in person.
There are a couple of times when webcam second opinion visits can be almost as good as meeting in the doctor's office.
There are lots of benefits to the webcam calls that do make them almost as valuable as in person visits.
When is a webcam second opinion just as good as an in-person doctor's visit for runners?
Well, that's what we're talking about today on the Doc On The Run podcast.
Today's episode comes from a great question I got during one of the Runners Aid station calls.
This was someone who had a plantar plate sprain and had talked to a doctor about a couple of different procedures that might actually, potentially, speed up the healing.
He wanted to know about the difference between these two things called dry needling or a PRP injection.
Today on the Doc On The Run podcast, we're talking about dry needling versus PRP in runners.
Ivan has a great question. After watching the watching the video "Can I Run After Wearing a Fracture Boot?” he wanted to know: “It still swells and
has a lot of pain what do I do?”
Anytime a runner gets a stress fracture, the main goal is to confirm the foot is healed enough to withstand the forces and stresses applied to the injured bone.
In the episode we are going to talk about:
- 3 indicators of ongoing tissue damage when you have a stress fracture.
- 3 strategies used to decide when it’s safe to run after stress fracture.
- Questions I would ask you if you called me for a stress fracture second opinion consultation.
Today on the Doc On The Run Podcast we’re talking about What to do if a stress fracture in the foot still swells and hurts a lot after wearing a fracture walking boot.
Let's say you've had an aching pain in the ball of the foot that's been going on for several weeks.
You've tried lots of stuff. You tried icing it. You tried some over-the-counter inserts that you got.
Maybe you stopped running all together. Maybe even used a fracture walking boot.
But after weeks, you're not getting anywhere.
Today on the Doc On The Run Podcast we're talking about how you need to find your target when you're not getting better.
I was just on a call with a cross-country runner who had had a second metatarsal stress reaction.
A stress reaction is basically like a mild stress fracture, but without any crack in the bone.
She was doing well and her foot had been getting better.
But then when she went for her first run, she had pain in her foot.
The pain during that first run was in a completely different bone. The new problem was not in the second metatarsal, it was in the fifth metatarsal on the outside of the foot.
Let's talk about how that happens.
Today on the Doc on the Run podcast we're talking about how a second metatarsal stress fracture might cause a fifth metatarsal stress reaction.
The radiologist reading your MRI knows nothing about your problem.
The only clues a radiologist gets about your injury are described in the clinical history section of the MRI order from your doctor.
I just got off a call with a runner who had gotten an MRI order from his doctor. He had a long history of injury but the only description on the MRI order was "Concern for fracture."
This runner had more than just a concern for a possible fracture.
But because there was such a limited description for the radiologist, the injured runner was understandably irritated and frustrated that the radiologist didn't have the full information.
I will admit that I also get very upset about this when I'm looking for something obscure that the radiologist is likely to miss, unless it's on their radar.
But there is an up-side to everything!
Today on the Doc On The Run podcast, we're talking about the benefit of your radiologist being clueless.
This episode has a whole bunch of complicated-sounding terms that you may have never heard before.
One of them is sinus tarsi syndrome, and the other one is FHL tenosynovitis or flexor hallucis longus tenosynovitis.
Sinus tarsi syndrome is often confused with ankle pain.
FHL tenosynovitis is often confused with plantar fasciitis.
These conditions affect opposite sides of the same foot. Yet, one can lead to the other.
Today on the Doc on the Run podcast, we're talking about how sinus tarsi syndrome can cause flexor hallucis longus tenosynovitis.
Imagine your doctor tells you that you have a metatarsal stress fracture and you should not run.
Why would you come home from the doctor and call me asking, "Can I run in cleats with a stress fracture?"
Believe it or not, that actually happened.
In this case we are talking about an athlete who is actually getting better and who wanted to train on the track.
He wanted to run in cleats.
Aside from the uncertainty, he was doing okay. He was a little hesitant and wasn't sure if cleats would aggravate the injury right or not.
Can I run in cleats with a stress fracture?
Well, that's what we're talking about today on the Doc On The Run podcast.
A runner called me and said, "I got some new running shoes and they made my bunions worse overnight. I think I need surgery now."
The problem is that bunions do not typically get worse quickly.
Bunions get worse slowly because the bone is changing position.
In this episode, we're going to talk about how it's possible bunions could get worse from a new pair of shoes.
If you are a runner with bunions this is a situation you may want to understand.
Today on the Doc on the Run podcast, we're talking about how new running shoes might have made your bunion bigger.
We've all heard the saying that time heals all wounds.
While that may be true, time also kills your running fitness when you're not training.
You have to remember that the enemy of your running fitness is not the fracture walking boot.
The enemy of your running fitness is not the crutches.
The enemy of your running fitness is not your doctor.
The enemy of your running fitness is time!
Today on the Doc On The Run podcast we're talking about how time is the enemy when you have a running injury.
Today I was talking with a runner who has been diagnosed with a longitudinal split of the peroneus brevis tendon.
The concern with this kind of tear in the peroneal tendon is that if you can't get it to calm down, it can only get worse.
Continually moving, irritating and producing inflammation in and around injured peroneal tendons just causes them to get weaker over time.
Many surgeons are quick to offer surgery to correct the problem.
This runner wanted to know the details of all the different treatment options when a runner gets diagnosed with a longitudinal split of the peroneus brevis tendon.
Today on the Doc on the Run podcast, we're talking about the 5 choices runners have when there is a split or tear in the peroneus brevis tendon.
It really seems incredible that we now have over 600 episodes of the Doc On The Run Podcast!
Today's episode is a little different in that I actually want to ask you a question.
How do you stay motivated when you have been injured?
I'm really interested to know because this is one of the most important things you can do as an athlete when you're recovering from an over training injury.
Much of what I've learned that helps injured runners is not stuff I learned in medical school.
Much of the strategies and techniques that seem to work best, I've learned in large part from seeing how creative injured runners can be.
Today on the Doc on the Run podcast, we're asking a question, how do you stay motivated when you are injured?
Today we're talking about some of the x-ray changes that happen when you get hallux rigidus or hallux limitus.
If your doctor tells you the x-rays show hallux limitus...what does it mean?
We're going to talk about these five things that you can see commonly on the x-rays when you have hallux rigidus.
Today on the Doc On The Run podcast, we're talking about five changes on x-rays when you get hallux rigidus.
I know a lot of people are not even going to listen to this episode because I'm talking about stretching.
Many runners seem to recoil from the topic of stretching.
But if you get injured and you go to a physical therapist, you can take it to the bank that they are going to give you some stretching exercises to do.
Why?
Because stretching helps when you have tissue that is predisposed to injury because it's too tight.
When you have that issue, you need to stretch that tissue.
Today on the Doc On The Run Podcast, we're talking about how stretching is like a rest day, finite pain that pays off.
If you have pain in your foot under the big toe joint, the doctor might tell you that you have an issue with one of these two little bones called sesamoids.
Interestingly, some people have a sesamoid bone that is not broken, but looks like it broke apart.
If you understand how that happens, it may help you understand your x-rays and the doctor's description of your condition.
Today on the Doc on the Run podcast, we're talking about a broken sesamoid versus a bipartite sesamoid. What's the difference?
Today's topic comes from a longtime listener named Jenny. She wrote a really nice review that I wanted to share with you.
She said, "If you are a runner, you need to listen. What I love about Doc On The Run Podcasts is that each one covers one topic, is short, sharp, full of useful practical information that you can apply right away without having to go and do more reading or research.”
She also asked, "Would you consider doing an episode on return to running after an accident and how to overcome the fact that everyone tells you that you should not run, even when your surgeons and physios have said that it is safe for you to run and really good for you to exercise?”
Thank you Jenny! And yes, that is a great idea for a topic!
Today on the Doc On The Run Podcast, we're talking about how to overcome friends, telling you not to run after a traumatic accident.
If you get pain and swelling and discomfort particularly in and around the big toe joint, you may have a condition called hallux limitus or hallux rigidus.
Hallux limitus and hallux rigidus are both conditions that affect the big toe joint. It causes pain right where your big toe attaches to your foot.
Many runners with this condition don't even understand the difference between hallux limitus and hallux rigidus.
There are really a few things that define the difference between these two conditions.
Understanding the differences may help you get clarity after a doctor visit.
Today on the Doc On The Run Podcast, we're talking about hallux rigidus versus hallux limitus. What's the difference?
The problem is not that you have a stress fracture.
The problem is not that you have an Achilles tendonitis issue that is bugging you.
The problem is that you have been given advice that freaks you out and convinces you to do absolutely nothing while you wait to recover.
How do I know? Because I don't help people get better from running injuries. Instead, I help injured runners figure out how to run.
That's what I really do.
Today on the Doc On The Run podcast, we're talking about why you need to focus on possibilities and not limits or obstacles when you're an injured runner.
Yesterday, I saw a runner who has plantar fasciitis. Plantar fasciitis is the most common condition affecting the foot in runners.
When a runner gets plantar fasciitis, it is often because the plantar fascia ligament is too tight. The tight ligament becomes overstretched and strained. Heel pain is the result.
Since it is safe to assume that the plantar fascia ligament on the bottom of the foot is just way too tight, you may want to stretch it. But with every potential treatment comes risk.
Stretching the plantar fascia can be risky and has the potential to cause more trouble for a couple of reasons.
Today, on the Doc on the Run Podcast, we're talking about two reasons that stretching the plantar fascia can be bad for runners.
I want you to really think about which decision might be missing in your process of running injury recovery right now.
Is it the decision to just go for it?
Is it the decision to start exercising today?
Is it the decision to sign up for some specific event that can get you motivated?
Is it the decision to get a second opinion?
Which decision is missing in your running injury recovery? That's what we're going to talk about today on the Doc on the Run Podcast.
I was just on a call with a runner suffering from a plantar plate sprain.
He had a great question:
Is inflammation really bad or is it good when you have a plantar plate sprain?
Physicians commonly prescribe anti-inflammatories. There are many approaches used by injured runners to manage inflammation, reduce inflammation, and hopefully make your foot feel better.
If inflammation is bad for the plantar plate ligament, part of your recovery plan should include some sort of anti-inflammatory treatment.
But if the inflammation is good for the plantar plate, you should not try to interfere with the inflammatory response.
Is inflammation good or bad for a plantar plate sprain?
Well, that's what we're talking about today on the Doc On The Run podcast.
Doubt comes from confusion. Confusion leads to paralysis when you've been injured and you don't know what to do to maintain your running fitness.
Doctors tell you to sit still.
Pill pushers tell you to take medicine.
Gizmo peddlers tell you to buy expensive devices.
Many runners don't really even know what they can do, other than rest.
If you are going to doubt anything when it comes to your running injury recovery, what you should doubt is the validity of sitting around doing nothing while waiting for healing.
Today on the Doc On The Run podcast, we're talking about how doubt does the most damage to a recovering runner.
If you are reading this, maybe you have sesamoiditis, a sesamoid stress reaction or a metatarsal stress fracture.
This is a real example from a real patient. This story really illustrates how MRIs can show misleading clues leading to a potential misdiagnosed leading your doctor astray.
It is crucial that you focus more on your running goals, your injury progress and what it really means precisely where you have pain in your foot. Then and only then can the MRI findings be put in the proper perspective.
Too much emphasis on MRI findings can make you think you have a different injury.
Today on the Doc On The Run podcast we're talking about how sesamoid pain got misdiagnosed as fourth and fifth metatarsal stress reactions.
How do you know your injury is improving? How do you know that you got the green light to start running? How do you know it is healed?
Well, when I talk to runners, most of them say something like:
"Well, my x-ray shows this. Does that mean that I can run?"
"My blood test showed that, does that mean I can run?"
"My doctor said this, but I heard that on some other podcast, so does that mean I can run?"
There is lots of confusion around how you can tell when you are getting better as you start regaining running fitness after an injury starts to heal. Timing is the crucial piece of information if you really want to run.
Today on the Doc On The Run podcast, we're talking about two ways an injured runner can tell the injury is actually improving.
I was recently invited to give a lecture at a foot and ankle medical conference in Seattle. I was giving a talk called Conservative Treatment of Ankle Sprains in Runners Who Want To Run.
This was an attempt to teach physicians what I do with ankle sprains. Mostly I was trying to get them to think about what they need to do to get runners back to running as quickly as possible instead of just doing the standard ankle sprain protocols with their patients.
The Ottawa Ankle Rules are a set of rules that were created in Canada to reduce people from getting unnecessary ankle X-rays when they have an ankle sprain and go to the emergency room.
Today on the Doc On The Run podcast, we're talking about a common fracture missed by the Ottawa Ankle Rules.
I was just on a call with a runner who called me for a consultation of an ankle injury.
He had some funny looking stuff on his ankle x-rays. That was why he was scheduling a second opinion.
The bummer in this whole thing was that he actually told me that maybe 10 years ago or so, he'd had a similar ankle injury.
He's pretty sure it was on the same side, but he wasn't really sure because he didn't have a copy of the x-rays.
Today on the Doc on the Run Podcast, we're talking about why you should always ask for copies of your x-rays.
I just got a call from a runner who I have seen before. He had swelling in his Achilles tendon, and he was worried about it.
He was worried that he could have a ruptured or completely torn Achilles tendon.
If you are a runner and you get a complete rupture of the Achilles tendon, this is one of the worst things that could possibly happen to you.
A torn Achilles is way worse than a broken bone. The worst thing you could do is ignore a torn Achilles. You do not want to ignore it!
Today on the Doc On The Run podcast, we're talking about an easy at home test you can do if you think you have a complete rupture of the Achilles tendon.
Every time I am in the Recovering Runner's Aid Station where I answer questions for injured runners, I get questions about how to get an advantage.
Everybody wants an advantage.
I don't think most people cheat.
There are some people who cheat, but certainly not everyone.
But I think it is okay to look for an unfair advantage when you're injured and you're trying to get back to running.
The truth is, getting an unfair advantage when you are injured is actually really easy to do.
Today on the Doc On The Run podcast, we're talking about three unfair advantages in healing running injuries.
Let's say you are out running on a trail and you catch a root and you roll your ankle.
You limp back home and you realize that your ankle is all swollen. It is bruised, it hurts and you're really bummed out.
You are trying to figure out what you can do to get this thing to calm down faster and get back to running. Well, there are lots of different options.
How can a diagnostic injection help an ankle sprain?
Well, that's what we're talking about today on the Doc on the Run podcast.
I was just lecturing at the International Foot and Ankle Foundation meeting in Seattle. I was giving talks on running injuries. A doctor in the audience asked me if "not running" was the safest way for runners to heal running injuries.
Keep in mind, this was a doctor asking the question.
Have you ever thought this makes sense?
After all, if a runner gets a running injury, and they stop running, that's the safest way to get it to heal. Or is it?
Do you agree that not running is the safest way to heal a running injury?
Well, that's what we're talking about today on the Doc On The Run podcast.
Let's consider you are a runner with a painful neuroma.
The more you run, the more painful the foot becomes.
But it only started with some weird little sensations.
Eventually it starts to get more numb. You notice more tingling, then more burning pain. Now your doctor wants to talk you into surgery.
You just want the problem fixed. So you go to the operating room and then you're shocked to find out that you still have pain later.
By the way...that's not malpractice. It just means you had a bad outcome.
But if you're the runner, you've got to figure out what to do.
Today on the Doc On The Run podcast we're talking about two different types of injections your doctor might offer you after a failed neuroma surgery.
I was listening to a podcast about the way that disagreements happen.
He said, anytime there's a disagreement, no matter what, there are two possibilities.
If there are two people arguing about something, one person could be right, and the other could be wrong. That means roughly speaking, there's a 50% chance that one person is wrong all the time.
This is true of physicians as well.
Let's say, I come to your home to see you and help you with a metatarsal stress fracture. You've been told you have a neuroma. But it seems like you have a stress fracture, based on your x-rays or your story.
What if there's a 50% chance your doctor might be wrong?
Well, that's what we're talking about today on The Doc on the Run Podcast.
One of the questions I got in the Runners Aid Station was:
“Do I really need a fracture walking boot?”
This is a runner who went to the doctor, and was told, "You have extensor tenosynovitis. The best way to get it to calm down is to remove the inflammation and stop aggravating the tendons."
If you get aching pain on the top of your foot, it might be caused by an irritated extensor tendon sheath (which is the little tube around the extensor tendons as it goes out to the toes on the top of the foot). If so, you might be thinking you need something drastic to stop the tendons from moving so it can calm down.
Do I need a fracture walking boot for extensor tenosynovitis?
Well, that's what we're talking about today, on the Doc On The Run podcast.
Maybe you have been taking some time off because you have been injured.
Maybe you took some time off because you spent way too much time in a fracture walking boot.
Maybe all of your training just took a backseat to all the chaos and confusion of the pandemic.
But none of that would be as bad as having a doctor tell you that your hip was injured because you are just way too fat to run!
Irrespective of why, if you are a runner, and you feel like you are running just a little bit too slow, I can promise this discussion is going to help you today!
We are going to talk about why it's not really so bad to be in the slow zone.
You're getting to hear from Martinus Evans, host of the The 300 Pounds and Running Podcast Network, who runs the "Slow AF Run Club” and who is also the author of the "Zero to Running" guide.
Today on the Doc On the Run Podcast, we’re talking about 300 Pounds and Running!
If you're reading this, it's probably not because you love toenail fungus. It it also probably not because you think black toenails are pretty. In fact, you probably think both are pretty gross and you would be right.
But this bruised black toenails and toenail fungus joining the party is mostly preventable.
All runners should understand the circumstances that can put you at risk of getting a fungus infection in the nail which runners call "toenail fungus," or which doctors call "onychomycosis."
It is often the fungus that actually causes the skin infection called athlete's foot.
It's very, very common. Fungus is all over the place! Don't freak out, but it's probably in your shoes right now!
Whether or not the fungal spores and fungal filaments will cause an infection on your feet, just depends upon the circumstances that you set up as a runner that actually allow it to get in and cause real trouble.
How can a bruised toenail from running cause toenail fungus?
Well, that's what we're talking about today on the Doc On The Run podcast.
If you get a plantar plate sprain, the first thing you may notice is pain and irritation at the ball of the foot, right where the second toe attaches to the foot. If the foot feels swollen, puffy or sore in that spot, it could be a plantar plate sprain.
A one common injection performed for plantar plate ligament sprains is a corticosteroid injection.
I just spoke with a runner who thought the doctor did the injection in the wrong part of the foot.
She saw a podiatrist, and the doctor did a corticosteroid injection for the plantar plate sprain. She was confused afterward and asked me if the doctor did the injection with the right or wrong technique. I'll explain why she was confused.
I think my doctor did the wrong injection for the plantar plate ligament.
Well, that's what we're talking about today on the Doc On The Run podcast.
This morning I was on a call answering injury questions live in the Injured Runners Aid Station.
This runner actually said,
"Well, my doctor said that since I got a running injury, the solution is to stop running."
When I think about this, there are really only two approaches to the questions of whether or not you have to stop running entirely to heal an overtraining running injury.
Do I have to stop running and lose my running fitness entirely just to heal?
Well, that's a great question and that's what we're talking about today on the Doc on the Run podcast.
I was just speaking with a woman who has a suspected mild plantar plate sprain. What was interesting is the fact that she doesn't really have a whole lot of pain.
I was explaining how important it is that she actually figures out her baseline "pain" numbers. I was explaining that even if you don't call it "pain" you have to rate the level of discomfort so you can track it.
How bad is it when walking with or without running shoes, or simple things like walking up and downstairs.
Now, the problem is that she said, "well, it's not really painful so I can't put a pain number on it."
I understand it may not really be painful. Particularly if you're an athlete with a high pain tolerance.
When you have a mild plantar plate sprain you must figure out what it is that you call discomfort or pain. You have to track it.
Does a mild plantar plate sprain always hurt?
Well, that's a great question and that's what we're talking about today on the Doc On The Run podcast.
I just got off a webcam call in the Injured Runners Aid Station. The runner who called me, had some down with a cold.
He had been sick for a few days. He wasn't running. He was curious about whether or not his injury was going to actually get worse while he was ill. Because he knows that when he's sick, his immune system is working really hard to try to fight the infection. And your immune system can't do everything all at once.
If you have an injury, it is widely accepted that the illness is going to slow down your potential ability to rebuild tissue and repair damaged tissue, whether a metatarsal stress fracture or an Achilles tendon injury.
Can my foot injury heal while I'm sick?
Well, that's a great question, and that's what we're talking about today on the Doc On The Run podcast.
The plantar plate ligament is a little ligament on the bottom of the ball of the foot, right where the toe attaches to the foot. The function of the plantar plate ligament is to reinforce the joint and support the toe by helping to hold it down against the ground.
Anatomically, the plantar plate ligament resists the motion doctors call "dorsiflexion," where the toe gets pulled up away from the ground.
Even though the plantar plate ligament is really small, its funcion is vital.
Doing exercises to help support the plantar plate, can help to decrease some load on the ligament.
Today on the Doc On The Run Podcast, we're talking about the single most effective exercise to support the plantar plate in runners.
If you recently started getting some aching pain on the outside of your ankle every time you run, you might have a condition called peroneal tendonitis.
Peroneal tendonitis is a problem often encountered by runners with high arches. It can often be exacerbated by running in ultralight unstable shoes or running on trails when you're feeling too tired to maintain good form.
The two peroneal tendons are both on the outside of the ankle. But they do different things. The way you position your foot to reduce the stress and strain on the one injured tendon, will have to be different because they each do different things.
Today on the Doc On The Run podcast, we're talking about how to tell the difference between the peroneus longus and the peroneus tendon when you're a runner.
If you get pain on the top of the foot when you're running you might discover you have a painful condition called extensor tenosynovitis.
"Tenosynovitis" just means you have irritation and inflammation within the tendon sheath, or the little tube that surrounds the extensor tendons that fan out toward the toes on the top of the foot.
There are really 2 keys to calming the tendon sheath. You have to decrease the inflammation with the tendon sheath. But you also have to stop irritating the swollen tissue inside the tendon sheath. The easiest way to stop that irritation when you run is to stop putting pressure right on that irritated spot.
Today on the Doc On The Run podcast, we're talking about how to lace your running shoes when you have extensor tenosynovitis.
The other day in the Recovering Runner's Aid Station, I got a great question:
“If I get stress and strain on my foot, because I'm overweight, should losing weight be part of the strategy to actually get my foot to recover as fast as possible?”
There are lots of ways to reduce the stress and strain on one injured part of your foot.
Obviously, the more your body weight, the more pressure on your foot when you stand, walk or run.
Sometimes doctors will tell patients, "If you weighed 20 pounds less or 40 pounds less, well, there'd be less stress and strain on your foot...and you would heal faster."
But it's an unrealistic strategy for several reasons.
Should weight loss be a part of your running injury recovery strategy?
Well, that's what we're talking about today on the Doc on the Run podcast.
Yesterday I saw a runner with a plantar plate sprain. She wanted to know if stretching the toe would help the plantar plate ligament heal faster.
Plantar plate sprains happen because the plantar plate ligament gets overstretched, and strained.
When you get a plantar plate injury, the fastest way to allow healing is to reduce the stress and strain on that injured ligament.
If you're thinking about whether or not to stretch the toe or do something to try to help the condition improve faster, you really need to think about the mechanics that are actually involved when you have a plantar plate injury.
Should you stretch the toe that has a plantar plate sprain?
Well, that's what we're talking about today on the Doc On The Run podcast.
Think about what happens when you start running.
You decide you want to run. You make a decision, then you go out and you actually run.
You start working on your running form. Maybe you hire a coach You add a little speed work. You also start doing some strength training to supplement your running fitness. Eventually you even start working on your pacing strategies for your races.
These are all things that are important pieces of running. But thinking about your pacing strategy when you haven't even started running is a really bad idea. It doesn't matter what you think about pacing if you can't actually run the whole distance.
There is a most important piece, at each point in the process. This is especially true in running injury recovery as well.
Today on the Doc On The Run podcast, we're talking about finding your number one missing piece in your running injury recovery.
Overtraining injuries only happen when you ignore a problem.
No runner wants to be injured.
Most runners who call me for web-cam visits have been tuning out the signs of impending injury...long before they actually got injured. You get an overtraining injury because you did feel something, but you ignored it.
Don't forget...you could not become an accomplished runner if you were not capable of tuning out discomfort and putting in the work to become a strong runner.
But that works against you when you get injured.
Tuning out injury, tuning in for recovery and that's what we're talking about today on the Doc on the Run podcast.
I just did a web-cam call with a runner who had a thing called a "mallet toe" deformity. He had pain in the ball of the foot when running.
He said he was reading about plantar plate sprains, and thought, "Maybe I have a plantar plate sprain because I got this funky toe."
He wanted to know if a mallet toe could cause a plantar plate injury.
Can a mallet toe cause a plantar plate injury?
Well, that's what we're talking about today on the Doc On The Run podcast.
When we think about training for endurance events like marathons, we expect the payoff to feel good.
We are patient with the process, yet in the progression of building fitness, we always expect that when we have a breakthrough run, it's going to feel great.
It is just not true.
When you do a run that is a lot longer, or a lot faster, you know you've made a breakthrough.
Breakthrough runs do not always feel great and that's what we're talking about today on the Doc On The Run podcast.
I was just watching an injured runner walk. We were trying to pin down her diagnosis and figure out why she was getting injured.
She asked me what I actually saw when analyzing her gait.
One of the things I saw was that she had this thing called extensor substitution.
She wanted to know how it contributed to the issues she has been having when she was running.
Today on the Doc On The Run podcast, we're talking about extensor substitution in runners.
What happens when you look down at your feet as you run?
Many injured runners start looking down toward the injury, even as they run.
What do I mean by that?
We start to hunch over, our running form falls apart, and we do all the things that are completely counter to everything that we know about good running form.
If you're running after an overtraining injury, you really need to keep your head up.
That's what we're going to talk about today on the Doc On The Run podcast.
If you are reading this because you are researching Achilles tendinosis, I'm sorry.
Achilles tendinosis is one of the worst injuries a runner can get.
Tendinosis is a serious problem and must be treated aggressively.
It is helpful to understand what you really need to do.
You also need to understand Achilles tendinosis treatments doctors often recommend, which you might want to avoid.
Today on the Doc On The Run podcast, we're talking about Achilles tendon calcification in runners with tendinosis.
One of the things that's really important is that you really have to think about what it takes to ramp up without getting injured, and that requires tracking and paying attention to everything.
I'm going to let you listen in on a recording from an actual live session in the Injured Runner's Aid Station explaining these keys to ramping up and running without getting reinjured, while using the advantages that you already have with your runner's mindset.
Today, on the Doc On The Run podcast, we're talking about how injured runners cannot find a solution when refusing to even look at the problem.
The reality is, there are only two kinds of runners that I think really need a fracture walking boot for plantar fasciitis.
The runners who don't mind losing all their running fitness and the other group of runners who really need a fracture walking boot for plantar fasciitis are those that basically assume they have the wrong diagnosis.
Which kind of runners really do need a fracture walking boot for plantar fasciitis? Is it somebody with mild plantar fasciitis? Moderate plantar fasciitis? Severe plantar fasciitis?
And that's what we're talking about today on the Doc On The Run podcast.
One of the worst things when you're an injured runner is to stop taking action.
Think about what would happen if you did this with a marathon. If you were to sign up for a race and you didn't do anything to actually gain fitness in preparation for that event, would you expecto to do well?
It blows me away when I see injured runners who have spent years in disciplined training, yet then when they get injured, they just sit in a puddle of inaction that keeps them stagnant and prevents them getting back to running.
Anxiety robs injured runners of action, and that's what we're talking about today on the Doc On The Run podcast.
A great question I got from someone recently who had a plantar plate injury and the toe was a little bit crooked.
His question was,
"Do I really need to have surgery if my toe is crooked? Is that a good indicator of whether or not I need plantar plate surgery just because the toe is sitting out of position a little bit?"
I thought it might be helpful to explain when it might actually be necessary to have surgery and when it might not be necessary to have surgery.
Does a crooked toe mean you have to have surgery for a plantar plate injury?
That's what we're talking about today on the Doc On The Run podcast.
Plantar fasciitis is one of the most common causes of heel pain and it's also one of the most common reasons people actually go to the podiatrist.
The fastest way to get it to calm down is to reduce the stress and strain to the plantar fascia ligament so that it'll actually heal.
So if you're going to try to run, you have to do something to reduce the stress and strain to the plantar fascia ligament, while you're running.
Today on the Doc On The Run podcast, we're talking about where to run when you have plantar fasciitis.
I do lots of running injury second opinions and I do most of those over webcam.
Sometimes I do them over phone, but webcam's way better because I can see you, we can talk, I can show you some stuff on screen, share if I need to, and I can look at stuff that you have that might be really useful for me to help you figure out what's going on.
Whether you're seeing me for a webcam visit or if you're seeing your doctor in your neighborhood, there are four things that you really should make sure that you have together and that you take to get your most valuable running injury second opinion.
Today on the Doc On The Run podcast, we're talking about the four things you need for a running injury second opinion.
If you are a runner with a plantar plate sprain, you may be really frustrated.
Unfortunately, plantar plate sprains are difficult injuries to get better quickly. One key is to make sure it doesn't come back once you're running.
When I do second opinions for runners with plantar plate sprains, they ask...Should I have a cortisone injection?
The short answer is there are only two times when it makes sense to get a cortizone injection around the plantar plate.
Today on the Doc On The Run podcast, we're talking about the only two times a cortisone injection makes sense for an injured runner with a plantar plate sprain.
Faith and doubt are both beliefs.
If you're taking action to maintain your running fitness, you have faith you're going to get better.
If you're doing nothing to maintain your running fitness it's because you have doubt.
But don't let this example convince you that there is only one way to decide whether or not you can do something to maintain your running fitness.
No matter what the specific injury, there is always some action, some step you can take to gain confidence, move from Doubt to Faith and start getting back on the right track.
Which belief is running your injury recovery?
Well that's what we're talking about today on the Doc On The Run podcast.
Is resting overrated for runners?
Well, the short answer is yes and no but I want you to think about something.
If it's true in training, then it must be true in over training injury recovery and whenever I say this, truthfully like most doctors if I'm speaking at a conference, they kind of cross their arms and glare at me and a lot of runners scratch their heads when I say that.
But it is true and I want you to really think about this. If it is true in your training, then it should be true in your over training injury recovery and this what we're talking about today on the Doc On The Run podcast.
This episode actually comes from Eryn and she's somebody who was listening to the Doc On The Run podcast and then sent in a question.
She said that she was 10 weeks out after getting a dancer's fracture in the fifth metatarsal while she was trying to qualify for Boston and getting ready.
What she said is, "I'm one week in using my EXOGEN bone stimulator one time a day for 20 minutes. I heard you say that you had a runner who healed after two weeks using the device."
She also wanted to know about, "What else was your patient doing? Did they follow the standard protocol? Was he taking any supplements or other treatment to help the bone?"
Today on the Doc On The Run podcast, we're talking about a dancer's fifth metatarsal fracture in a runner who was training for Boston.
All day long I talk to injured runners and help them figure out what they could be doing differently to get back to running as quickly as possible.
I have realized is that the majority of injured runners are choosing, or have been told by a doctor, to follow one of four different running injury recovery strategies.
Today on the Doc On The Run podcast, we're talking about the 4 strategies for running injury recovery.
In today’s podcast we have Patrick from the Running Lean Podcast here on the show, and you’re going to love this episode.
Patrick McGilvray is a podcast host, Licensed Primary Sports Nutritionist, NASN Certified Personal Trainer, UESCA Certified Running Coach, Master Life & Success Coach, experienced marathoner and ultrarunner, and The Weight Loss Coach for Runners.
Patrick helps runners properly fuel their bodies and their minds so they can achieve peak performance and optimal health and fitness.
Today on the Doc On The Run Podcast we’re talking about how "Running is NOT an effective weight loss strategy."
I was just on a call with a guy who signed up for the Runner’s Aid Station and one of the things we were talking about is he had noticed that while he was doing some specific exercise I gave him to restore some of the balance to actually make him a little more stable and more efficient.
He noticed he was getting a lot of soreness in his leg.
He was actually explaining what he was getting in terms of muscle soreness and we discussed whether or not it was really a problem and something you really need to pay attention to.
Today on the Doc On The Run Podcast, we're talking about soreness in your leg when you're working on your balance and you're trying to get back to running after an injury.
What exactly is primary repair of the planter plate? Well, that's a surgery where we actually go in and sew it back together. We fix it. We repair it. We do something to actually make it strong and hopefully heal again, so you can get back to running.
But we're going to talk about three different methods for actually doing that and some of them are kind of similar.
They're different approaches and they have different risks and benefits.
Today on the Doc On The Run podcast, we're talking about three different techniques for primary repair plantar plate ligament surgery.
When other doctors ask me what I do, I tell them rather simply I help runners figure out how to stay fit, hang onto their running fitness and get back to running as quickly as possible.
The other day I was talking to a woman, who wanted my help and wanted to schedule a consultation, and she committed what I call the cardinal sin of runner-self-criticism.
She said, “I know you only work with runners. I only ran 2.65 miles yesterday, and so I am not really a runner."
When she said that, I not only immediately thought of Jill Angie from the Not Your Average Runner Podcast…but I found myself quoting her!!!
The very next day I asked Jill if she would come back on the show to share some of her insight, wisdom and glowing energy with all of you today.
Today on the Doc On the Run Podcast, we’re talking about how you can get back to running in 30 days.
I have talked about this before in other episodes where you basically have four kinds of structures that you could consider having surgery on.
You could have bone surgery, you could have ligament surgery, tendon surgery, or joint surgery and of course, when you have an injury to only the ligament, the plantar plate ligament, you might be wondering why in the world would the doctor want to do surgery on the bone as well?
Today on the Doc On The Run Podcast, we're talking about why you might need bone surgery for a plantar plate ligament repair.
The worst runner to call me for a second opinion is someone who has been in a fracture walking boot or not running for 12 weeks or so.
Why is that so bad?
Well, they're extremely aggravated. They've seen at least one doctor, probably a bunch of times. They've probably had several x-rays.
They've been waiting and waiting but they're not getting better and they're very upset about that.
Today on the Doc On The Run podcast, we're talking about how waiting for an x-ray can cause you to miss your window with a stress fracture.
If you are a runner and you're thinking about surgery, you're probably maybe thinking about a second opinion, but maybe just doing your initial research, but some doctor has probably already suggested the idea of surgery to you.
This is one of the four categories is tendon surgery and we're going to talk a little bit about that, about what it means, what tendon is actually operated on and what the procedures really entail so that you can understand that a little bit better.
Today on the Doc on The Run podcast, we're talking about tendon surgery for plantar plate repairs.
In this episode we're talking about stress fractures and we're talking about what happens when you as a runner, wished something to be true and it's not a fact.
It's really important that you understand this.
Some of the wishes are things like, well, I want to run. The second one is I don't want there to be a crack on my x-ray. Some facts are, well, my podiatrist took an x-ray and there was no crack.
So what does that do?
Today on the Doc On The Run podcast, we're talking about stress fracture wishes as fodder for facts.
In today’s podcast we're talking about two different joint surgeries that are commonly performed as a component of plantar plate repair in injured runners.
This is a really important thing to understand. There's two different kind of procedures. They both have different risks and benefits, and we're going to talk briefly about them so you at least know what they are.
So if your doctor tries to sell you one of these procedures, you can at least know what you're buying.
Today, on the Doc On The Run podcast, we're talking about two different joint surgeries for plantar plate repair.
In today’s episode we're talking about bias and bias, of course, is where somebody is already kind of made up their mind about what should be going on with you.
They're biased, they've got a slanted opinion and that opinion is based on something other are than exactly what is going on with you.
When you get a second opinion, bias is the worst possible thing, because it's very difficult for a doctor to change their mind once they think they know what's going on.
Today on the Doc On The Run podcast, we're talking about bias in second opinions for runners and how you can avoid it.
In today’s episode we're talking about the four classes of procedures that affect four different anatomic structures in your foot when you have a plantar plate injury.
I think t's really helpful if you're really frustrated, you're really demoralized and you're in this very vulnerable place where it'd be easy for a doctor to talk you into surgery without you really understanding what's going on.
That's what we're going to talk about today is give you a basic understanding of the four different kinds of surgeries that are offered to patients with these injuries so that you can make a better decision when you talk to your doctor.
Today on the Doc On The Run Podcast, we're talking about the four types of procedures you might get offered as surgical correction for a plantar plate sprain.
I get questions all the time, daily almost, where somebody will send me a message and they'll say, "Well, I saw a doctor and they said I had this injury, and they said that I couldn't run for six weeks. Would you let me run?"
Well, the answer is no.
There's a reason doctors don't give you permission to run, and there are really four ways that you can tell, ways you can get permission.
I think it's important to talk about these four ways that you can actually get permission to run.
No proof, no permission to run. That's what we're talking about today on the Doc On The Run podcast.
A couple of years ago Martha was on the podcast talking about how hip arthritis has impacted her running and how she has been able to gain a different perspective on her running goals.
She is the host of the Martha Runs The World Podcast.
In this episode are talking about some basic principles and strategies for resuming running after surgery or a major over-training injury.
Today on the Doc On the Run Podcast we have Martha Hughes back on the show.
This is the thing I came up with when I actually was thinking about what I do differently with runners now that I've been for about a decade, basically focusing just on injured runners, what do I do differently than when I had a normal practice where I saw everybody with any kind of foot problem?
Let's think about what happens when you decide to run a marathon. Nobody just wakes up and says, I think I'm going to run a marathon today, it doesn't work that way. What usually happens is you have something that triggers your desire to actually run a marathon.
We all know it's really a big goal, we know it's inspirational, and you decide that you want to do a marathon.
So, what do you do?
Today, on the Doc On The Run podcast, we're talking about the Marathon Method of Running Injury Recovery.
Today's episode actually comes from something I read in one of the running forums where someone actually was saying that they were confused.
They had been to see a couple of different doctors and had a couple of different recommendations because they had heel pain.
The heel pain was in a little bit of an unusual area, the heel pain wasn't exactly on the bottom, the heel pain wasn't exactly on the back and it was sort of in the middle, right at the back of the heel where it curves around and they wanted to know what to do.
Is it plantar fasciitis or insertional Achilles tendonitis? That's what we're talking about today on the Doc On The Run podcast.
Several years ago I had the honor of speaking with Gary and interviewing him for an episode of the Doc On The Run Podcast, called From 400 Pounds To Running 100 Miles.
At one point in his life Gary, was seriously overweight and weighed about 400 pounds. But he was able to not only lose that weight, he became a 100 mile ultramarathon finisher and even did Leadville.
Gary's not just an incredible athlete but he's also a personal development expert. Today were really fortunate to have him back on the show to share his wisdom, experience and inspiration with you today.
“Success Is Spelled Action” and that's what we're talking about today on the Doc On The Run podcast.
Let's say you have this aching pain in the ball of your foot. You've been running and when you run, you get some sort of weird aching soreness in the ball of the foot.
You just know it's in the middle of the ball of the foot and it hurts more when you run and it hurts kind of after you run.
Well, you go see a doctor. They look at you, they poke around, and they say, "I think you have a Morton's neuroma."
Then later you figure out either because you got a second opinion, either or you sign up for the Plantar Plate Masterclass and went through those things and started self-diagnosing you figure out that you actually have a plantar plate sprain.
You get really confused about why it is that someone would misdiagnose you with a neuroma.
Can a plantar plate sprain be misdiagnosed as a Morton's neuroma? Well, that's a great question, and that's what we're talking about today on the Doc On The Run podcast.
I was just giving a talk recently at the IFAF where I was talking about protocols that I use with injured runners to help them get back to activity after common foot and ankle injuries that happen to runners.
The thing is, and what I was telling them is there are a few things that I use as protocols. When I say my protocol or a doctor says protocol for a stress fracture is six weeks in a boot or two weeks on crutches, that is their protocol and that is a cookie-cutter treatment plan.
So in many ways, those decisions are made before you even show up and see the doctor.
But what you really need is a customized treatment plan.
The best protocol for injured runners is a customized recovery plan and that's what we're talking about today on the Doc On The Run podcast.
If you're a runner and you think you have a grade 5 stress fracture because your radiology report said that or some doctor told you that, well, I have some good news and some bad news.
The good news is, is that you don't even have a stress fracture if you have a grade 5 stress fracture. It's not a stress fracture at all.
The bad news is, is a grade 5 stress fracture, is what we call a non-union where you had a stress fracture but that stress fracture actually failed to heal.
You have basically an unhealed, and probably not going to heal, stress fracture, unless you do something.
What is a grade 5 metatarsal stress fracture? Well, that's what we're talking about today on the Doc On The Run podcast.
What are the three best ways to diagnose extensor tenosynovitis in runners?
Well, it's pretty simple. They're really three ways that I think are effective and they can work, all of them.
It's not necessarily true that one is better than another, but they all three can work.
Today on the Doc On The Run podcast, we're talking about something really simple, it's the three best methods for diagnosing extensor tenosynovitis in runners.
The way that I thought about this episode today is that I just got off the phone, I was on a consultation with a runner and he has a plantar plate injury and he was planning on getting an injection to help the plantar plate sprain heal a little bit faster.
He asked me a question that really stopped me in my tracks. He said, "How long should I give it before I throw in the towel?"
I thought, well, are you planning for this to not work? I actually literally asked him that, I said "If you're thinking about when you're going to decide that this hasn't worked, that means you have to be planning for it to not work."
Today on the Doc On The Run podcast, we're talking about why you should not focus on plan B.
This is a great question that I got from somebody on a call who actually signed up and enrolled in the plantar plate class for runners.
He was going through the plantar plate course and he was actually trying to figure out what to do, and he was going to jumpstart the healing process by using a fracture walking boot.
He tried it on and he noticed that he was feeling some pressure because the inside of the fracture walking boot is basically flat.
Today on the Doc on the Run podcast, we're talking about two ways you can modify a fracture walking boot if you have a plantar plate injury.
I recently got a call from someone who had a son who was in cross country and he's been having some trouble. He's had several weeks of not running, and she wanted to get some advice on what to do.
I got an interesting response via email, where she wanted to know what free advice I had for her son.
First of all, I don't give advice when I don't know what the problem is. I didn't really know the story with her son.
We didn't do a consultation, and no physician is going to give you advice if they don't actually know what your circumstances are.
Today on the Doc On The Run podcast, we're talking about the best free advice for injured runners.
Believe it or not, most of the time when I see a runner, either on webcam or in their home, and they have shin splints, and they've been given a fracture walking boot, they need the fracture walking boot and maybe even more.
But what that really tells me when a doctor says you have shin splints but you need a boot, that it's really that the doctor is uncertain about the actual diagnosis, because in my view, most of the time, if you have shin splints, you do not need a fracture walking boot.
Should I use a fracture walking boot for shin splints?
Well, that's what we're talking about today on the Doc On The Run podcast.
I was just lecturing at the IFAF meeting in Lake Tahoe and I was giving a couple of different lectures on running injuries, and one of them was about the protocols that I use with injured runners so that they can maintain their fitness, stay fit, stay active, and keep running.
One of the doctors asked me about how I make these decisions and I explained to them was that the worst piece of advice I myself ever received as someone who was injured was when this doctor told me, "Just let pain be your guide."
How can you as an injured runner use pain as your guide? Well, that's what we're talking about today on the Doc On The Run podcast.
Today's episode is going to be a good one for you to listen to, if you've been told that you have a tibial stress fracture, or if you just think you might have a tibial stress fracture.
If you get a tibial stress fracture, the chances are really good that the doctor's going to do something to really restrict your running, and potentially your ability to move around at all.
For example, if you get a fracture walking boot and it's on your right foot, well, you can't even drive a car so you've got to take this seriously.
Is a fracture walking boot enough when you have a tibial stress fracture and you're a runner?
Well, that's what we're talking about today on the Doc On The Run podcast.
One of the phrases I often tell injured runners is that “nothing in medicine is free.”
For every potential treatment that might help some particular injury, you pay for it in risk.
A fracture walking boot is one of the simplest and most-often-prescribed treatments for overtraining injuries in runners. And although fracture walking boots maybe inexpensive, treating your running injury with one is definitely not free.
Today on the Doc On The Run podcast, we’re talking about how nothing in medicine is free especially with running injuries.
Today's episode actually comes from a question sent in by Shay.
She said, "I have a plantar plate complete tear and I had surgery on my left foot in October 2019. So that was a couple years ago. I'm running with some new issues in the right calf, but the main thing I want to learn is how this injury occurs. I'm really afraid of it happening to my right foot."
I talk to injured runners all the time. I lecture at medical conferences, teaching doctors what I do with runners who have these plantar plate injuries and Shay is reasonable to be concerned about this.
Today on the Doc On the Run podcast, we're talking about the three ways plantar plate injuries occur in runners.
This weekend I was lecturing at the International Foot & Ankle Foundation meeting in lake Tahoe, and I was lecturing on running injuries.
At the beginning of that lecture, I was asking the group of doctors there and I said, "Well, if you had a runner with a fourth metatarsal stress fracture and they had this level of pain and this level of disability and this level of complaint about it, how long would you expect to have them in a fracture walking boot?"
There was a doctor from Flagstaff, Arizona who actually raised his hand and he said, "It depends."
I was shocked because normally, people say four weeks or six weeks.
Today on the Doc On The Run podcast, we’re talking about how I finally got the correct answer on how long before you can run after injury.
I just got off the phone with a runner who had a plantar plate sprain. He was out on a run, he got a plantar plate sprain.
I saw him, I helped him understand what to do and what I showed him to do was exactly the same stuff I show you in the plantar plate sprain course.
He was doing much better, but he had a great question.
His question was, "When is my plantar plate sprain really healed enough that I don't have to worry about it anymore?"
Well, that's a great question and that's what we're talking about today on the Doc On the Run podcast.
Yesterday I was giving a lecture at the International Foot & Ankle Foundation meeting in Lake Tahoe. The topic was on protocols for return to running after recovering from over training injuries.
One of the most important points I was trying to make to the doctors in that session was that fitness is transient.
Fitness is only present in the presence of growth.
If you're an injured runner this is terrible news.
Today on the Doc On The Run podcast, we’re talking about why running fitness is transient.
One of the worst injuries you can actually get if you're a runner is a plantar plate ligament sprain.
The plantar plate ligament is a very small ligament on the bottom of the foot, where the toe attaches to the metatarsal phalangeal joint, right at the ball of the foot.
These can happen for lots of different reasons but it's a very small structure and the unfortunate reality is, is that every single time that you stand, you're stepping on the ligament.
Why do plantar plate sprains take so long to heal? Well, that's a great question and that's what we're talking about today on the Doc On The Run podcast.
I talk to injured runners all the time, and what I see is there are some runners who are kind of over the hump.
They've started figuring out that they're injured and they're going to have to do a whole lot of work to actually get back to running quickly.
Then there are other runners I see who are basically just demoralized and depressed because they're stuck in a rut.
Are you an injured runner or a recovering runner?
There is a difference, and that's what we're talking about today on the Doc On The Run Podcast.
I got a question from a runner who's had a metatarsal stress fracture who's very frustrated, who's trying to figure out how to get back to running.
He went and saw a doctor and he was told that he had a stress fracture and the doctor told him to take some time off of running.
Then he started watching some YouTube videos, started listening to some podcasts, and then asked me a very serious question:
How long do I have to wait to run with a metatarsal stress fracture?
Well, that's what we're talking about today on the Doc On the Run podcast.
I just got off a consultation call with a runner who called me for a second opinion, and she had an injury.
She actually said that a doctor told her she wasn't built to be a runner.
I'm not built to be a runner.
Is that true? What does a runner look like?
Well, that's what we're talking about today on the Doc On The Run podcast.
In this podcast episode we’re talking about one of my favorite false beliefs. It's that rest equals recovery.
This sort of makes sense to most people, but then runners get confused and wind up calling me for second opinions because they're still a little confused when they hear this.
Rest equals recovery. That's what we're talking about today on the Doc On The Run podcast.
In this episode we're talking about whether or not you can't run just because you got a running injury and this is a thing I hear all the time from injured runners.
They call me because they're frustrated because they're runners, they got a metatarsal stress fracture, or a plantar fasciitis, or a plantar plate ligament sprain, or Achilles tendonitis.
They say, “My doctor said I can't run because I got a running injury. Does that make sense to you?”
Well, that's what we're talking about today on the Doc On The Run podcast.
A running injury is always bad. No runner is ever happy to have a stress fracture or to have plantar fasciitis or Achilles tendonitis...or something worse.
If you get an overtraining injury and you're trying to recover, but you're not getting better fast, you need to stop and evaluate.
The biggest problem I see with most injured runners is that they half do the recovery.
You stop running. You stop working out. All you do is sit around.
You are waiting and waiting and waiting to heal. But all of that waiting puts injured runners in a dangerous place.
Today on the Doc On The Run podcast we're talking about the slippery slope of running injury recovery.
If you are a runner with a plantar plate injury, it is pretty easy for a doctor to make a convincing sales pitch on surgery. There are a couple of reasons that you should consider surgery for a plantar plate sprain.
The first reason surgery makes sense is you tried everything else and nothing non-surgical will work.
But you have to be honest about your non-surgical attempts.
Here are some examples I often hear from injured runners.
"I used the fracture boot a little bit, but had to take it off to drive."
I "sort of taped the toe."
I used some pads, "but I'm not sure if they are in the right spot."
You have to be honest with yourself about those treatments before you can say that you failed those treatments. that.
But when you have clearly failed all of the non-surgical treatments and you cannot get better, then and only then does surgery makes sense.
Should a runner have surgery for a plantar plate injury?
That's a great question and that's what we're talking about today on the Doc On The Run podcast.
I was recently doing a webcam call with an injured runner who wanted to know whether or not he should try to work on his running form.
He got injured and he started to get better. But the injury kept coming back. He was in a cycle of yo-yo healing. Better, then worse, then better again.
After a big race he got a lot worse. His question was whether or not working on his running form might help halt the recurring running injury cycle.
Should an injured runner work on running form?
Well, that depends and that's what we're going to talk about today on The Doc on the Run podcast.
One thing that's really demoralizing if you get a stress fracture is to spend a bunch of time in a fracture walking boot and then go get something like an MRI and be shocked and horrified when the doctor says, "Well, not only do you have a stress fracture in that bone, it looks like you've got a stress fracture in another bone as well."
If you think this stress fracture might have spread well, it could.
But not the way an infection would spread.
There is a way that stress related inflammation in a neighboring bone can spread after getting the original stress fracture.
Can a stress fractures spread from one bone to another?
That's a great question and that's what we're talking about today on the Doc On The Run Podcast.
I was just on a call with an injured runner who's been having trouble for a couple of months. He wanted to know what to do next.
The very next step in most cases is getting baseline numbers so you can figure out where you really are with your fitness, your injury, and your recovery...or lack thereof.
You've got to take an honest inventory!
The whole key to getting recovered as quickly as possible is letting the injury heal...while you work to maintain your running fitness so that you can get back to running faster.
Today on the Doc On The Run podcast, we're talking about taking an honest inventory when you're a runner with an injury who's trying to get back to running.
If you're a runner with running pain on the top of the foot, it could be lots of different things.
The actual diagnosis depends on what happened, what you did, and what it feels like now.
There are a couple of really common things causing pain in the top of the foot in runners.
Let's talk about two common causes. It may be either a tendon or a nerve on the top of your foot.
Today on the Doc On The Run Podcast, we're talking about how a runner can tell tenosynovitis from neuritis in the top of the foot.
If you've got an overtraining injury, but you're trying to figure out how to stay fit, a lot of people are going to think that you're not normal.
But if you ran 50 miles you are not normal.
If you signed up for a marathon, you're not normal.
If you are a runner, you are not normal.
Don't think you will be told you're normal when you are injured, in pain, but still working out.
But that's exactly what all the rapidly recovering injured runners do.
I call them injury hackers.
Today on the Doc On The Run Podcast, we're talking about how injury hackers are not normal.
I just saw a comment on our YouTube videos from a runner named Mary. She viewed the video on permanent calf atrophy, and how that can happen if you spend way too long in a fracture walking boot or a cast.
Mary replied and basically said, "Great. Now you depressed the crap out of me. Thanks. Ugh."
Realizing that you have lost fitness to the point of atrophy can be really upsetting for any runner.
Well, I've got some good news and some bad news for you, and that's what we're talking about today on the Doc On the Run podcast.
If you've been running and you started having pain on the outside of your foot and then you went to see a doctor who diagnosed you with a thing called a Jones fracture, you're probably really worried right now and that would be reasonable because most of the time when you get a Jones fracture you might wind up in surgery.
I think it's important, if you're considering whether or not you could run with a Jones fracture, you really have to think about what a Jones fracture is, where it's located, why it's so scary, and what you can do about it. The first thing is, of course, what is a Jones fracture exactly?
Can I run with a Jones fracture? Well, that's what we're talking about today on the Doc On The Run Podcast.
This may seem like a crazy question when you first think about it, because skiing seems like a high stress activity. But I have had lots of runners who have asked me this question, and usually when they do, they have thought about it, and they point out that a ski boot is a very stiff and very protective piece of equipment.
The question though is not really, if it's safe for you to wear the boot, the problem is, is it safe for you to ski with the boot and that leads to several questions that you've really got to ask yourself if you want to think about whether or not it's actually safe for you to do it.
Can I ski with a metatarsal stress fracture? Well, that's a great question and that's what we're talking about today on the Doc On The Run Podcast.
If you rest long enough any overtraining injury will eventually calm down.
But if you rest too long, you will lose all of your running fitness.
The difference between elite athletes who get better fast, and average runners who take forever to recover are the daily activities they focus on while recovering.
Today, on the Doc on the Run podcast, we're talking about the two most important questions for recovering runners.
Let's say you're out on a run and you start noticing this weird aching pain in your foot and so you suspect you have a metatarsal stress fracture. I often get consultation calls and webcam visits, and I even do house calls for athletes who have metatarsal stress fractures.
The good news is that a lot of the times, if you actually do something, when you first notice that aching pain in your foot, when you're running, it may not actually be a true stress fracture.
Today on the Doc On The Run podcast we're talking about the five most important things you can do for first aid for a metatarsal stress fracture if you're a runner.
I often get questions from runners and this is actually a common one that I get from runners when they have either enrolled in the plantar plate sprain treatment course for runners, or if they've signed up to do an individual webcam consultation.
Everybody seems to think that an MRI will give you a crystal clear image of what's going on inside your body and in some sense, that's true. It is amazing, the amount of detail you can get when you get an MRI. However, you have to remember that the plantar plate ligament is a very small structure and when you get an MRI, it doesn't necessarily show everything.
Is it okay to run before I get an MRI of a plantar plate sprain? That's a great question and that's what we're talking about today on Doc On The Run Podcast.
I lecture at medical conferences about stress fractures, trying to teach physicians the difference between a stress response, a stress reaction, which is basically an irritated and inflamed metatarsal bone, and a stress fracture where there's actually a crack that can cause real trouble.
One of the questions doctors ask me is what's the best way and the worst way to tell a stress reaction from a stress fracture, because it does make a difference.
What is the worst way to tell a stress reaction from a stress fracture? Well, that's what we're talking about today on the Doc On The Run podcast.
If you only get one thing from this episode, let it be this…Thank you!
From the bottom of my heart I am grateful for you as a listener of the show!
More than 10 years ago I started writing a blog talking about running injuries, and the various treatments that we as physicians offer. A few years later, at which point I had actually only listened to a few podcasts myself, I thought it might be useful to start recording a podcast to talk about foot and ankle injuries in injured runners.
Well, its hard to believe but today is episode #500. And that’s what we’re talking about on the Doc On The Run Podcast!
Every time I do a second opinion consultation with a runner who has a plantar plate injury, I hate to tell you this, but I hear the same story over and over and over.
Basically they call me and they say, "Well, I have a plantar plate sprain. I know I have a plantar plate sprain. I went through the plantar plate sprain course and I've been doing some of those things to actually try to get it better and it's starting to improve, but I was misdiagnosed with another condition."
And we're going to talk about why runners get misdiagnosed so frequently when they have plantar plate injuries and why it can be difficult to figure out whether or not that's actually a problem in the first place.
Today on the Doc On The Run Podcast, we're talking about why plantar plate injuries get misdiagnosed so frequently in runners.
Metatarsal stress fractures are one of the most common overtraining injuries afflicting runners. Much of the time the stress fracture is preceded by what we as doctors call a “stress reaction.”
If you ignore the warning signs of a stress reaction and keep on running in the same way, applying the same stress, the stress reaction will advance to a full on stress fracture they can keep you out of training for months. Most people think and X-ray of the foot is the best way to tell the difference between the stress fracture and a stress reaction. But that assumption is false.
If you're trying to figure out whether or not you're in the early phases of the stress fracture injury process you have to take action to figure out what is going on immediately. This episode will explain that process.
Today on the Doc On The Run Podcast we’re talking about the difference between stress fracture and stress reaction.
This question came up from somebody in the coaching groups who wanted to make sure that she wasn't going to get re-injured.
She wanted to know which running shoes she should use to reassess her pattern, and make sure that she's working her way out of this compensation pattern, where she's essentially limping because of this prior injury and that's a really useful thing to do.
Today on the Doc On The Run podcast, we're talking about which running shoes show running form wear patterns best.
An MRI can be very helpful when you have a strange injury that doesn't seem to fit in any of the common running injury boxes.
I just had a call from a runner in that very situation. He is someone who has an injury and has something kind of strange going on.
He actually had an abnormal finding on an MRI from a little more than three years ago.
At the time that he had that previous MRI that thing that was a little weird on his MRI wasn't really causing a problem, but now his pain is in exactly that same spot.
Today on the Doc on the Run podcast, we're talking about why runners should always get the second MRI at the same imaging facility.
Today's episode actually comes from a second opinion telemedicine visit with a runner who wanted to know more about a tarsal coalition.
He had an X-ray and the doctor found this thing called a "C-sign."
The "C-sign" is an abnormal appearance on an x-ray that suggests a tarsal coalition. When you look at the lateral view of the foot X-ray, a bridge of bone can form, partially encircling the talus bone and the calcaneus or the heel bone. It creates a bridging bright white thing that looks like the letter C on your X-ray.
A C-sign is abnormal, and it is one of the classic signs of a tarsal coalition.
How can a tarsal coalition start causing pain in a runner? Well, that's a great question, and that's what we're talking about today on the Doc On The Run Podcast.
Today's episode comes from an injured runner who saw a doctor, got x-rays and found what looked like bone fragments in the peroneal tendons.
We were doing a telemedicine second opinion consultation, and she wanted to know whether or not she should have surgery to take the bone chips out of the peroneal tendon.
That's a great question!
How did bone chips get in my peroneal tendon? Well, that's what we're talking about today on the Doc On The Run Podcast.
I was just on a second opinion telemedicine call with an injured runner.
She had a recurring injury that was still keeping her from running.
Unfortunately, that injury first started eight years ago.
When you have an injury, and you get x-rays, an MRI or a CT scan, or any kind of medical imaging study that shows more detail than the x-rays, you should always get a copy of that disc.
This runner's story is a great example of why you need those images.
Today on the Doc On The Run podcast we're talking about why runners should always get copies of the x-ray or MRI imaging disk.
Today's question comes from a telemedicine visit second opinion for a runner.
She was asking if she should have surgery to remove bone fragments.
I said, "Well, let's talk about what's going on with you first."
Anytime we see something abnormal on an x-ray or an MRI, we often think that it's pathologic. We presume something is wrong, just because it doesn't look right.
We think if something's wrong, we should go cut your foot open and fix it.
Should a runner have surgery to remove bone fragments? Well, that's a great question and that's what we're talking about today on the Doc On The Run podcast.
The other day I was talking to a runner who had some abnormal findings on the x-rays.
What we could see was calcification in the Achilles tendon that looked like bone chips.
She wanted to know if she should have surgery to remove the calcification or little bony chips that were inside her Achilles tendon.
Now, the interesting part of the story is that the Achilles calcification was discovered from an x-ray where she had a stress fracture in one of the metatarsals....in a completely different part of her foot!
The pain she was having when running didn't even come from an Achilles tendon problem.
Today on the Doc On The Run Podcast, we're talking about the difference between pathologic versus abnormal findings on x-rays and MRIs in runners.
Today's episode comes from a runner who was having some weird aches and pains when running.
One doctor suspected he might have a thing called a "tarsal coalition."
A tarsal coalition is an abnormal union or connection between two bones.
He was even told me might need surgery to remove the tarsal coalition.
He asked me whether or not an injection, like a stem cell injection, might actually help a tarsal coalition.
You have to think about the runner's goals, and we expect different injections will actually do to figure out which is best for you.
Today on the Doc on the Run podcast, we're talking about two opposite ways injections could help a tarsal coalition in a runner.
A podcast listener sent in a great question for the Doc On The Run Podcast.
Sandra asked, "Is there a best way to ascertain if a person has a leg length discrepancy? MRI, measuring, what is it?"
"Limb length discrepancy" just means one leg is a little bit longer than the other.
There are lots of different ways to figure out whether or not you have a limb length discrepancy. Figuring out how big that difference might be is really important if you want to fix it.
Today on the Doc On The Run Podcast, we're talking about three different ways to determine limb length discrepancies in a runner.
Today's episode comes from a discussion in our Monday, Wednesday, Friday coaching group.
This was someone who actually had a metatarsal fracture and had graduated from using crutches to using the boot and was transitioning out of the boot and she asked me a great question.
She said that her foot was hurting a little bit as she was transitioning out of the boot. She wanted to know if that was normal. Or was the aching associated with walking in a normal shoe something to be concerned about.
Today on the Doc On The Run podcast, we're talking about why healing fractures might hurt after you stop using the boot.
Today's discussion actually comes from a question from a runner in the Monday, Wednesday, Friday Coaching Group.
This is a runner who has a condition called "hallux rigidus."
He wanted to understand the best way to assess your running shoes. He also wanted to know whether or not it was possible to identify hallux rigidus just by looking at the soles of a runner's running shoes.
When you get hallux rigidus, your big toe doesn't actually "dorsiflex" or come up away from the ground enough to allow you to walk or run without doing something to compensate. That shift in the way you walk creates a characteristic wear pattern on the sole of the shoe.
Today on the Doc On The Run Podcast, we're talking about running shoe wear patterns with hallux rigidus.
Today's episode comes from a discussion I had with a runner in person who had some foot pain, it was kind of weird.
He's an elite runner and he started developing this symptom that he couldn't figure out and it was in a weird spot.
He got an evaluation and part of his evaluation was X-rays of his foot. When we got the X-rays of his foot and we were looking at him, he had this thing that we call talar beaking and he wanted to know what that was.
What is talar beaking on the X-ray of a runner? Well, that's what we're talking about today on the Doc On The Run Podcast.
Every treatment in medicine has pluses and minuses. Applying ice is no different. Ice can make some things better, and some things worse.
If you ice something, in general it will calm that inflammatory response, reduce the pain and make you more comfortable.
But your goal is to get back to running as quickly as possible, not to just make you feel better.
Today on the Doc on the Run podcast, we're talking about whether or not an injured runner should ice a broken toe.
Every day I do telemedicine calls with injured runners. They often ask questions that remind me of things learned in the past, that help them understand what to do right now.
It's interesting how many times I actually think of this guy that was my mentor when I was racing motorcycles. His name is Fred Provis. Everyone called him "Motorhead Fred."
Fred and I raced together and won an endurance championship, and he taught me a ton of stuff about life (not just racing).
Much of what Fred told me, I never would've thought about doing on my own.
I did what Fred said, because I trusted him.
Today on the Doc On The Run Podcast, we're talking about why you need to trust in a real expert.
Ankle sprains are incredibly common in runners.
Sprained ankles account for about 10% of all musculoskeletal injuries that show up in the Emergency Room.
But there is another injury that can seem sort of like an ankle sprain, but doesn't respond to treatment the same way.
This sprain is not in the ankle. It is a sprain of the joint under the ankle...the subtalar joint.
It's called a Subtalar Joint Sprain.
What is a subtalar joint sprain in a runner? Well, that's what we're talking about today on the Doc On The Run Podcast.
If you suffer a severe running injury, some doctors will give you crutches to speed up the recovery process.
Healing any running injury is a race against time.
All overtraining injuries will eventually heal.
But if you take a long time to heal, you're going to lose a lot of running fitness. You will get weaker, stiffer and develop a loss of coordination.
That loss of fitness will make it very difficult for you to achieve your running goals after you fully recover. The goal isn't to heal. The goal is to run without re-injury.
Today on the Doc On The Run Podcast, we're talking about the best and worst ways to stop crutches if you're an injured runner.
This podcast episode comes from a telemedicine visit second opinion with a triathlete and runner who was having pain as he ramped up his mileage.
It turns out he had what we call a limb length discrepancy, where you actually have one leg that is a little bit shorter than the other.
This is something we see a lot in runners who are starting to get problems as they increase mileage during training.
Today on the Doc On The Run podcast, we're talking about three signs of limb length discrepancies in runners.
This is a great question from a runner I've been helping in the Monday, Wednesday, and Friday coaching group.
She had a fifth metatarsal fracture and wanted to know if this could actually cause posterior tibial tendonitis.
Since they're on the opposite sides of the foot, a lot of people think that it won't cause the same kind of problem, because you wouldn't expect to have problems on both the left and right sides of the same foot.
Can a fifth metatarsal fracture cause posterior tibial tendonitis? Well, that's what we're talking about today on the Doc On The Run Podcast.
A runner in the in the recovering runners coaching group asked a great question.
She had just broken her toe and could barely walk on it. She was really worried that she was going to have to use a fracture walking boot for a month or month and a half to get the toe fracture to heal.
She wanted to know specifically when she could start running.
Today on the Doc On The Run Podcast, we're talking about what happens if you run on a fractured toe before it completely heals.
I just got a great question from somebody who said he went rock climbing over the weekend, and he got a huge blister on his big toe from his climbing shoes.
He didn't really complain that much about the blister, in fact, he'd even been running. But then he said he was getting peroneal tendonitis. He was having this pain on the outside of the ankle where the peroneal tendons go down around the back of the fibula bone.
He wanted to know if it was somehow related to the blister on the big toe.
Can a blister on the big toe caused peroneal tendonitis? Well, that's what we're talking about today on the Doc On The Run podcast.
I recently got a great question from a runner who was calling me for a second opinion during a telemedicine visit.
She wanted to run but had a partial rupture in the plantar fascia.
When we were talking about her history, she told me that she had had a couple of corticosteroid injections (or cortisone) injections for the plantar fascia when she had plantar fasciitis.
Is a cortisone injection malpractice if it causes a plantar fascia rupture in a runner? Well, that's what we're talking about today on the Doc on the Run podcast.
I got a call from a runner who has a really interesting situation.
He's been doing lots of running, but he's been getting pain in his ankle whenever he runs.
He gets a little bit of swelling in the ankle at the end of the day.
But when he wakes up, the swelling in the ankle is completely gone.
The ankle swelling is completely resolved and he seems fine the next morning.
So his question was, “Can I run with arthritis in my ankle?”
Well, that's what we're talking about today on the Doc On The Run Podcast.
This is a great question I got from a runner during a recent telemedicine visit and this was a runner who actually called me for a second opinion because she had a tear in the plantar fascia.
She felt like it was healing, and she wanted to get back to running. She was really hoping to get some kind of real positive affirmation or confirmation that she was okay to run and wanted to know whether or not she should get a repeat of the MRI that she had previously that actually discovered she had a partial tear in the plantar fascia and not just plantar fasciitis.
Now, this is a great question and it's a completely reasonable one. In fact, I just discussed this with doctors last week at the International Foot and Ankle Foundation meeting, where I was actually lecturing on runner’s heel pain.
Should I get an MRI of my healing plantar fascia tear before I start running? Well, that's what we're talking about today on the Doc On The Run Podcast.
I was just doing a call with a runner who started running before his fracture was healed on the x-ray.
In fact his regular doctor said he couldn’t run on it until the x-rays showed healing.
I let him start running on it, in a very structured way. Now he is back to full running.
If the bone is always getting stronger while it is healing, do you really need to wait until the x-ray finally proves it has fully healed?
Today on the Doc On The Run Podcast, we're talking about whether or not you can run if you fracture is not yet healed on x-ray.
This episode actually comes from a question I got during the live question and answer period at the end of a talk I was giving at the International Foot and Ankle Foundation meeting in Hawaii.
The question was about one of the conditions that can often be misdiagnosed as plantar fasciitis, and that's a condition called medial calcaneal neuritis.
With this condition a nerve on the inside of the heel becomes inflamed and painful.
In short, the patient had alcohol injection under ultrasound guidance by another doctor, but the condition dod not get any better.
The question from the doctor in the audience was basically asking me what my opinion about that procedure using ultrasound.
Today on the Doc On The Run Podcast, we're talking about heel neuritis in a situation where a doctor did an alcohol injection with ultrasound and another doctor wanted to know if that was a scam.
A doctor at a medical conference asked me a great question!
I was giving a lecture at the International Foot and Ankle Foundation meeting in Hawaii on runners heel pain, specifically about the, what we call the differential diagnosis or the things that can cause runners heel pain.
In that talk I was also teaching about the differences in treatments between runners like us, and non-runner patients with heel pain.
At the end of that lecture a doctor wanted to know which kind of imaging study was better for a runner with a suspected small tear in the plantar fascia ligament.
Today on the Doc on the Run Podcast, we're talking about MRI vs Ultrasound. Which is better for Plantar Fasciosis or Partial Rupture in a runner?
Today I got a question from a doctor who wanted to know what I would do with a runner after surgery to remove non-healing sesamoid fractures in both feet.
You have two sesamoid bones under the big toe joint in each foot. When one of them develops a stress fracture, it can break.
If it breaks into two pieces, it can be very difficult to get the broken sesamoid to heal completely.
If it doesn’t heal, becomes arthritic and turns into what we as doctors call a “sesamoid fracture non-union” your doctor may recommend surgery to take it out.
Today on the Doc on the Run Podcast, we're talking about what to think about when a doctor is trying to rehabilitate a runner after tibial sesamoid non-union removal surgery in both feet.
I was just given a talk at the International Foot and Ankle Foundation's 40th Annual Hawaii Seminar.
And at the end of the session, we got a couple of questions from the audience during the live Q&A for the doctors.
A doctor in the audience she had a runner who is one of her patients.
This runner had been basically running on a mild stress fracture, which I would really consider a stress reaction, for a period of about two months but wanted to do a race.
Today on the Doc on the Run Podcast, we're talking about what a doctor should do when she is helping a runner with a stress fracture who has been running on it for 2 months and still wants to run a race.
This episode comes from a question from a runner I saw in person during a second opinion house call.
She had a metatarsal stress fracture and felt like it was more comfortable when she was barefoot.
The more you can reduce the stress and strain to the injured metatarsal bone and the healing stress fracture the faster it will heal.
The types of shoes you wear during the recovery can change those stresses for better or worse depending upon which shoes you are wearing.
You need to focus on protecting and healing that metatarsal stress fracture if you want to get back to running as fast as possible.
Today on the Doc on the Run Podcast, we're talking about whether or not it is better to go barefoot with a stress fracture.
If you want to get back to running faster after a foot fracture (or any overtraining injury), the whole key is make sure that you are increasing your activity to get stronger, instead of just sitting around and waiting, while you get weaker.
But the only way you can do that is with constant readjustment based on how you feel and what happens in response to that activity during that recovery process.
This episode is about runner with a healing fracture who was told by a doctor, “don’t run.” Instead he was supposed to wait for another x-ray to prove it was healed.
And after I did a consultation call with him, I actually cleared him to start running now.
Today on the Doc on the Run Podcast, we're talking about a recovering runner with a fracture who wants to ramp up his intensity today.
A podcast listeners wrote in and she asked,
"How long do I need to stop running or take it easy after taking five doses, meaning two and a half days, of Cipro?
I told my doctor I was a runner, so I didn't trust their opinion on when or how I should run.
I haven't run since finding out the side effects two weeks ago, and the Achilles feels weak and a little thicker than the other side."
This is a great question, and she is right to be concerned because the FDA issued a black box warning because of an association between Cirpo antibiotics and Achilles tendon ruptures.
Today on the Doc on the Run podcast, we're talking about a runner with Achilles tendon worries after taking Cipro antibiotics.
A couple of weeks ago, I was working on my motorcycle, and I accidentally cut myself open.
Long story short…I let a middle school kid put the stitches in the wound.
In this episode we talk about how that turned out.
We also talk about how that story applies to running injury recovery.
Which is more important when you have surgery to heal a running injury?
Is the actual procedure done by the surgeon the most important?
Or is the process of injury recovery after the surgery more important?
Today on the Doc On The Run podcast we’re talking about procedure vs process in healing faster.
A new runner was having some aching in pain in the shins and he asked,
"I just started running. I started having shin splints. Some people told me I have to stop. Some people, say I don't. What do I have to do?"
Obviously, if you started running, you're starting to develop some fitness and you're finally getting to the place where you can run consistently, the last thing you want to do is give up your running routine.
The good news is that in some cases you don’t have to stop running just because you have aching pain in your shins. You just have two figure out whether or not it is really a big problem or something that can improve with minor changes in your running routine.
Do I have to stop running to cure shin splints? That's what we're talking about today on the Doc On The Run podcast.
I was just doing a second opinion consultation over webcam with a runner who had an overtraining injury.
She was really worried that she could to lose all of her fitness while waiting to heal.
It is just not okay for a runner to sit and wait for weeks, or months, to heal an injury.
If you don’t exercise at all, you will lose your base of aerobic fitness, the neuromuscular connections that keep you coordinated and help you maintain good running form.
You start to lose it all at a very fast rate compared to how long it takes to build that running fitness.
Today on the Doc On The Run Podcast, we’re talking about how healing running injuries is a race a against time.
I just did a second opinion consultation with a runner who called and said she was diagnosed with a grade five stress fracture.
The doctor didn't actually explain what that meant. He just said it was serious.
Stress fracture are rated by severity from grade one through a grade five. Grade five is obviously the worst to runner.
She wanted to know if she needed a bone stimulator since her stress fracture was serious.
Do I need a bone stimulator for a grade five stress fracture? That's what we're talking about today on the Doc On The Run podcast.
I was just doing a second opinion consultation with a runner who was really stressed out.
She said, "I'm going to lose all my aerobic fitness. I'm going to get weaker. I'm going to get stiff or my running form is going to be terrible!”
There are some mental tricks you can use that will be very helpful anytime you get an over-training injury, whether it's a stress fracture, Achilles tendonitis, or any injury.
If a doctor tells you, you have to rest and sit still, that can be stressful. But all runners have the tools to navigate it, whether you have ever been injured or not.
Today on the Doc On The Run Podcast, we're talking about how you should think of your over-training injury recovery, as an extended rest day.
The fifth metatarsal bone goes from your midfoot out to your little toe. And if you break it, it could be one of three things.
You could have a shaft fracture, which heals pretty uneventfully, most of the time.
You could have an evulsion fracture, where it actually rips a piece of bone off when your peroneus brevis tendon tries to pull so hard to keep your foot under you, that it actually cracks the bone.
Or you could get this thing called a Jones fracture. Now, if you have a Jones fracture, that is a bad thing. Out of those three, it is definitely the worst.
But sometimes a doctor will say you have something called a pseudo-Jones fracture, which implies it's kind of like a Jones fracture, but not really as bad.
What is a pseudo-Jones fracture? Well, that's what we're talking about, today, on the Doc On The Run podcast.
This episode actually comes from a YouTube comment. This runner saw an image from when I was running a 50 mile trail race wearing Hoka trail running shoes.
He said, "I would never take advice from a coach, a biomechanics expert, or a running injury expert who was wearing Hokas."
Would you take your running coach seriously if he was wearing clown shoes?
Well, that's what we're talking about today on the Doc On The Run Podcast.
Today's episode actually comes from a podcast listener who had a question:
"I got an MRI just to give me the green light to resume training and it showed a grade three stress reaction of the left tibia. Do you think I can run?"
Deciding whether or not you can run with a stress fracture really depends on understanding how bad it was when it started, and how bad it is right now.
How bad is a grade three stress fracture? Well, that's what we're talking about today on the Doc on the Run podcast.
Today’s episode comes from a podcast listener with a stress fracture and wants to get back to running.
Jennifer says, "I went to see my doctor again today for my MRI results.
He told me that I still have a stress fracture.
I was a bit confused, because after 10 weeks without running I thought there would have been more signs of healing.
So I asked if he could see a fracture line and he said, 'Yes and that I should stop running immediately!'
(I guess my doctor forgot that I had stopped a long time ago).
I want to get back to running and I don’t believe my doctor is truly getting me there. Prior to this appointment, I was feeling confident that I could continue with my walk/jog routine as long as there was no pain.
However, now I am feeling scared because he could still see the fracture."
In short, it sounds like Jennoifer is saying, "I don't trust my doctor."
Well, that's what we're talking about today on the Doc On The Run podcast.
I had a really great question from a patient on a second opinion webcam visit.
“I have a partially torn plantar fascia. Can I keep running and let it heal later?”
He had purchased The Runner's Heel Pain course and based on his self-diagnosis, he concluded that he definitely did not just have plantar fasciitis. It was more likely plantar fasciosis with a small tear in the plantar fascia.
Unfortunately, the treatment that we would normally do and normally recommend for somebody with a partial tear in the plantar fascia, well, he just cannot do right now. He does not have time to actually take off of his activity and stop running completely right now.
Today on the Doc On the Run podcast, we’re talking about Torn Plantar Fascia: If I run can it heal it later?
It's no secret..I like to talk about running injuries!
But after so many years working with injured runners, helping runenrs race after they get an injury, and showing them how to maintain their running fitness while injured: I have uncovered a couple of "secrets" that really help injured runners most.
If you have a running injury and you're trying to figure out what to do, if you're confused why the doctors are just telling you to sit around and wait, this episode may help you understand it.
Today on the Doc on the Run podcast, we're talking about the top three running injury recovery secrets.
Extensor tenosynovitis is one of the running injuries doctors don't often talk about simply because it's a relatively rare condition.
But extensor tenosynovitis can be really painful when running.
Sometimes it's actually misdiagnosed as a stress fracture, both by doctors or by the runners themselves.
Any misdiagnosis can force you to take time off of running unnecessarily.
Today on the Doc On The Run Podcast, we're talking about three foot types that are prone to extensor tenosynovitis.
Just this weekend, I got a call from somebody who said that she was out on a run, she felt a pop in the back of her heel, she went to the emergency room and she was told that she has a partial tear in her Achilles tendon.
I'm not really sure if they did x-rays or an MRI or an ultrasound or anything to confirm that, but the doctor seemed very confident that she had torn her Achilles tendon.
And so, she said that all they did really was they gave her some crutches and they told her to see a specialist, which is why she called me.
She asked me “I just found out that I tore my Achilles tendon. The emergency room physician gave me crutches. What should I do?”
Well, that's what we're talking about today on the Doc On The Run Podcast.
Every day I talk to injured runners who ask me to help them recover faster so they can run sooner. Some runners call me for a one-time, one-hour consultation. Some runners call me and hire me to literally coach them day-by-day for a full month.
Others who don’t want to spend that kind of money, simply join a coaching group where they can get advice for an entire month and join group web-cam sessions every Monday Wednesday and Friday for 4 weeks in a row.
In those sessions recovering runners get to pick my brain to see what they might be able to do to recovery faster and get back on course sooner.
Today on the Doc On The Run podcast, we’re talking about why some runners should never pay for advice.
Today's episode actually comes from a question that is a real-world situation.
Should I take Lovenox after an ankle fracture? I broke my ankle. The doctor gave me a prescription. Should I take this thing or not? Is this appropriate for me?
This is actually a great question and it points out a couple of things I think are worth hearing.
Today on the Doc On The Run podcast, we're talking about whether or not you should take Lovenox after an ankle fracture.
Most of the runners who call me when they are inured have hired a running coach. Some of them don’t realize they have a running coach.
A coach is someone who one who instructs players in the fundamentals of a sport and directs strategy.
When you sign up for online coaching, and get a marathon training plan, you hired a coach.
When you go to the doctor and ask for help with a stress fracture you hired a coach.
Both of them are supposed to be helping you (in different ways) get to the finish line.
Today on the Don On The Run podcast, we’re talking about how to pick your running coach wisely.
A body at rest remains at rest.
Now that is a law of physics. That's not something I came up with, but it definitely applies to running injuries.
This is what I see happen over and over and over. Somebody gets a stress fracture, they go to the doctor, the doctor takes an X-ray, they don't see a crack. They don't see anything on the X-ray. And they say, "Well, I don't see anything, but you have a stress fracture." Here's a boot, wear it for four weeks, we'll see you in a month. Come back and we'll do another x-ray.
You leave there thinking, "Wait a minute, you didn't see a crack. You didn't see anything. In fact, I'm not even so sure that you know it's a stress fracture, because you said there was no crack on the X-ray yet you gave me a boot and you told me to sit around for a month and then do another X-ray. Like, what does that mean?"
Today on the Doc On The Run podcast, we're talking about running injury truth number five, a body at rest tends to remain at rest.
If you want to get back to running as quickly as possible you need 3 essential ingredients:
Recovery, Strength and Balance
When something is weaker because it is still recovering, this approach is all the more important.
NEWSFLASH: you can work on recovery, building strength, and better balance at any stage of injury.
Get moving now!
Today on the Doc On The Run podcast, we’re talking about the 3 Ingredients required for rapid recovery from running injury.
The action you and ONLY YOU take are all that matters now.
I can show you the way, but I can’t carry you there.
It takes work. Lots of work. It’s like training for a marathon, without cheering crowds or medals.
The speed with which you return to running ONLY depends on how much effort you put into your recovery.
Today on the Doc On The Run podcast, we’re talking about how no one can save you.
There is NO over-training. There is ONLY under-recovering. You did not run too much. You made a mistake in the order of your workouts or the intensity of one workout or in the strategy you used to rebuild tissue.
That is EXACTLY the same mistake runners make when they get injured again after “healing” an injury.
Today on the Doc On The Run podcast, we’re taking about running injuries can happen to everyone.
The premise is that your crazy physical activity is the problem.
The promise is that you will heal if you simply sit still.. long enough.
The hope is that recovery will magically take place through sacrifice like a perverse form of penance for your exercise sins…crazy.
But a prescription of 100% Rest only guarantees 100% loss of fitness.
Today on the Doc On The Run podcast we're talking about the advice to rest is a lie.
If you're a runner with a running injury, you need to listen up.
The biggest problem with running injuries is not that you have a broken bone, not that you have a sprained ankle, and not that you have Achilles tendinitis.
The biggest problem is that you're going to lose your running fitness while you recover from that injury, if you're not really proactive.
Today on the Doc On The Run Podcast, we're talking about muscle atrophy, and whether or not it's reversible.
I was recently doing a presentation about how runners go wrong.
They know all of this stuff about training, running biomechanics, running form and nutrition. And that's not enough.
Runners still get injured and have to call me...even after they've seen other doctors.
Today, on the Doc On The Run Podcast, we're talking about the number one cause of confusion in injured runners.
This episode comes from Amanda who wanted to know how to tell the difference between contact dermatitis and athlete's foot.
It's summertime, she's been running, her feet sweat a lot, and she noticed a bunch of peeling skin on her feet.
She assumed it might be athlete's foot, but one of her friends said it might be dermatitis.
This is a great question!
How can a runner tell athlete's foot from contact dermatitis?
Well, that's what we're talking about today on the Doc on the Run podcast.
This episode actually comes from a visit with a runner where I was asked to check her foot.
This runner happens to also be a physician.
She assumed that she was having plantar fasciitis because she had some pain in her heel when she was running, and after her run, she would have a little bit of pain when she was just walking around.
Because she was having this occasional weird twinge of heel pain, she asked me to see what I could figure out.
Today on the Doc On The Run Podcast, we're talking about how you really need to check your shoes whenever you have pain from running.
I know blisters are not really an exciting topic.
But I can tell you one thing for sure, if you're running a marathon and you get a blister, it is going to wreck your performance.
You cannot perform at your best if you're thinking about some little stinging aching pain that you're getting because of a blister, and it really can make a real dent in your training too.
Today on the Doc On The Run Podcast, we're talking about the causes of blisters in runners.
I just spoke with a runner during a telemedicine visit who has been having some pain that is flaring up in a couple of different workouts.
He's now a little worried that he's going to wind up with something that sidelines him.
He remembered that he was told he had some kind of "limb length discrepancy."
Today on the Doc On The Run Podcast, we're talking about limb length discrepancy compensation in runners.
Today's episode comes from a recent group coaching call for recovering runners. All of the runners on these calls have been injured and they're getting back to running, and today's call will help you understand several things.
Even if you don't have cuboid pain, even if you didn't have flatfoot surgery, this will help you think about your pain differently and help you look for opportunities to maintain your running-specific strength as you continue to recover from your overtraining injury.
Today on the Doc On The Run Podcast, we're talking about cuboid pain with running after flatfoot surgery.
I had a recent group coaching call for recovering runners, and the main point of this episode is that you've got to do more frequent follow-up. Even if you manage that follow-up recovery process on your own, it needs to be frequent.
This particular runner was someone who was having an improvement in her injury. She was actually running, but she still had some foot pain when running and she had one of the best and most common questions I get:
“Should I just keep running and see what happens?”
Well, if you're in that spot, you don't want to miss this episode.
Today on the Doc On The Run Podcast, we're talking about whether or not you can just keep running and see if the foot pain gets better.
This episode comes from a live group coaching call where recovering runners get to ask me anything they want.
Today on the doc on the run podcast we're talking about whether or not you can get a stress response in your good foot when you're wearing a fracture walking boot on your bad foot to treat a stress fracture.
Today's episode comes from a live Q&A. We hold these sessions for runners enrolled in the self-diagnosis courses, and those in group coaching sessions, who just want to make sure that they're staying on track and getting back to running as quickly as possible.
We were talking about why injured runners should ask better questions.
Today on the Doc On The Run podcast, we're talking about how to ask better questions at the doctor, for an over-training injury.
This episode actually comes from a recent live Q&A I did with recovering injured runners and during these calls you can come on and you can ask me anything that you want about your specific situation. This was a really great question that came from one of the runners on the call and he was concerned about this discomfort he was getting in his foot a full year after he had a metatarsal stress fracture. Today on the Doc On The Run Podcast, we're talking about what can cause aching pain in the top of the foot a year after a metatarsal stress fracture?
I recently did an episode where I was talking about the causes of black toenails in runners after long runs, and I got a lot of comments and questions about, "Well, what should I do?"
We did talk about a couple of different things during that episode, where I was telling you how to check and make sure that you have sufficient space at the end of the shoes, that your running shoes aren't just too small or how to make sure that if you do have a lot of room in the shoes or if it seems like they're big enough.
But if those two things are not your issue, then it's more likely that when you're swinging your foot through, during what we call the swing phase of gait.
Today on the Doc On The Run podcast, we're talking about the top three tips to avoid getting black toenails from your long runs.
I just had a discussion with a runner during a telemedicine second opinion.
She rolled her ankle and went to the emergency room. They gave her a brace to stabilize the ankle and an ACE wrap to compress it.
She started some rehab exercises, and frankly she improved a lot.
But when she got back to running, she had intermittent pain in the back of her ankle.
This was not the same spot where she got the sprain.
She called because this pain has now been going on for a long time, and when she got an x-ray someone told her she might have a posterior process fracture of the talus.
She asked me, "What exactly is a posterior process fracture?"
Today on the Doc On The Run Podcast we're talking about posterior process fractures of the talus.
Today's episode comes from a discussion during a recent television fitness segment interview where I was actually asked about black toenails in runners.
If you've been running for a long time, undoubtedly you've had this happen at least once. I've had it happen multiple times.
I realized, after many years of racing, that if I did any run longer than about 20 miles, and I didn't do some specific things to really provide care for my nails and protect them, I would wind up with one of my second toenails bruised, discolored and painful.
Today on the Doc On The Run podcast we're talking about the top three reasons runners get black toenails after long runs and races.
This was a great question from a runner enrolled in the metatarsal stress fracture course. She wanted to know whether or not a bone stimulator would really be helpful.
Can a bone stimulator help a stress fracture?
Well, that's what we're talking about today on the Doc On The Run podcast.
I was just on a telemedicine call with a recovering runner. He asked me about different forms of training that he could do to maintain his running fitness, while he fully healed the injury.
He asked a question I get all the time, "Is cycling really helpful or not?"
Well, the short answer is yes, it is very helpful for several reasons.
Today on the Doc On The Run podcast, we're talking about whether or not cycling will help maintain your running fitness while you're injured and recovering.
This episode actually comes from one of the live Q&As I did with course members who are actually enrolled in courses like the Plantar Plate Sprain Course for Runners or the Metatarsal Stress Fracture Course.
"One of my friends said that I could get an injection to help my planter plates sprain heal faster. What is that injection?"
Today on the Doc on the Run podcast, we're talking about what kind of injections might help a plantar plate injury.
This is a question sent in by a listener to the Doc On The Run Podcast and this is someone who's had a stress fracture, and it's now turned into what the doctor called a delayed union.
She said, "My doctor has told me that my stress fracture is now a delayed union. What does that really mean? What is a non-union? What's a delayed union?"
Well, that's what we're talking about today on the Doc On The Run Podcast.
The anti-inflammatory medications you can get over the counter at the pharmacy do a great job at decreasing musculoskeletal healing, but there is a little bit of a problem.
There's some research that actually shows that some anti-inflammatories, particularly non-steroidal anti-inflammatories, may slow down healing of tendon to bone junctions.
Today on the Doc On The Run podcast, we're talking about should I take ibuprofen when I have a plantar plate injury?
I was just having a discussion with a runner about the things that she could do to accelerate her running injury recovery.
She has been yo-yoing through a cycle or workouts and short runs when she feels good, then does a little bit too much.
That's when she gets re-injured.
She is aggravating the injury over and over. The real problem isn't her injury. She's just pushing her recovery too fast.
Today on the Doc On The Run Podcast, we're talking about how you have to slow down if you want to speed up.
A runner just asked a great question about when runners should get a plantar fasciitis injection so she can run.
If you've signed up for the Runner's Heel Pain Course, or you've listened to the podcasts on Runner's Heel Pain about plantar fasciitis in runners, you've probably heard me say that I don't inject most runners with cortisone when they have plantar fasciitis.
The way I break it down is that it depends on one of three different scenarios.
"Should I get a plantar fascia injection so I can run?"
That's what we're talking about today on the Doc On The Run Podcast.
Look, if you get injured, you're going to need help and if you want to maintain your running fitness and you really want to get back to running as quickly as possible, sometimes you've got to talk to an expert.
I'm an expert on running entries. I do telemedicine visits, but telemedicine does not work for everything or everybody.
You don't have to talk to me. You can find somebody else and there's several ways to figure out whether or not that might be a good person.
Today on the Doc On The Run Podcast, we're talking about three tips for finding a local expert on running injuries.
I got a question during a telemedicine second opinion consultation with a runner over webcam.
He was worried that he had some fat pad atrophy in his foot and was getting heel pain as a consequence of that.
The fat pad atrophying in itself does not cause pain, but since the plantar calcaneal fat pad that cushions your skin under the heel bone really does prevent the skin from getting squished. Well, yes, you can definitely get pain if your fat pad gets atrophied.
Does calcaneal fat pad atrophy cause pain when running?
Well, that's what we're talking about today on the Doc On The Run Podcast.
This is a great question from one of the people I was just working with on a telemedicine visit.
Does running really make me nicer?
She actually said, "It's been really tough being injured, because it seems like when I can't run, I'm not nearly as nice as I usually am."
Well, if you're anything like me, it probably does and that's what we're talking about today on the Doc On The Run podcast.
This is a great question from one of the YouTube viewers. Can I do calf raises with hallux rigidus?
He wanted to know whether or not calf raises might cause more damage to the big toe joint. He wants to make sure that condition does not get worse.
This runner wanted to know whether or not it was safe.
And that's what we're talking about today on the Doc On The Run Podcast.
This morning I was interviewed as a guest expert on a television program for a health and fitness segment. We were talking about how running shoes are really your only piece of injury protection equipment as a runner.
The only thing between you and the ground is your running shoe. When you are training in them just a little bit too long, they start to get worn out.
Today on the Doc On The Run Podcast, we're talking about the best three ways to tell when to replace your running shoes.
This episode comes from a question actually from a YouTube comment on one of the plantar plate videos in there, on the Doc On The Run channel and the question was, "Can I do leg presses with a plantar plate sprain?"
This is actually a great question. It seems really simple, but it's not that straight forward.
It's really key that you maintain your running fitness when you get an injury that takes a long time to heal like a plantar plate sprain.
Today on the Doc On The Run podcast, we're talking about whether or not you can do leg presses with a plantar plate sprain.
This episode comes from a podcast listener who is training for the High Lonesome 100 mile race.
Kate wrote in to ask:
I rolled my foot at my child's field day. I heard a crunch and immediately saw swelling and discoloration on the lateral midfoot area of my left foot. An x-ray was negative. A week later there is no change. I have not run but it is not healing. Could it be broken?
That's a great question and that's what we are talking about today on the Doc On The Run Podcast!
I was speaking with a runner who had an over-training injury and she wanted a second opinion. And the reason she called was that she went to see a doctor and the doctor recommended a specific treatment for her.
So she went home and she started doing some online research, and she started thinking that maybe this treatment might actually be bad for her as a runner.
Everything in medicine is about risk versus benefit.
We take every treatment that we offer to a patient that we recommend to someone who has an injury or an illness and we have to decide, is this treatment actually going to make the person better as a whole, or could potentially make them worse?
Today on the Doc on the Run podcast, we're talking about whether or not this treatment is bad for runners.
This episode comes from a house call I just did with a runner who actually has some heel pain. It wasn't plantar fasciitis.
Haglund's is a problem where you get inflammation and irritation at the back of the heel. There is a little bursa in between the Achilles tendon, where it attaches on the back of the heel, and that little part of the heel bone that can protrude on the back.
He had a really great question.
If I have bursitis of the heel, should I do aggressive Achilles tendon stretches with wedges for my Haglund's deformity?
That's what we're talking about on the Doc On The Run podcast.
I was just doing a telemedicine visit for a second opinion with a runner who's had a longstanding plantar plate sprain. These can be very frustrating injuries because if you don't treat them appropriately or you ramp up your activity too early, well, it can recur and they can go on for a really long time.
It had been a long time since he's running, he needed a second opinion, he wanted to know whether or not the PRP injection, or a stem cell injection, or dry needling, or some other procedure might actually help him.
I've had one myself I was very cautious about reducing the stress and strain to the plantar plate ligament while I continued to maintain my running fitness as I recovered from that injury.
Today on the Doc On The Run Podcast, we're talking about whether or not you might need crutches after a PRP injection for a plantar plate injury.
What does Goldilocks and the Three Bears have to do with running shoes?
This morning I was doing an interview for a television program explaining some basics about running shoe selection based on your foot type.
There are really three things you need to think about.
It's a lot like Goldilocks and the Three Bears. You don't want it to be too hard. You don't want it to be too soft. You want it to be just right for you, and that depends upon your foot type.
Well, you're going to find out because today we're talking about running shoe selection basics and your foot type on the Doc on the Run podcast.
When you're recovering from a running injury, the most important thing you can track is your pain.
Changes in pain level is what tells you whether or not you should move from one activity level to the next.
Although many doctors will ask you in your initial interview, "What is your pain on a scale of one to 10? How much does it hurt?" They very rarely ask you many more specifics about that pain.
Today on the Doc On the Run Podcast, we're talking about pain point measurements that are crucial for recovering runners.
How is it that a runner can actually have a stress fracture that was never even broken in the first place?
Well, this is a real-world situation that I had with a runner who called me for a second opinion.
It was a runner who thought he had a stress fracture, who even had an MRI that showed a stress fracture. The doctor said it was a stress fracture. But it wasn't actually a stress fracture at all.
Today, on the Doc On The Run podcast, we're talking about a runner with a stress fracture that was never broken.
The number one question I get on social media from runners, whether it's a direct message or an email, or even a comment on a YouTube video is:
"My doctor said I can't run. Is it okay for me to run my race this weekend?"
And I'll always scratch my head a little bit and wonder, "Does this person really think it makes sense to ask a complete stranger, who has absolutely no idea about what's going on with them, whether or not it's okay for them to run, particularly when their doctor told them to not run?"
Today on the Doc on the Run Podcast, we're talking about why I don't tell runners whether or not they can run over social media.
This episode comes from a medical conference last week.
I was asked to give a couple of different lectures on running injuries at the International Foot and Ankle Foundation meeting in Sonoma, California.
One of the sessions was about runner's heel pain and the differences between normal everyday patients and runners.
Today on the Doc On The Run Podcast, we're talking about the top five differences between normal patients with heel pain and runners.
No runner wants pain.
However, when injured and trying to recover, pain is actually one of the most useful tools at your disposal.
I often tell injured runners and doctors at medical conferences something you should think about:
Pain is the most abundant and most underutilized evaluation tool available to runners when they're trying to get back to running.
Today on the Doc On The Run Podcast, we're talking about how pain is the most underutilized tool for recovering runners.
This episode comes from a lecture I was giving at a medical conference just last week.
One of the lectures was on the differences between stress response, stress reaction, and stress fractures in athletes.
There are really just a few main points doctors need to understand when treating runners with stress fractures.
Today on the Doc On The Run Podcast, we're talking about the top three stress fracture takeaways from the International Foot and Ankle Foundation meeting in Sonoma, California.
There is no hope on a downward slope.
I know that sounds really negative and terrible, but it's true.
A recovering runner recently called for a called me for a second opinion telemedicine visit. Her doctor had told her to wait...to wait to get better. In fact, she waited for 12 weeks and she did exactly what she was told: nothing. She did no exercise for 12 weeks.
If you just think about the last time you were really fit, and if you just stopped exercising completely, right then for three months, how fit would you be at the end of that 12 weeks?
Today on the Doc On The Run Podcast, we're talking about how there is no hope on a downward slope.
In the last week alone I had telemedicine calls with two different runners with different types of stress fractures who asked what it means when they have no pain, but an MRI that "shows a stress fracture, but no crack in the bone."
It gets really confusing when it comes to classifying stress fractures based only on medical imaging like x-rays or MRI.
If you wonder...
Can I run if my MRI shows a stress fracture, but I don't have any pain?
That's what we're going to talk about today on the Doc On The Run podcast.
This episode comes from a discussion I had recently with a recovering runner during a telemedicine visit. She was asking me what to do.
She is stuck in a cycle of getting frustrated, she gets better, and then gets injured again when she actually gets back to running.
She seems to have a tendency to get re-injured, with different injuries.
To recover from injury, you have to make sure you don't rot while you wait.
Today on the Doc on the Run Podcast, we're talking about how to make sure you recover and don't rot when you have a running injury.
I got a call from a runner who asked me about staying fit while training with a femoral neck stress fracture. What is interesting to me is that this person has seen a qualified sports medicine orthopedist who told her that she should not train or should not run with this femoral neck stress fracture.
I'm a podiatrist, I treat foot and ankle problems specifically in runners, but I do not treat femoral neck stress fractures. However, I can tell you what I would do if I had a femoral neck stress fracture.
How can I train with a femoral neck stress fracture? Well, that's what we're talking about today on the Doc On The Run Podcast.
Recently I was interviewed on a television program about telemedicine, who it helps and who it doesn't help. I do a lot of telemedicine visits with athletes.
Meeting with a doctor via telemedicine can be very helpful because you can get quick access. You can get immediate answers from an expert.
There are three kinds of runners for whom telemedicine is actually incredibly helpful.
Today on the Doc On The Run Podcast, we're talking about the three types of runners who get the most from telemedicine visits.
This episode comes from a question sent in by a runner who was listening to the Doc On The Run podcast.
This is a runner who had an Achilles tendon issue and was recovering and getting back to running.
He has recovered enough that he is back to running, he's doing better, he's running without any pain, but he wanted to incorporate some strength training in the form of either hill repeats or running stairs.
He wanted to know...
Which is worse for my Achilles tendon, running hills or running stairs?
Today on the Doc On The Run podcast, we're talking about which is worse for your Achilles tendon, running hills or running stairs.
I was just doing a telemedicine consult with a runner for a second opinion. He has so much pain in his foot he actually can't even walk on the foot, much less run on it.
One of the questions I asked him was whether or not he was doing single leg squats to try to maintain some of the strength in his non-injured foot.
He actually said he wasn't doing any single leg strengthening because he didn't want to get "wonky."
Today on the Doc On The Run Podcast, we're talking about why wonky is better than weak in a recovering runner.
A bunion deformity is a really common problem, and a bunion is when your big toe moves over and starts pushing against the second toe. Over time that can get bad enough that the big toe actually sits on top or underneath the second toe.
Now because this thing is so common, whenever you get a bump of any kind around that area, people often think that they have bunions, and that's exactly what happened with this runner when I did his second opinion consultation.
Today on the Doc On The Run podcast, we're talking about a runner who said that he thought he had a bunion, but his big toe was straight.
I just did a telemedicine call with a runner who had a very interesting complaint. This was heel pain and heel pain in itself is not really interesting, because most of the people who get heel pain have plantar fasciitis, but this was one of those cases where somebody had heel pain that was not plantar fasciitis, and was definitely something else.
I actually had this exact same problem myself during the last year. I work at a standing desk, I record podcasts at a standing desk, I do Zoom calls with all kinds of people, all kinds of different meetings.
Most people who get plantar fasciitis, or bursitis, or a partial rupture of the plantar fascia, or even a stress fracture in the heel bone, they generally get it only in one foot, but this pain was pretty much the same in both feet.
Today on the Doc On The Run Podcast, we're talking about aching pain in the heels from standing at a desk during the pandemic.
I was doing a telemedicine, second opinion consultation with an elite triathlete who got a stress fracture and this is actually a very common sort of discussion that I have with runners who schedule telemedicine visits, who call me for coaching calls and second opinion advice.
This guy has been athletic his entire life and he was ramping up for an event and then he got a metatarsal stress fracture and you would think that it's pretty simple. In this particular case, the doctor looked at his x-rays and told him that she thought she saw a crack in the x-ray and so she thought there was a crack in the bone but she wasn't really a hundred percent sure.
Now he asked me a really great question. He said, "Well, if it doesn't really hurt that much, is it okay if I walk on it?"
Today on Doc On The Run Podcast, we're talking about if your hand was broken, would you walk on it?
A question came up during a recent telemedicine visit I was doing with a runner who has hallux rigidus. He wanted to know whether or not it was a good idea or a bad idea to inject the big toe joint with cortisone to treat his hallux rigidus.
The doctor is basically looking at your circumstances, trying to figure out what you really want short-term and long-term, and then figuring out whether or not that treatment is actually appropriate given your circumstances.
There is nothing risk-free in medicine.
So when you have a cortisone injection in the big toe joint for hallux rigidus, the goal is to reduce the inflammation. Corticosteroids, however, are also very effective at breaking up collagen bonds.
Today on the Doc On The Run podcast, we're talking about whether or not cortisone injections are good or bad for hallux rigidus.
This episode comes from a question sent in by one of the Doc On The Run Podcast listeners, and she wanted to know whether or not it was okay to jump rope if she has shin splints?
Well, the short answer is, you can do whatever you want. You just have to be willing to pay the consequences. You can have a couple of different consequences from jumping rope with shin splints.
But if you're sure that you just have shin splints, if you've done a telemedicine consultation with an expert on running injuries, or if you've seen your doctor and your doctor poked around on you and was sure that you really and truly only have shin splints, then in that case, it is probably safe for you to do it and just see what happens.
Today on the Doc On The Run Podcast, we're talking about whether or not it's okay to jump rope with shin splints.
I was just doing a telemedicine call with a runner with a long history of plantar fasciitis, that has not been getting better. She had been doing stretches, icing, and even an injection of corticosteroids around the plantar fascia.
We were doing a second opinion telemedicine call to talk about what's really going on. We talked about her whole history. She had been keeping track and has kept a pain journal.
During this one hour second opinion call, we figured out that she had been misdiagnosed.
We figured out she actually had bursitis on the bottom of the heel.
Today on the Doc On The Run podcast, we're talking about plantar heel bursitis, misdiagnosed as plantar fasciitis.
Just this morning I was interviewed on a television program about telemedicine. Since I have been doing telemedicine for a little more than 10 years they invited me to come on as an expert to talk about the changes in telemedicine resulting from the pandemic.
During the interview, we were discussing all the different ways telemedicine can be more helpful than in-office visits. At the end, I was asked an interesting question, and I remembered that I actually created a check-list years ago for runners to actually take to their in-person doctor visits. That same list can help make telemedicine visits more helpful as well.
Today on the Doc On The Run podcast, we're talking about why you need to make a list for your telemedicine visit.
This episode comes from a discussion I just had with a runner during a telemedicine visit where I was helping her figure out a second opinion and what to do about her hallux rigidus. So she was very confused because she's been diagnosed with hallux rigidus.
She's been told that that's what's causing the pain in her big toe joint when she runs and she was a little confused because she said the doctor explained to her that she might want to get some kind of plate to put in her shoe to make it stiffer.
But at the same time said that she has high arches and because she has high arches and what we call a neutral foot type that have in part, led to her hallux rigidus, that she needs to have more cushioning in her running shoes.
Today on The Doc on the Run Podcast we're talking about running shoes for hallux rigidus. Should they be hard or soft?
This episode comes from a discussion I just had with a runner during a telemedicine visit. This person brought up a great idea that really seemed like it would make a great episode and something that' would be really helpful for you to understand.
When you get injured, your goal is to actually recover as fast as possible and maintain your running fitness while you heal that specific injury.
Now, everybody wants some timeline, like two weeks, four weeks, six weeks, something that says this is how long I have to wait for it to be healed and me to get back to running safely. But it never works out that way consistently. What you have to do is you have to figure out how you can push your timeline and how you can actually speed things up.
Today, on the Doc on the Run podcast we're talking about how you need to find your line if you want to recover from running injury faster.
On this episode, we're just giving you a quick tip on how you can actually reduce some of the stress and strain on the plantar fascial ligament when you have plantar fasciitis and you want to keep running.
Now everybody knows, if you stop running you're going to lose your running fitness. That's not really confusing. That's not hard to understand. But what you really need to understand is that plantar fasciitis is not really self-limiting.
It does not miraculously go away like a cold virus. It hangs around if you continue to aggravate it because the stress and strain to the plantar fascia that makes it irritable and causes this condition called plantar fasciitis, is a consequence of excess stress and strain.
Today on the Doc On The Run Podcast, we're talking about repositioning your heel bone so you can run with plantar fasciitis.
The number one question I get on social media is can I run with this injury?
So the problem with this is that whenever I get this question, whenever somebody says, "Can I run?" what's really never disclosed to me in that runners question is how bad is it?
The thing that determines whether or not you can run is whether or not you can reduce the stress and strain on that injured piece of tissue enough that you're not going to make it worse by running.
I get this same question for people with Achilles tendonitis, with plantar fasciitis, with metatarsal stress fractures, plantar plate strains, you name it.
The thing everybody wants to know is can I run right now or not.
Today on the Doc on the Run Podcast, we're talking about question number one, how bad is my injury?
I just got off a telemedicine second opinion call with a runner who thought she had a stress fracture. She got an MRI. Then her doctor said she has “fraying” of several plantar plate ligaments. She wanted to know if this was serious.
Part of the difficulty lies in determining the severity of plantar plate injury and making the call on when you can run. Most runners want a clear answer. Often times an MRI is performed in the hopes of getting a clear picture of the plantar plate damage.
Sometimes the MRI report not only suggests damaged to the plantar plate that hurts, but may mention “fraying” of other plantar plate ligaments that don’t hurt at all.
This often creates even more confusion and more frustration in recovering runners.
Is there any proof that you don't have to stop running when you get a metatarsal stress response in your foot?
A lot of doctors and patients are really confused about the differences between a stress fracture and a stress reaction and a stress response in runners.
A stress response is a normal physiologic response when you stress any tissue as a component of training. The goal of your running workout is to stress the tissue, get it, to react, and rebuild in a way that makes it stronger.
Today on the Doc On The Run Podcast, we're talking about the evidence you really don't have to stop training when you're a runner who gets a metatarsal stress response.
When a runner gets an overtraining injury and goes to a doctor, the doctor’s only priority is healing the injured tissue. Most runners also think healing the injured tissue is the highest priority.
Healing is not really a problem. All tissue will heal eventually, if you reduce the stress and strain enough to allow healing.
The problem is healing an overtraining injury can take weeks or months.
If you stop running and stop training for weeks or months, you’ll never get back to running at the same level again.
Today on the Doc On The Run Podcast, we're talking about why maintaining running fitness is the injured runners main priority.
I just got off a telemedicine call with a runner who wanted to know why she sometimes feel popping and clicking in the ball of the foot after she runs.
She saw a doctor and was diagnosed with a Morton's neuroma.
The doctor gave her some metatarsal pads, which made the neuroma feel better.
But she could not figure out why she seemed to only get this weird popping and clicking sensation after she went for long runs and hill repeats.
Today on the Doc On The Run podcast we're talking about why a neuroma might pop or click after you run.
One of my favorite podcasts is called The Not Your Average Runner Podcast.
I recently sat down with Jill Angie, who hosts that show.
Self-criticism heals no wounds!
When you have an injury, and you have been training hard, it is very easy to beat yourself up. Jill is the best person to explain how we can take an injury and reframe it so we don’t beat ourselves up when we are injured.
Today on the Doc On The Run podcast we're talking about how self-confidence and self-love beat finish times, every time with Jill Angie from The Not Your Average Runner Podcast.
I get questions all the time on social media from people who want to know if they can run, and at the base of their question is really, how long does it take for some particular injury to heal?
There's actually a wide variety of timelines on how long it takes for all of different injuries to different types of tissues to heal, even depending upon anatomic location.
Your age plays into the timeline for healing running injuries
Today on the Doc On The Run podcast we're talking about how long tissue takes to heal so you can run.
This episode comes from a question sent in by an injured runner who was listening to the Doc On The Run Podcast.
"I am 30 with medium arches. No prior injuries. 7 months ago I began having left med ankle pain at the calcaneal insertion.
MRI confirmed a plantar fascia rupture of med cord. I was told to just ice and stretch.
I have a distal 4th fracture on the right. Both feet at once?!
What should I do? It hurts!”
Today on the Doc On The Run podcast we're talking about what a runner should do when you have a rupture of the plantar fascia and metatarsal stress fractures.
This episode comes from a question from one of the Doc On The Run YouTube channel viewers who wanted to know about “bilateral bipartite sesamoid bones” and what that really means.
I get these kind of questions all the time, when somebody really wants to know what a term means, and what the implications are for them as a runner. Usually the runner is trying to figure out how to keep running while the sesamoid heals.
Sometimes the concern is a sesamoid stress fracture or a condition like sesamoiditis where you start to get pain under the big toe joint.
If you see a doctor, they look at your x-rays, they may tell you, "Oh, you have bilateral bipartite sesamoids."
Today on the Doc On The Run Podcast, we're talking about bilateral bipartite sesamoid bones in a runner.
This episode comes from a question from a runner, who wanted to know what it means when calf muscles are tight and you have metatarsal stress fractures.
He wrote in and said, "Hey doc, I meant to inquire about stress fractures in the metatarsal joints and how you can tell. I have a friend who's experienced a stress fracture, and he says his calves seemed to tighten up when the pain developed."
There are really two ways tight calf muscles can be related to metatarsal stress fractures. One is the cause. The other is an effect.
Today on the Doc On The Run Podcast, we're talking about how tight calves are related to metatarsal stress fractures in runners.
I was just doing telemedicine visit with a runner who has a red, painful big toe joint.
Gout is an accumulation of painful sharp crystals in the joint.
Gout certainly can cause your big toe joint to become red, hot, swollen and painful.
But gout is only one of three different conditions that might cause big toe joint pain.
The pattern of redness around the big toe joint can help you decide which condition might be causing the problem if you are a runner.
Today on the Doc On The Run Podcast, we're talking about whether or not a painful red big toe joint means a runner has gout.
The other day I was doing a telemedicine visit with a trail runner who asked me, "Which is better, soft or hard trail running shoes?"
If you're thinking about getting some new trail running shoes, you have to really think about what's going to be best for you.
When comes to how stiff or how soft the shoes should be depends upon three variables:
- Your foot type.
- How hard or soft is the trail.
- How steep is the trail.
If you keep these 3 variable in mind the you go to your local running shoe store, you are much more likely to end up with a very best trail running shoes for you.
Today on the Doc On The Run Podcast, we're talking about which is better: soft or hard trail running shoes.
A runner with pain under the big toe joint said she was told she had a problem with the sesamoid bones in her foot.
The doctor said maybe it was sesamoiditis, or a sesamoid stress reaction or possibly even a sesamoid stress fracture.
Her question was, “What exactly are the sesamoid bones in the foot?”
Today on the Doc On The Run Podcast, we're talking about these weird little things called the sesamoid bones in the foot.
A plantar plate ligament sprain can cause aching pain in the ball of the foot when you run.
Plantar plate sprains are caused by excess stress applied to the ligament at the base of the toe.
If you want to heal it and keep running, you have to decrease the stress and strain on the plantar plate, and address the root cause of the injury.
A runner with a plantar plate sprain, and tight calf muscles, had a great question:
Does the plantar plate ligament cause tight calf muscles, or can a tight calf muscle cause a plantar plate sprain?
Today on the Doc On The Run Podcast, we're talking about whether a plantar plate sprain causes tight calf muscles in runners, or other way around.
Shin splints and tibial stress fractures can feel similar when you run.
Most runners understand there is a huge difference between shin splints and a tibial stress fractures.
I recently did a telemedicine second opinion call with a runner who had a tibial stress fracture.
What she did not understand, and what her doctor had not explained is why some tibial stress fractures are very low risk of breaking, and another is very high risk of landing a runner in the operating room.
Today on the Doc On The Run Podcast, we're talking about different types of tibial stress fractures in runners.
I was just doing a telemedicine call with a runner with a stress fracture, and he had a really interesting question.
He said, "Look, I just really want to know if I really have a stress fracture because my doctor took an x-ray and there was no crack in the bone. I looked it up myself and the definition of a fracture is a visible crack."
Do I really have a stress fracture, or not?
This is a great question, it brings up a really interesting point.
Today on the Doc On The Run Podcast, we're talking about whether or not a runner can have a stress fracture, if there is no crack in the bone.
Raynaud’s Phenomenon is an interesting condition in which spasms of small blood vessels cause changes in the skin color of the hands and feet. Raynaud’s phenomenon can also cause pain in the feet. Foot pain is also very common in runners.
Raynauds is one of those conditions that isn’t typically diagnosed with a blood test or and x-ray. The diagnosis is typically made “clinically” meaning the doctor hears your story, listens to your history and decides you probably have the condition, because nothing else fits.
The question is whether or not a runner who gets an MRI because of foot pain, might have something show up on the MRI images that can indicate Raynaud's is contributing to the runner’s trouble.
Today on the Doc On The Run Podcast, we're talking about wether or not you can see Raynaud’s Phenomenon on an MRI in a runner.
When you get any stage of Achilles injury and you're a runner, you're trying to figure out what you can do to get it to heal as quickly as possible.
The biggest concern with runners when they have an Achilles tendon injury is that the tendon is going to continue to degenerate, turn into Achilles tendinosis, and then potentially even rupture.
But the good news is that stress, when actually applied in the right way, can help your Achilles tendon recover faster, become stronger, so you can get back to running, possibly even with less risk of re-injury.
Today on the Doc On The Run Podcast, we're talking about how stress can actually help your Achilles tendon recover faster.
There are the three forms of stress that can affect you and the injured tissue when you actually get back to running after you've been injured and you feel like you've recovered.
I was just recently doing a telemedicine visit with someone who had an injury and was getting better. She was told to start running, but she wasn't really given any specific instructions.
She was told, "You can go and just kind of run a little bit and see how it feels."
If you're a runner and you haven't been running for weeks because of an injury, you're probably going to feel so good when you start running that you're going to do too much. If you do too much, and then you start having pain, you're going to completely freak out because you're going to be worried that you've completely set back your injury.
Today on the Doc On The Run podcast, we're talking about the three forms of stress when you start running after injury.
Just a couple of days ago I was doing a telemedicine call with a runner who wanted to know what it meant to have “thinning of the plantar plate ligament on his MRI.
He asked, "What does ‘thinning’ really mean? Do I really have a plantar plate tear? Is it a problem? Will I be able to continue to run?"
“What is the issue with this idea of thinning of the plantar plate ligament, and why does it happen?”
Today on the Doc On The Run Podcast we're talking about thinning of the plantar plate ligament on an MRI in a runner.
When you break down the goal of running a marathon, it really only has 3 key elements.
You are crystal clear on the distance, the starting point and the end point.
All you have to do to compete the marathon successfully is break your training down into the daily and weekly stages of growth to establish the fitness required of your body on race day.
Running injuries are difficult because they lack the clarity and simplicity of training for a marathon. But make no mistake. The process is just the same.
Today on the Doc On The Run Podcast we're talking about the 3 key elements of marathon training and running injury recovery.
Metatarsal stress fractures are one of the most common injuries in runners. Unfortunately for runners, 4 weeks to 6 weeks in a fracture walking it boot is the common recommendation from doctors.
Part of the reason you get the boot for 4-6 weeks, is that you didn’t give your doctor enough information to recommend anything else. The doctor wants you to heal. The way you tell your stress fracture fracture story leaves the doctor imaging the worst possible scenario and you get the worst possible treatment as a result.
To heal a stress fracture you need to stop stressing the bone. You need to stop causing damage. It is that simple.
Today on the Doc On The Run Podcast we're talking about why doctors prescribe 4-6 weeks in a fracture boot for stress fractures in runners.
This weekend, I was giving a lecture at a medical conference that was specific to running injuries.
During the question and answer period, one of the physicians in the audience asked a completely valid question.
She asked, "Why wouldn't you just begin with a prescription medication if you're 100% sure that medication had the highest probability of reducing the patient's symptoms?”
The difference between the treatment options really lies in what is best for a runner long-term, versus what may best in the short term.
Today on the Doc On The Run Podcast we're talking about why runners should not start running injury treatment with prescription medications.
Think back to the last time you really remember getting a second wind. Maybe it was 2 miles into your fastest 5K. Maybe it was mile 18 or mile 22 of a marathon.
Just when you felt you really couldn’t got on, just when you hit an all time low, your energy started to grow. You felt revived. Energized, you pressed on the the finish, thrilled with the boost of energy moving you forward.
Every runner recovering from a running injury will have dark days. The energy vaporizes and is replaced by frustration. If not careful, despair can set it.
On these days in your recovery it is crucial you dig deep.
Today on the Doc On The Run Podcast we're talking about finding your second wind in running injury recovery.
A few minutes ago I was on a second opinion telemedicine call with runner who was told he had an MRI showing an “osteochondral defect.”
The doctor told him to stop running.
If a joint surface gets damage, you may develop a little soft-spot called an “osteochondral defect.”
Just because you have an osteochondral defect, it doesn't necessarily mean you have to stop running, but you do need to figure out whether or not it's actually a problem that could get worse if you don't address it.
Today on the Doc On The Run Podcast we're talking about osteochondral defects in runners.
I just got off a telemedicine call with a woman who was an elite runner in college.
She has been having a difficult time getting back to an acceptable level of activity after recovering from her overtraining injury.
When you have been doing a certain run at a certain pace, as a part of your training for years, you always fell like you can do that workout.
But when you get a running injury and take time off, unfortunately, your sense of reality is off in that moment. What you sense about your fitness is off.
Today on the Doc On The Run Podcast we're talking about how your sensor is broken.
If you over-stretch any nerve it can become inflamed and painful.
If you roll your ankle on a trail you can get a condition called traction neuritis.
Most of the time when I am on a telemedicine or second opinion call with a runner with traction neuritis, they have been misdiagnosed with some other condition.
If you understand how to tell the difference, you can understand how to get back to running sooner.
Today on the Doc On The Run Podcast we're talking about traction neuritis in a runner and what it really means.
If you hire a running coach, your coach is going to design a program that is going to actually test you physically and mentally, and push you to your physiologic limits on a regular basis to make you stronger.
Any running coach will give you a series of workouts to execute.
And when you do runs correctly then what happens is that you do the maximum amount of tissue damage that your body can sustain and rebuild before your next workout.
Today on the Doc On The Run Podcast we're talking about why runners need to flirt with overtraining injury.
Osteophytosis is a common finding on foot and ankle x-rays of runners. Bone spurs can form anywhere bone is irritated or otherwise aggravated by jamming, jarring motion.
Most often, osteophytosis is found in the heel, big toe joint and ankle joint.
The real is question is whether or not the osteophytosis a problem that needs to be removed, treated, or even prevented.
Today on the Doc On The Run Podcast we're talking about osteophytosis in the foot and ankle in a runner.
The biggest mistake any runner can make when seeing a doctor for a running injury is leaving the office without a clear picture or how bad the injury actually may be.
If you don’t have a clear idea of your state of injury, you (or your doctor) are only guessing at how long it will take to get better and return to running.
Part of the lack of clarity is your fault. You have to communicate what really happened when you got injured, what happened between the injury and the day you show up in the doctor’s office, and your running goals.
Without doing all of that, you cannot get an accurate baseline on your injury or expect to use it for comparison as you maintain your fitness now and ramp up your running later.
Today on the Doc On The Run Podcast we're talking about the 3 most important days in healing any running injury.
The chances are good a lot of your friends secretly admire your ability to run. Unfortunately it seems a lot of people who want to start running, but don't think of themselves as runners find it very difficult to start.
Sooner or later one of your friends is going to call you or talk to you and ask for some advice.
The real challenge and helping one of your friends begin running is to get them to go for the initial run, and be proud of themselves for doing it.
I really believe that we as runners to understand how good it makes us feel have an obligation to be as encouraging as possible to our friends, when they want to start running as well.
Today on the Doc On The Run Podcast, we’re talking about the 3 steps you can give to any friend who wants to start running.
I am sure that you have heard your running buddies use an analogy:
"We just banked another long run.”
“We got another hard workout in the bank.”
All these efforts and investments in our training add up. They create this great store of energy for us. The accumulation of fitness is what prepares us for a marathon an Ironman, or an ultramarathon.
Today on the Doc On The Run Podcast we're talking about how running injuries are a lot like a savings account.
Snowboarder’s fracture is a small fracture in your foot that is often misdiagnosed as an ankle sprain.
The injury occurs when you break a portion of the talus bone called the lateral process.
The lateral process of the talus sits at the outside of your foot and ankle.
You can break it when you roll your ankle running on a trail or stepping in a pothole while running on the road.
These fractures are much more common that previously taught. Not surprisingly, if you think you have an ankle sprain, but you really have a lateral process fracture, it won’t get better.
Today on the Doc On The Run Podcast we're talking about what a snowboarders fracture really is, and why runners need to know about them.
Many times doctors look at you cross-eyed when you tell them how much you run, how far you run and how much you want to run now. They tell you that you ran “too much” and got injured. The snap recommendation is to stop running.
Doctors want you to heal your running injury. Many times doctors recommend the “safest” path…stop running. Be patient. Wait for healing.
Slower treatment is not always better, and isn’t even always safer.
The goal for most injured runners is not to just heal the injury.
The goal for most recovering runners is to get back running.
The critical piece is to not lose sight of what “not running” does to your longevity as a runner. Time is of the essence.
Today on the Doc On The Run Podcast we're talking about how the safest path to healing is the slowest.
A runner with a stress fracture called me for a telemedicine visit because she was confused.
The doctor told her that she has a stress fracture. But there was no crack on the x-ray.
The doctor said she only had a “periosteal reaction” which suggested she had a metatarsal stress fracture.
She wanted to know if a periosteal reaction meant the foot was really broken, or not.
The periosteal reaction is one of the earliest findings that you can see on your x-ray when you have a stress fracture in one of the metatarsal bones in your foot, before you even see a crack.
Today on the Doc On The Run Podcast we're talking about periosteal reaction in a runner with a stress fracture.
If you're not actually healing as fast as you want to it is just not a priority.
I talked to a runner the other day who said that he was trying to lose some weight, but he already felt like he was off track, yet it's only a couple weeks into the new year.
The fact is that if you can't get to run and exercise, if you can't take the time to prepare meals and eat food that is healthy, it's just not a priority for you. That's not a judgment, it's just a fact.
If we are not really taking the time to pay attention to how we sleep, how we eat, how much stress we have applied to the injured tissue, if we are not doing all of those things, it’s because it's not a priority.
Today on the Doc On The Run podcast we're talking about how if you're not healing fast is just not a priority.
The sesamoid bones, these two little bones and they sit under the big toe joint and interestingly when I show X-rays to someone like somebody who has a stress fracture almost always the first thing they say is “what are those two things” and they're pointing to the sesamoid bones.
They are also very small and they don't have a great blood supply. So if you get a problem with the sesamoids and you get sesamoiditis, it gets flared up and gets worse and worse and worse.
A lot of times it'll turn into a sesamoid stress fracture which is very serious because it can actually crack and break.
Today on the Doc On The Run podcast we’re talking about why sesamoiditis is so serious in a runner.
The only thing worse than a running injury is a re-injury.
Most of the runners who call me for a telemedicine visit are demoralized.
You get inured. A doctor tells you to stop running so you can heal. You wait. You heal. You go for a run. And you get injured again.
The cycle of running injury and re-inury is a result of being de-conditioned during the “healing” period.
Going for your first run in that untrained state is risky and completely unnecessary.
Today on the Doc On The Run Podcast we're talking about why the first days of running on a healed injury are so risky.
I recently got a great question from a runner...
Why are flat feet less stable when you run?
Pronation of the foot happens as your arch collapses and the foot elongates. You do that every time you land as you run. You need pronation to absorb impact and decrease forces.
Supination is the opposite of pronation. Supination transforms your foot from a flexible, force-absorbing adapter to a rigid lever to propel you forward as you run and push off.
Today on the Doc On The Run Podcast, we’re talking about why flat feet are less stable.
One of my best friends has pain and swelling in his Achilles tendon, right in the watershed region that we know develops Achilles tendinosis and can even rupture.
He was understandably worried. He asked me, “Does my Achilles tendon need a PRP injection or Stem Cell injection?”
I explained to him that he was asking the wrong question.
I said, the right question is, “Do I need an injection at all.”
Next I gave him access to the Achilles Tendon Course where he could go through the 5 step process I teach in the Achilles Tendon Course for Runners so he could figure out how serious your Achilles tendon really may be.
Problem solved…no stem cell injection no PRP injection. No stem cell injection. No fracture walking boot. No cast. No surgery. Today he is running.
Today on the Doc On The Run Podcast, we’re talking about whether or not a PRP injection vs. a stem cell injection would be better in an Achilles tendon injury.
----more----When you get any kind of over-training injury, something also incredible happens. You limp.
You compensate to remove all of the pressures and forces and friction that goes through that injured structure by “compensating.”
But the reason compensation is a problem is that if you think about holding your foot in an uncomfortable and natural position, what you're doing is you are strengthening one thing and you're stretching and weakening something else.
Today on the Doc On The Run Podcast, we're talking about compensation from over-training running injuries.
I was recently doing a call with an athlete who has a sprain of the plantar plate ligament.
One of the things that happens with runners is we get an MRI, sometimes just for what we suspect is a plantar plate sprain.
He went and got an MRI. In fact, he got a couple of MRIs. The MRIs were different.
It is reasonable to want reassurance that your foot is healing before you start running. But an MRI doesn't always provide the reassurance you seek.
Today on the Doc On The Run podcast we are talking about whether or not you need to see healing of the plantar plate ligament on your MRI before you can run.
We always want obvious signs when we are healing form something like a metatarsal stress fracture, Achilles tendinitis or peroneal tendinitis or any injury that is keeping his from training as much as we would like.
But the results aren’t always obvious.
Think about your pace, what it feels like. Think about how those feelings of pace, perceived exertion and heart rate keep you on track.
These are are performance clues when training and racing.
We also have to look for performance clues when recovering.
Today on the Doc On The Run Podcast we're talking about how healing leaves clues, but they are often subtle.
I was just talking to a runner in one of the sessions where people call in who are taking the One Run Away challenge. In that challenge course, I'm helping you try to figure out what is the step that you're not taking that is holding you back from recovering as quickly as possible. So this is the thing that goes on and every few days I do calls and let people ask questions directly to me over webcam.
I got an interesting question and this was about how to actually do something that Dr. Schreider talked about during the recent runners rapid recovery summit. Now he works with professional soccer players and he was talking about how he gets athletes back on track after they have an Achilles tendon rupture and have to have surgery. Now these are professional athletes. So the owner of the team is not going to do things by guesswork. They want to make sure that these athletes are on track as quickly as possible.
Today on the Doc On The Run Podcast we're talking about how runners do not recover faster by guesswork.
I was just doing a telemedicine visit with a runner who has had an injury to the plantar plate ligament with pain for months.
He's been getting better slowly, but he was trying to figure out how bad it really is. And one of his first questions he asked me was what I see on the x-rays.
Can you see anything about the plantar plate where it's torn, where it's injured or anything else?
Most of what doctors see on a foot x-rays are changes that imply ligament damage.
But there is really only one thing on an x-ray that truly indicates that you probably have a tear or rupture of the plantar plate ligament.
Today on the Doc On The Run Podcast we're talking about whether or not x-rays can show a plantar plate sprain.
I just got off a telemedicine call with a runner and she asked me an interesting question, she said, "I just want to know, am I on the right track?”
When a runner calls me for a telemedicine visit, after they've seen two or three or four other doctors, I do something differently.
What I do differently is something you can do on your own right now, you don't even have to talk to me. Just look at your results.
If you track those results, you look at those results, you will know what's going on and then you can change course faster.
Today on the Doc On The Run Podcast we're talking about how you can tell whether or not you're on the right track when you're recovering from a running injury.
Dr. Duane Scotti, host of the Healthy Runner podcast was one of the guest experts at the 2-Day Runner’s Rapid Recovery Summit.
This replay is a recording of his session on Hip Pain in Runners is one you won’t want to miss. Here is some of what we’re going to cover:
The top 3 most common causes of hip pain in runners.
What exactly is the labrum and how does it get injured in runners?
How does joint laxity or hip instability contribute to hip injuries?
What is the number one indication that somebody has a tear of the labrum and should seek medical attention before continuing to run?
Today the Doc On The Run Podcast, we’re talking about hip pain in runners and some simple things you can do to address it, improve it and keep it from getting worse.
I was just doing a telemedicine visit with a runner who needed a second opinion for a metatarsal stress fracture.
She wanted to know if her healing timeline was accurate and if her estimate on getting back to running was realistic.
The healing timeline for any running injury always depends upon is what you do. Not what your read, and not what your doctor said.
The “realistic” part is based on what you do, not arbitrary timelines.
Today the Doc On The Run Podcast, we’re talking about whether or not your healing timeline is realistic.
If you're a runner who's been injured, recovering, and you feel like you're plateaued or you're not really getting anywhere, I have some very good news for you today. That's awesome!
Most of the runners who call me for a telemedicine visit, they've hit a plateau.
Although that can be really frustrating, I can tell you from experience, this is very, very good news.
What's going on is really simple.
The changes you need to make, they're all around you, they're right in front of you, and they're available to you right now. You just have to notice them.
Today the Doc On The Run Podcast, we’re talking about how it is actually great if you’re not getting better.
Just for a moment I want you to imagine something. You made a decision to become a champion. And after years of continual effort and constant training you have won a World Championship.
Today you are packing and getting ready to travel to Switzerland to defend your European title. And then you fall and break both heel bones. In that painful moment everything changes.
You aren't getting on a plane to go to defend your European title. Instead you're going to the emergency room.
The question is what would you do to rebuild your life and your own self-perception as an is athlete immediately after that kind of injury.
Today the Doc On The Run Podcast, we’re talking with Barbara Edelston Peterson about what she did to go from two broken heel bones becoming a Whole Champion.
One of the worst possible injuries you could get as a runner would be a rupture of the Achilles tendon.
Because if you tear the Achilles, whether you have surgery to repair the Achilles tendon or you if don't have surgery and allow the tendon to heal without surgery, even if it heals, I can promise you, you are never going to be the same.
Running hills puts a lot of stress on the Achilles.
If you have Achilles tendinitis, Achilles tendonosis or just mild Achilles irritation, understanding what to do to avoid rupturing the Achilles will also help you avoid aggravating the tendon when running hills.
There are really three simple things that you really need to do when you're going to run up hills so that you don't put yourself at risk of an Achilles tendon rupture.
Almost all runners who call me just need to take one step to change course. My job on that call is to help you identify and recognize the step you are missing.
Every run begins with one step. Right now, you are doing one of two things. Either you are getting stronger. Or you are getting weaker. You are never staying the same. That is the biggest problem with recovering from an injury.
Doctors typically tell you to stop running and then you get stuck in a trap of decreasing fitness, increasing stiffness and you actually become more prone to re-injury.
Most recovering runners are missing the key step that will change everything.
Today the Doc On The Run Podcast, we’re talking about how you’re only one step away.
This morning I was on a telemedicine call talking to a recovering runner, from my inner circle coaching private group. This guy was having some trouble and tenderness in his Achilles Tendon.
We talked about his plan for running tomorrow. It turns out he had a plan of actually going and running on a winding, hilly trail.
If you have Achilles tendon pain and want to make it worse, do 4 things in succession.
Because Achilles ruptures happens when you take 4 very specific steps in a specific way. Those 4 Steps put your aching Achilles Tendon at risk of further injury.
Today on the Doc On The Run podcast, we're talking about the 4 steps to Achilles tendon rupture when running.
As an injured runner who wanted to run the worst piece of advice of I ever received from a doctor, was, “Go run and see how you feel.”
Sometimes, we as doctors take what we think will work for most people in and we apply it to everyone, including runners.
But walking is not running. If you check yourself and do a little self evaluation you can be more confident you won’t hurt yourself and have a setback.
Today on the Doc On The Run podcast, we're talking about how running injury testing is as simple as 1 2 3.
Earlier today, I was doing a telemedicine call with a runner who has been injured. She actually mentioned that she thought she might have started getting this injury back when the whole COVID shutdown happened.
Because she started running with a mask.
She started trying to stay away from people and she was socially isolating.
Today on the Doc on the run Podcast, we're talking about how you need to be careful when you're dodging other runners out on a run during this period of social isolation.
"Time heals all wounds.” Or at least that is the saying.
The medically speaking I can tell you that is completely false when it comes to running injuries. It does take time to heal running injuries, but a tincture of time is not enough.
I just spoke to an injured runner so I helped over a telemedicine visit. Her question was,
"I sprained my ankle two months ago and I still have pain. Is this normal?"
The answer is no. It's not normal to have pain anytime, much less two months after you sprain your ankle running on a trail.
Today on the Doc On The Run podcast, we're talking about how time does not heal running injuries.
I just got off a coaching call with a guy who I've talked to a number of times over the years with a number of different running injuries and this guy is not a new runner. He actually is a running coach and he understands how to train and what to do to make sure that he decreases his risk of getting an over-training injury by recovering appropriately after all of his workouts, so this guy is not a novice. But running injuries are a fact of life, if you are going to be a lifelong runner. You are always pushing to see if you can get stronger and faster and in the course of that process, it is easy to get an over-training injury. That happens. Today on the Doc On The Run podcast, we're talking about how someone can heal an Achilles tendon injury and then get a stress fracture.
Today on the Doc On The Run Podcast, we're talking about what is capsulitis in the big toe joint. Yesterday, I was seeing someone who is a long-time athlete and she had pain in the big toe joint and she was given a diagnosis of capsulitis.
I was seeing her for a second opinion and when we started talking, she was a little dismayed because she said that she was given this diagnosis of capsulitis and she felt a little bit like it wasn't a real thing, it wasn't a real problem, and I have talked about this some with other conditions like metatarsalgia where you get a diagnosis of metatarsalgia and that means basically pain somewhere in the area around the metatarsal, which is sort of like going to the neurologist and getting a diagnosis of a headache.
I just got a telemedicine call with a runner who had a question about neuroma treatment for somebody who likes to use minimalist shoes. And he had a really good question.
He said he went and saw another doctor who made a couple of recommendations, but he was a little concerned about the neuroma treatment options that were given to him.
Runners have to realize that runners are different. And I don't think most runners should want to jump to a drastic neuroma treatment, especially not when the neuroma is first beginning.
Today on the Doc On The Run Podcast, we're talking about 3 Neuroma treatment considerations for minimalist runners.
When pro runners get running injures, they get different treatment.
Elite athletes and professional athletes all have, if not better medical care, they certainly have more consistent follow up, earlier interventions and better access to medical specialists than the average person.
So we know that something is different when someone is a professional athlete.
But its not just better, faster care, it is also the approach pro runners take to the recovery process that helps them accelerate their recovery from a running injury.
Today on the Doc On The Run Podcast, we're talking about the secret to healing like a pro runner.
This past weekend, I was giving a lecture at a medical conference. It was the International Foot and Ankle Foundation Conference that was supposed to be in Las Vegas, but it ended up being an online conference as many of these conferences are these days. But in any event, it's a large medical conference where doctors, foot and ankle surgeons, podiatrist, where they all go to get continuing medical education credits to maintain their licenses and learn new techniques.
Today on the Doc On The Run Podcast, we're talking about the three times a runner should not get an MRI for a stress fracture.
Today on the Doc on the Run Podcast, we're talking about how a grade one stress fracture is not a stress fracture at all. This weekend I was lecturing at the International Foot and Ankle Foundation meeting, which was supposed to be in Las Vegas, but it ended up being online, as many things are these days. But still, this is one of the largest medical conferences that is put on by the International Foot and Ankle Foundation For Education and Research specifically to help doctors, podiatrists, foot and ankle surgeons all get continuing education credits so they can maintain their medical licenses. So, it's all doctors. Well, I was asked to give a lecture on stress reactions and stress responses and stress fractures, specifically in athletes.
The most difficult thing about being injured is not having a plan to follow.
As Mark Spitz once said, “If you fail to prepare, you’re prepared to fail.”
So if you're an injured runner and you're trying to figure out how to get back on track and get back to running the most important thing you can do right now is to plan your injury recovery.
Prepare for your journey ahead, by looking back at past successes.
Today on the Doc On The Run Podcast we're talking about how you can use your running success to plan your injury recovery.
I just got off a telemedicine call with a guy who has an Achilles tendon injury and called me specifically because he wanted me to do a PRP injection on his Achilles tendon.
This guy's a physician. He understands injuries. He understands athletics. He actually had a PRP injection before. He's even had surgery in the past for his Achilles tendons.
So this is an athlete and a doctor who actually really understands and knows all of the stuff that goes into the decision process when you're thinking about getting a PRP injection for an injured Achilles tendon.
Today on the Doc On The Run Podcast we're talking about some of the ways you can tell if you really need a PRP injection for an injured Achilles tendon.
I was just on a telemedicine call with a patient. We were doing a webcam call and she had been running on a trail, rolled her ankle, and had a really bad ankle sprain.
Her ankle was black and blue, swollen, and really painful. She was having trouble walking. This is a really active runner who wants to get back to running as quickly as she can.
Running on trails is obviously a little more difficult and puts you at a little more risk of having another ankle sprain just because it's an irregular, undulating, unpredictable surface.
So in my discussion with her, I realized that there are three major mistakes that runners often make when they roll an ankle running on a trail and want to get back to running after they heal.
Today on the Doc On The Run Podcast we're talking about the three biggest mistakes runners make with ankle sprains.
I just got off a telemedicine call with an injured runner who has pain and swelling in her foot. We were on a recovering runner coaching call talking about all of the little things that can help you recover and heal faster.
During our discussion she asked a great question. She kind of laughed and said she was confused about something as simple as going up the flight of stairs to her bedroom.
How do I go up steps when my foot is painful? Do I start with my good foot or my bad foot?
Today on the Doc On The Run Podcast we’re talking about how to go up stairs when you are recovering from a running injury.
Today’s episode comes from a runner named Gordon who asked a question during a live webinar entitled “Am I Ready to Run? How to tell if its safe to start running again.”
He asked, “Is it okay to run on a treadmill? I'm returning from a stress fracture injury. I read that a treadmill gives the exact same stress with every step versus, say a trail, but with COVID-19 and smoke, running outside is a challenge and all that."
That is a great question! Because, there is a lot of evidence that treadmills cause the same repetitive stress in the same way that might lead to stress fractures in the foot.
Today on the Doc on the Run podcast, we're talking about whether or not you should run on a treadmill when you're recovering from a stress fracture.
Every day, all day, I help injured runners get back to running.
I have noticed runners consistently make crucial mistakes in each of the three phases of injury recovery.
These are simple avoidable errors in recovery that can slow the process of returning to running, or increase the chances of getting re-injured once you get back to full training.
Avoid these mistakes to make sure that you heal your running injury as quickly as possible and then don't get re-injured when you're returning to running.
Today on the Doc On The Run Podcast we’re talking about the 3 biggest mistakes injured runners make when recovering from an overtraining injury.
One of the biggest problems when you get a metatarsal stress fracture is deciding when it's safe for you to go to the next level of activity.
I just got a great question from a high school cross country runner who is healing from a stress fracture and wanted to get back to running as quickly as possible.
The question was whether or not it was okay to begin a walk/run program at four weeks of stress fracture healing?
Today on the Doc On The Run Podcast we’re talking about whether or not it is okay to begin a walk/run program when you are well on your way to healing a metatarsal stress fracture.
What does it mean when your doctor says you might be able to run in 3 weeks, depending on what your x-rays shows?
If your doctor guesses that in three weeks, you're going to have something appear on an X- Ray, that assumes the bone is going to be stronger at that time you get the x-ray. Right?
So what that also really means is that until three weeks from today, every single day, healing happens. Tissues are getting stronger. More collagen is forming. The osteoblasts and osteoclasts are working in conjunction to remodel the bone. More bone is getting laid down. Tissues are getting stronger.
But every single day, if you get stronger, then in theory, every single day, you could do a little bit more activity.
Today on the Doc On The Run Podcast we’re talking about why you should question every timeline of how long it's going to take to get back to running after an injury.
A runner broke her ankle and foot in five places and had surgery. She wrote in and wanted to know if she might run again:
“I’m 34 years old. I had a bike accident 4 days ago. I broke my tibia bone at the medial malleolus, distal fibula bone, and metatarsal bones 2, 3, and 4. The surgery went well. I was a runner. I used to run 4 times a week. Is there any chance I can run again?”
Today on the Doc On The Run Podcast we’re talking about what whether or not there is any chance you can run again after breaking five bones in your foot and ankle, and recovering from ankle fracture surgery.
Everything about the process of training is inherently inspiring and aspirational. It is all positive, and with each step of the process we get the opportunity to make a conscious decision to move forward.
Overcoming a running injury is inherently negative. It just feels like damage control mode. Running injuries feel more about digging yourself out of a hole, and less about accomplishing something significant.
Every over training injury is unique and can have a unique healing timeline. But it all depends upon what you do.
How can you make the mental shift between a coaches plan a doctor’s plan?
Today on the Doc On The Run Podcast were talking about two perspectives for recovering runners.
I was recently watching the Wizard of Oz with my kids.
There’s this one scene, where Glenda tells Dorothy that she already had has all the ability to get home. That all she has to do is click her heels together and say, “There's no place like home” and she'll be transported there.
Dorothy had that power all along.
When I see runners who have had running injuries, they've been injured. They've been on this long journey of seeming like running through the haunted forest and trying to dodge the wicked witch and trying to get over this running injury.
All injured runners really do already have the power to get better.
Today on the Doc On The Run podcast were talking about how you already know the path to recovery.
There's nothing worse than being in a race, and you feel like your stomach is upset. You're sick to your stomach and you're keeping on pace, but then suddenly, because you literally have an upset stomach, and you start losing pace.
You know that your competition is getting further ahead, and you're getting further behind. That is what's really painful.
Most doctors think runners like you call me because I can help you heal your running injury. I know that those doctors are wrong. It's not really that pain that stops you from running. It's not that foot pain that gets you to call me. That's not really the real reason that most runners call me for a telemedicine visit or consultation call.
Today on the Doc On The Run podcast were talking about the most painful part of a running injury.
Earlier today I was talking with a runner who felt some pain in her foot during a run yesterday. So she got worried she might have a metatarsal stress fracture in her foot. So she booked a consultation call and we had a discussion on the phone about the possibilities.
Here is what she asked:
“I had an aching pain for a few steps during my run yesterday...is that a stress fracture? The aching pain was on the top of my foot for a few steps today…I want to know if it could be a stress fracture?”
So I thought it might be useful to talk about some of the questions I asked her to help figure out whether or not her foot pain might actually be a metatarsal stress fracture, or something else.
Today on the Doc On The Run podcast were talking about questions that make a stress fracture more, or less likely in a runner.
A partial rupture of the plantar fascia can be a truly debilitating injury for a runner.
It's much worse than plantar fasciitis. You take time off. It starts feel better. Then you run and it starts to feel worse again.
Because it can be so frustrating it becomes very easy to convince yourself that you need surgery.
In fact I was just having a conversation with an athlete who started to talk himself into surgery, even though he has absolutely no desire to have surgery one the plantar fascia.
His story highlights how easy it is to become frustrated, and how to overthink a mild setback in your recovery.
Today on the Doc On The Run podcast were talking about how a runner with a plantar fascia rupture talks himself into surgery
Whether you are conscious of it or not, when you are recovering from a running injury you are probably a little bit gun shy.
Every runner who has ever had to cancel a race or abandon a training plan because of an over- training injury understands how demoralizing and frustrating it is to lose all of your fitness and start training just so you can rest and heal.
If you suffered through that routine it shouldn't really be surprising that you probably have some trepidation in the back of your mind. Although it's probably been pushed into the deepest corners of your brain you have fear holding you back.
Injured runners become afraid of pain.
Today on the Doc On The Run podcast were talking about how pain is not a setback in your running injury recovery.
Yesterday I was speaking to an ultra-marathoner who had a metatarsal fracture.
Fortunately, the broken bone has been healing well and she's back to running.
But during our discussion yesterday she revealed something interesting. She was running every day. Just 3 miles…every day.
During that discussion I was trying to help her understand how it is that running every day, even short distances, in fact, extremely short by her standards as an ultramarathoner, those every day runs could actually put her at risk of re-injuring the metatarsal fracture.
Today on the Doc On The Run podcast were talking about how you should skip a day to skip ahead in your injury recovery.
In the pursuit of any running goal you really are only in competition with yourself.
When you become injured, you immediately give yourself an underdog status.
You start to think about all of the problems that your injury presents to prevent you from completing the workouts that you previously believed would make it possible for you to achieve your goal.
Of course, none of that is true. All of those problems we call “reasons” are really just excuses.
There is always a way.
One thing I know for sure. Every runner I have ever worked with you got injured and then set a new P.R. working from an underdog advantage.
Today on the Doc On The Run podcast were talking about the injured runner underdog advantage.
Can you get faster by not running?
Can get stronger by not working out?
If you're a runner and you’re listening to this my guess is that you're clear answer to both of those two questions is “NO!”
And if your answer both of those questions is no…
Why do doctors call rest a treatment plan?
The brutal truth is that rest is not a treatment plan.
Today on the Doc On The Run podcast were talking about how rest is an atrophy plan.
Healing after a hard workout and recovering from a running injury are basically the same process.
But when a runner gets an over training injury everything goes sideways.
We become confused about what has happened and we start to confuse ourselves about what what should happen next. We get off course. We forget the basics.
Our self induced confusion delays our recovery, hampers our healing and keeps us from getting back to running as quickly as possible.
Today on the Doc On The Run Podcast we’re talking about Today on the Doc On The Run Podcast we’re talking about the 3 keys to recovering at a faster pace.
I was just invited to give a lecture at the International Foot & Ankle Foundation’s 42nd Seattle Seminar. I was asked to give a lecture entitled “Potential Complications of Returning Athletes Back to Activity After Injury.”
The very last question of the entire weekend seminar was directed to me.
“Dr. Segler…How can you work with injured runners all day?”
Today on the Doc On The Run Podcast we’re talking about the 3 reasons I love working with injured runners.
Your identity as a runner is crucial to your running goals. You cannot run a four hour marathon if you cannot imagine it, cannot visualize it and cannot believe it is possible.
You must believe to achieve any goal.
It's interesting to me that so many runners understand how visualization of achieving the goal is absolutely critical to finishing a marathon within a specific goal time.
Yet these exact same individuals will almost develop the exact opposite negative visualization and intention setting by identifying ourselves as injured runners who are unable to achieve goals. That negative focus can keep you stuck in a cycle of running injuries.
Today on the Doc On the Run Podcast we’re talking with Toni Kengor about letting go of your identity as an injured runner.
Sesamoid injuries can be serious and can keep injured runners running.
Sesamoids are small fragile bones and if they become inflamed and turn into a stress fracture they can crack, break and become permanently damaged. If you have surgery to remove a permanently damaged sesamoid bone, your foot will never be the same.
Our guest today went through a long battle with a sesamoid injury and then got back to marathon training.
Today on the Doc On The Run Podcast we are talking with Isabel about the strategies she used to recover from sesamoiditis and start training for the London marathon.
Today on the Doc On The Run Podcast we are talking with Jonathan Ellsworth, founder and Editor in Chief at Blister AND host of the Off The Couch Podcast about how we can assess running gear reviews, decide when we should try something new, and how new gear isn’t always better, just because it is different.train
Ultra-marathon by definition means running lots of miles on trails. That's a lot of opportunity to get injured!
One of the best parts of running is social interaction. But it's not always easy to find the right group of runners for you. If you find if you find a local running group you'll get advice, encouragement and guidance that may help you train harder, run longer and avoid injuries.
If you want to build a huge base fitness for endurance events like ultra-marathons you need to be able to put in the miles, recover faster make sure you don't get injured.
Today on the Doc On The Run Podcast we are talking with Melody Dowlearn, the host of “She Runs Trails” podcast about trail running, recovery, and injury prevention when training for ultras.
Sooner or later, all of us will have to deal with some uncertainty and adversity in making it to the finish line. Right now, obviously there's a lot of uncertainty for athletes in training…having difficulty just making it to the starting line.
Many runners have to cancel events a goal race because we get sick or injured. Overtraining certainly has a much higher probability to disrupting your goal race then another pandemic.
Today on the Doc On The Run Podcast we are talking with the hosts of the podcast Coaches on Couches about changing plans, modifying training and how to shift mentally when races are cancelled and training as we know it evaporates.
Arthritis of any type can cause a lot of pain when you run. The word “arthritis” really and truly just means inflammation within a joint. There are lots of different kinds of arthritis.
But in general when a runner hears a doctor deliver a diagnosis of “arthritis” it's pretty easy to start thinking your running days are numbered.
But sometimes you just need a shift in perspective.
If you’re runner and you've been worried that you might have arthritis in your hips or your knees or anywhere else I can assure you…you’re going to love hear from Martha today.
Today on the Doc On The Run Podcast we are talking with Martha Hughes about how hip arthritis has impacted her running and how she has been able to gain a different perspective on her running goals.
Arthritis of any type can cause a lot of pain when you run. The word “arthritis” really and truly just means inflammation within a joint. There are lots of different kinds of arthritis.
But in general when a runner hears a doctor deliver a diagnosis of “arthritis” it's pretty easy to start thinking your running days are numbered.
But sometimes you just need a shift in perspective.
If you’re runner and you've been worried that you might have arthritis in your hips or your knees or anywhere else I can assure you…you’re going to love hear from Martha today.
Today on the Doc On The Run Podcast we are talking with Martha Hughes about how hip arthritis has impacted her running and how she has been able to gain a different perspective on her running goals.
Find your why. Write it down. Just live towards that.
Jonathan Flores is the host of the Run With Purpose Podcast. He is also a runner who set out to run 50 marathons in 50 states, which obviously requires a lot of effort and a knowledge of running recovery to avoid injury.
Jonathan understands how to recovery, how to stay on track when plans go sideways, particularly through intention setting and making plans that turn dreams into experiences.
Today on the Doc On The Run Podcast we are talking with Jonathan Flores, host of the Run With Purpose Podcast about intention setting for runners when race plans change and training schedules plans go sideways.
Carrie Tollefson is by any standard and elite runner. Olympian. 13-time State Champion. National record holder for the most consecutive cross-country titles. First person in NCAA history to win both the 3,000 and 5,000 meter titles. 5-time NCAA. NCAA Indoor Track Athlete of the year. And if all that isn’t enough, Carrie has been on the cover of Runner’s World magazine 5 times!
She has ben running and setting records for decades, and yet still, just last year ran a marathon under 3 hours. Today she is going to help you understand a little better how you can GET AFTER IT, without getting injured.
Today on the Doc On The Run Podcast we’re talking about how to GET AFTER IT and recovery faster with Carrie Tollefson.
Today on the Doc On The Run Podcast we are talking with Jonathan Levitt about the strategies he uses to recover quickly after hard training blocks, or an Ultra before resuming training.
I am sure most of you listening know Jonathan Levitt as the host of the podcast For The Long Run. Fortunately for all of us, he is taking time out of his schedule and away from his microphone to join us here and provide his insights on rapid recovery for ultra runners.
We will have all the links for you at the bottom of the show notes for this particular episode at DocOnTheRun.com under the podcast section. We will have links to his show For The Long Run, make sure you start listening to his show as well. You will love it!
Kim Conley: 2-time Olympic athlete and middle and long distance track star.
Part of what I find so inspiring about Kim is the way in which she has pulled it out and come back in the final meters and final seconds of races to secure the win.
We're really fortunate to have Kim on the show today to share some of her strategies and tactics that have helped her stay fit, train hard and recover after all those hard workouts throughout her career.
Today on the Doc On The Run Podcast we are talking with Kim Conley, about the strategies she uses to recover quickly after hard training blocks, or when resuming training after a world-class event.
If you want to complete an ultramarathon, you will have to put in lots of training. One of the big keys to successfully training for an ultra-marathon is to log lots of miles without getting sick or injured.
Ken Michal has stood on the starting line of almost every significant ultra, including Western States 100 and multiple rounds of the HURT 100.
And when I asked him about what it takes to successfully train for these kind of ultras, he says, “You're going to hate me for saying this, but its risk and reward.”
Today on the Doc On The Run Podcast we are talking with Coach Ken Michal, host of the Running Stupid Podcast about recovery, rehab and injury prevention when training for ultras.
Lucy Bartholomew went from running with her dad at age 15 to finishing on the top of the podium at some biggest ultras around the globe, all while setting course records in the process.
Not surprisingly, her travel, training and race schedule keeps her pretty busy so it has taken almost a year of trying to get Lucy on the show, but with some luck we are able to have her here today to talk about her strategies and tactics on staying healthy, and recovering effectively while training for ultra-marathons.
No one can clock the times and distances Lucy does without riding the fine line between training and overtraining. Obviously she knows how to get the full benefit of her training sessions by effectively recovering.
Today on the Doc On The Run Podcast we are talking with Lucy Bartholomew about the strategies she uses to recover quickly after an Ultra before she resumes training for the next event.
When I was running yesterday, we were noticing a couple of things that may put people at risk. And so, I was thinking about three simple ways you can really decrease your risk of exposure and keep true social distance, which I believe should be more than six feet.
There's a couple of simple ways to think about this. The first thing is to stay away from people. And then, the second thing is that when you do encounter people to make sure you're far enough away from them. And so, I came up with three simple tips that may help you avoid what I call the “coronacloud,” which is being within that pocket of air that could be contaminated.
Today on the Doc On The Run podcast, we're talking about the top 3 ways runners can avoid the “Coronacloud.”
The biggest difference in speed of recovery is motivation. Your motivation leads to the actions required to heal and recover as quickly as possible.
Healing is not a passive process. If you're just sitting around waiting for some specific timeline to make your injury go away, you're making a big mistake.
The only guarantee in the waiting-to-heal-plan is that you're guaranteed to lose all of your running fitness. But there is a better way. Just think of your recovery the same way you think of training.
Today on the Doc On The Run podcast, we're talking about whether or not you are motivated enough to recover.
I listen to lots of podcasts and I recently have heard lots of other speakers in all genres talking about how important it is to stay healthy and avoid illness, and reduce your risks or contracting Covid-19.
All of these people are right. Now, more than ever it is important to maximize your immune system.
In thinking about that, I realized that all of these same strategies people are talking about to help you avoid a viral illness can also help you heal from training, prevent over training and maximize recovery after hard workouts.
Today on the Doc On The Run podcast, we're talking about how stress reduction is critical during coronavirus lockdown downtime for runners.
Right now all of us are inundated with rapidly changing circumstances and a wide variety of news stories about the coronavirus. With all of the uncertainty, none of us really knows what we are supposed to do.
As a doctor who focuses completely on helping injured runners get back to running, most of what I do Is recognize mistakes in training and the recovery process causing failure.
But what I do know is that right now, all over social media, I am seeing examples of completely avoidable mistakes which could have serious consequences.
Make no mistake, I think runners should keep running, even when they began to encounter an overtraining injury. But it's all about taking a sensible approach. It's about managing risk. In some activities are riskier than usual right now.
Today on the Doc On The Run podcast, we're talking about the top 3 coronavirus mistakes for runners.
Yesterday I was looking at the latest news story about the coronavirus lockdown in Italy. Strict lockdown.
Don't go out of your house.
Government orders.
And the representative image in the news story showed a street scene of beautiful Italian architecture in Florence Italy.
There was only one person on the street. And that person was a runner, who was running.
So while we are afraid to go to the grocery store, or that someone might cough on us while we're getting gas, we all want to go out for run. Even under the threat of personal harm or imprisonment…we want to run.
Today on the Doc On The Run podcast, we're talking about the coronavirus and how it has you on lockdown, unless you’re a runner.
I was on stage at the International Foot & Ankle Meeting in Lake Tahoe this weekend and was giving a presentation designed to help doctors understand why running isn’t the problem with running injuries....why they as doctors shouldn’t always tell runners to “stop running” as a way to decrease stress.
Running is only one form of stress. Running is biomechanical stress.
But one of the most helpful strategies in recovering runners is managing oxidative stress.
So, I gave a brief Biochemistry 101 explanation of what “oxidative stress” means, why it is so important and why recovering runners need ti think about it.
Today on the Doc On The Run podcast, we're talking about how oxidative stress slows running injury recovery.
Any diagnosis ending in “-itis” means inflammation. If you have inflammation in the tendons, a short course of oral corticosteroids will help to shut off the inflammatory response and reduce the inflammation.
It took me nine years to get my spot at the Ironman World Championships. And unfortunately I got pneumonia right before the race.
I had to take oral corticosteroids preceding and during Ironman Hawaii. Now to be clear, I did the race, but I did not run at all for two months after Ironman Hawaii.
I wasn't resting. I wasn’t recovering. I was concerned that I would develop an Achilles tendon problems as a consequence of running immediately after having finished the course of oral corticosteroids.
Today on the Doc On The Run Podcast we're talking about whether or not a runner should take steroids for chronic tendinitis.
An over training injury is one of the worst possible things that can happen to a runner.
You've been working toward a goal, hard, making sacrifices and then disaster strikes and you get injured.
Of course the best thing to do is to start healing and get back to training as fast as possible.
There are lots of reasons I see runners procrastinate and unnecessarily put up their own roadblocks between them, healing, and getting back to running.
Today on the Doc On The Run podcast, we're talking about the Top 10 reasons injured runners procrastinate.
The Ironman triathlon is widely considered to be one of the worlds most grueling single day athletic events.
2.4 mile swim, 112 mile bike ride and a full 26.2 marathon, all in the same day.
My Ironman journey taught me a couple of really important lessons.
Because I know what it feels like, when you think you can't run, even worse, when a doctor says, you can't run…but deep down inside, you know you can.
The most important thing Ironman taught me about running injuries is that you, injured runners have a goal. And that goal is important!
Today on the Doc On The Run podcast, we're talking about what Ironman taught me about running injuries.
If you are a runner and you have a weird aching pain, and you’re not really even sure if it's in your foot or your ankle you may have a condition called sinus tarsi syndrome.
When a doctor tells you you developed a case of sinus tarsi syndrome That just means that you have irritated and inflamed the lining of the subtalar joint.
So of course as a runner suffering from this condition and trying to figure out what to do, so you don't get it again, it may be helpful if you can understand the three common causes of sinus tarsi syndrome in runners.
Today on the Doc On The Run podcast, we're talking about three causes of sinus tarsi syndrome in runners.
The best decision is the decision to take the right action. The second best decision is to take the wrong action. And the worst decision of all if you are an injured runner is make a decision to take no action at all.
More often than not, when an injured runner limps into a doctor's office, the doctor tells the runner she has to stop running. We as runners are told to rest. These well-meaning doctors are trying to heal the one specific injury but they are doing so at the risk of ruining your ability to run permanently.
When we sit still we get weaker, stiffer and our fitness vanishes. Believe it or not, we as injured runners often do the same thing to ourselves.
I get messages all the time from injured runners who are trying to find the best decision before they will take any action.
Today on the Doc On The Run podcast, we're talking about the best decision and worst actions for injured runners.
Just today I got an interesting question from Victoria, who has been suffering with a bad case of sesamoiditis which has been keeping her from running.
She saw an orthopedic surgeon who who thinks there is scar tissue around the sesamoid bone restricting the range of motion and causing the pain under the big toe joint.
The doctor explained to her that one other conservative option, which might help her avoid sesamoid surgery would be a corticosteroid injection which is sometimes also called a Cortizone injection.
So her question was:
“How exactly do steroid injections help? Do they break up scar tissue? The orthopedic surgeon told me to be cautious about doing steroid injections, but I never got a clear explanation as to why.”
Today on the Doc On The Run podcast, we're talking about the good and bad of cortizone injections for sesamoiditis in runners.
Just today I was talking to a runner who has an injury and although this injury has gone on for a long time, I thought that she would know exactly whether it's improving or not.
She said she thought it was improving, but we don't really know if it's improving, because there is no data.
It is easy for us as runners to tell when our fitness is getting better, we feel stronger, we feel better.
But unfortunately we don't really want to think about pain. We don't want to think about injury. We don't want to think about setbacks
Today on the Doc On The Run podcast, we're talking about how wishful thinking can kill recovery from a running injury.
The single most important thing you can do when you think you have a running injury is to make a decision, quickly.
You only have two choices.
-
Realize and admit you are injured and get about the business of recovery.
-
Confirm you aren't really injured and then adjust your course to continue your training.
But what most runners do is something in between. We want to believe we are not injured. We want to think we can continue training.
And instead of just kidding about the business of recovering and then training, we just make things worse.
Today on the Doc On The Run podcast, we're talking about how indecision prevents running injury recovery.
I got an interesting question sent in from a runner, who said…
I fractured my left ankle. I have been in an Aircast ever since. So, should I continue with the Aircast for another three weeks or try out an ankle brace?
Obviously when you want to get back to running, you think the key is always to advance as quickly as possible from one stage to the next...and that is true.
You definitely want to try to advance as rapidly as possible.
Today on the Doc On The Run podcast, we're talking about when a runner can use an ankle brace instead of an aircast when healing from an ankle fracture.
No treatment is best for every runner. Not even metatarsal fracture surgery.
Your task as an injured runner who wants to run is to figure why a treatment is right for you…or not right for you…even if it gets recommended by a doctor or surgeon.
When a comes to surgery to fix metatarsal fracture in your foot there a few considerations runners need to think about.
Risk of NOT healing with or without surgery.
Risks of surgery themselves and risks related specifically to your running goals.
Today on the Doc on the Run Podcast, we're talking about when surgery is better for a metatarsal fracture in a runner.
Doctors sometimes prescribe treatments than can be bad for runners.
If wear a fracture walking boot, your muscles get weaker, your tendons and ligaments get stiffer, your bones start to lose calcium.
If you take ibuprofen during a race you can get gastrointestinal upset that complete wrecks your nutrition plan. In the the worst cases you could even get kidney failure.
If you break a bone and a doctor puts a cast on your leg you could get “cast disease.”
Even an adhesive bandage can cause trouble.
Today on the Doc on the Run Podcast, we're talking about how everything in medicine is bad for runners.
Most runners are aggressive by nature. Planning, training, eating, analyzing, reaching for goals in way that your friends may label…“obsessed.”
Sometimes we are so aggressive we make a mistake, do too much and get an injury.
The bad news is that we are now inundated with an air of “self-care” mentality that backfires.
The good news is that you already know how to heal. It is the same as recovery when training.
You need to be just as aggressive in your healing plan as you are in your training plan.
Today on the Doc on the Run Podcast, we're talking about how injured runners need aggressive healing.
I just had a consultation with an injured runner who asked…
“Are crutches bad for injured runners?”
The correct answer is yes, crutches are bad for injured runners, especially if you use crutches any longer than it takes to heal your injury enough to start walking without crutches.
But if you needed crutches, and you avoid them, that could be even worse for you as a runner.
Nothing in medicine is black and white. Everything is gray. And crutches are no exception.
Today on the Doc on the Run Podcast, we're talking about what injured runners should think about when injured and offered a pair crutches in a doctors office.
I just had a consultation with a woman who has been having pain in the toes and the end of the big toenails just after running.
The pain in the big toes has been getting worse. She was also getting some numbness or tingling around the corner of the toenails.
She wanted to know…
"Am I doing something wrong with my shoes?”
“Am I cutting my toenails wrong?”
“Is there really something wrong on the inside of my toe?"
Today on the Doc on the Run Podcast, we're talking about what you need to think about if your toenail hurts when you run.
Every runner who is injured and has been told to stop running wants to get back to running as quickly as possible.
We all want a secret path to healing and a fast track to return to recovery.
When it comes to getting better after you get an over training injury there are really only two possibilities if you want to get back to running as quickly as possible.
Today on the Doc On The Run podcast, we're talking about how injured runners must learn or earn the knowledge and experience necessary to recover from an overtraining injury.
Today a runner asked a great question…”Can I run with shin splints?”
The short answer is yes, you can run on shin splints for a short period of time…if it shin splints.
The problem is, is that there are a couple of different conditions that are often called “shin splints” that could be something else.
The real questions are:
If I stop running because of shin splints will I lose all of my fitness?
Can I run with shins splints and still heal?
Can I run with shinsplints without getting worse?
Today on the Doc On The Run podcast, we're talking about whether or not you can run and train with shin splints.
Today I heard a great question from a runner…
She asked, “A doctor told me that I have a neuroma in my foot and I need to have surgery to remove it because it hurts when I run. Should I get a surgical second opinion?”
There is really one clear indication of when you really need to seek a second opinion when a doctor recommends surgery.
Today on the Doc On The Run podcast, we're talking about whether or not how to tell if you need a surgery second opinion as an injured runner.
Do bone stimulators help with sesamoiditis?
Will a bone stimulator help the sesamoids, if the bone is not fractured?
Is there clinical evidence that bone stimulator will help sesamoiditis?
Today on the Doc On The Run podcast, we're talking about whether or not bone stimulator might help sesmoiditis in a runner.
I was just on a consultation call with the runner who got a metatarsal stress fracture after a long run in minimalist running shoes.
The question asked was, “do minimalist running shoes cause stress fractures?”
Minimalist running shoes do not cause stress fractures.
In fact. running doesn't even caused stress fractures.
Today on the Doc On The Run podcast, we're talking about how minimalist running shoes do not cause stress fractures.
Do I have to stop running to rest a metatarsal stress fracture?
Let’s imagine 10 rowers in a boat. If one rower gets tired or injured, does the boat have to stop?
Do all 10 rowers have to stop rowing, park the boat and sit on the shore?
When you have 10 metatarsal bones in your feet and only one bone is injured you don't have to necessarily stop all activity.
Today on the Doc On The Run podcast, we're talking about whether or not you have to stop running to rest a metatarsal stress fracture.
You cannot plan a trip without a destination.
And you cannot expect to heal as fast as possible if you do not have a clear goal and a defined timeline.
The quality of the medical advice you get will depend on the clarity
of your running goals.
Running injury treatment needs to be tailored to you, your specific injury, the severity of your injury and your unique running goals.
Today on the Doc On The Run podcast, we're talking about why you should define your goal if you are injured and want to run.
Today's question comes from Diane who was listening to the podcast and wrote in because she wanted to know more about the long-term effects of ankle sprains.
Ankle sprains frequently lead to two main problems.
Many runners mistakingly move their ankles too soon, and can wind up with chronic pain.
Many other runners fail to rehabilitate their ankle and can end up with chronic ankle instability.
Both of these common problems related to ankle sprains are completely preventable in runners.
Today on the Doc On The Run podcast, we're talking about the long term effects of ankle sprains in runners.
A runner with a stress fracture just called me for a phone consultation.
He was concerned because he got an X-ray and saw a bulge in the bone.
The question was whether or not this bulging area of healing bone in the stress fracture was a good thing or a bad thing.
More than anything else he just wanted to know if the lump of bone on the x-ray was an indication that it was okay to start running.
Sometimes a lump of bone on your x-ray is good thing, but sometimes a bad thing.
Today on the Doc On The Run podcast, we're talking about whether or not a bulge in your metatarsal bone on an x-ray of a stress fracture tells you if it is healed enough to start running.
If you're a runner who has had aching pain in the ball of the foot you may have been diagnosed with a plantar plate sprain or a plantar plate tear. Or maybe you were told you had a plantar plate rupture.
The most important factor to a runner is how quickly you can heal the plantar plate injury and get back to running.
The chances are good your doctor didn't really discuss this component of your treatment plan.
When you get a plantar plate injury many doctors will simply tell you to stop running and let it heal.
That plan can take months.
If you're a runner with a plantar plate injury you need to understand the differences between the terms used to describe the condition so you can better understand what you need to do to heal and get back to running.
Today on the Doc On The Run podcast, we're talking about the difference between a plantar plates sprain vs. a tear vs. a rupture when you are a runner.
It’s cold and flu season and one question that comes up this time of year is, "Should I run when I am sick?"
The obvious concern is that if you have a training schedule and marathon on the calendar your fitness will suffer. You don’t want to lose ground.
This is a valid concern. If you stop, it can wreck your training.
But you have to understand something that seems to get lost on most sick runners in training.
Not running when sick isn’t nearly as bad as not running when injured.
Today on the Doc On The Run podcast, we're talking about whether or not you should run when you are sick.
When you are sick or injured, you may feel like you are helpless.
You think you can’t run.
You think you can’t build your running body.
You think that you can’t do anything to help the situation.
If you're injured, you're probably sitting around thinking, "Well, I can't do anything. I can't run. I can't go to the gym. I can't do anything."
But that's not true. You just have to think about what can you do today. You have to focus on what you can do today.
Today on the Doc On the Run Podcast, we're talking about how you should focus on what you can do today if you want to recover from an over-training injury.
Many runners seem to be surprised when they get an overtraining injury.
However, once we start talking about the injury, they almost always know something is wrong days or weeks before they actually get the pain and real injury.
Every runner in training should pay attention to the subtle signals that tell you when you are heading for an over training injury.
If you get the sense you are in an overtrained state, you can talk to your coach, or just back off from one or two of your workouts to allow your body to recover and make sure you don't wind up injured, when you should be training
Today on the Doc On The Run podcast, we're talking about the 5 overtraining indicators that precede running injury.
Every time you go out for a run you deliberately damage the muscles, tendons, bones and ligaments just enough to stimulate healing response that makes them stronger.
An overtraining injury is nothing more then a little bit too much tissue damage, in one particular tissue.
If you are training for a marathon, your number one priority is to make sure you are recovering fast enough to avoid an over training injury.
If you are an inured runner, your number one priority is rebuild that injured tissue so you can get back to running.
I get asked all the time about what runners need to eat in order to rebuild tissue. And recently I was thinking about how it's not really so much what you eat as how often you eat.
Today on the Doc On The Run podcast we're talking about how if you eat like you are racing you will recover like a champion.
If you are runner trying to get down to your race weight, you may be considering a new diet.
If you are a runner trying to build more muscle, or build tissue faster after workouts to recover faster, you might need to modify your diet.
I get questions about diet nutrition all the time from injured runners.
Do you really need more protein?
Do you really need to eat like a cave man?
Do you really need to build protein with protein?
Do you have to eat protein or meat to build protein?
Today on the Doc On the Run Podcast, we’re talking about how the best diet for runners is consistency.
Fracture walking boots are over-prescribed and often worn for way too long by many injured runners.
Nobody who's a runner wants to be injured or wants to have to wear a fracture walking boot.
It's really easy to get angry and resentful about feeling like you wasted time in a fracture walking boot while you are recovering.
You may be upset just because you've been sitting around recovering.
You may be angry because you feel like a boot is the standard routine and deserve something better.
Maybe you think your doctor hasn't been proactive enough and you haven't been able to get back to running fast enough.
Today on the Doc On The Run podcast, we're talking about being angry about having lost time from running in a fracture walking boot.
Running injuries are not random.
Over training injuries are actually very predictable.
Runners get injured as a result of too much stress, applied at the wrong time.
Certain life circumstances can coincide with stressful blocks of training that put you at risk of developing an over training injury.
If you're training for a marathon and you want to make it to the starting line in tact, you need to know what to watch out for during these dangerous times.
Today on the Doc On the Run Podcast, we’re talking about the 4 risky times for running injuries.
Endurance athletes are uniquely prone to self-sabotage.
Ironically the destruction rises out of the very skill that lends us the strength to finish a race like a marathon.
Success comes from being strong.
Healthy runners are fast runners.
No one runs their marathon as fast as possible when injured.
No one gets a new PR with pneumonia.
Today on the Doc On the Run Podcast, we’re talking about how endurance leads to marathon failure.
Destination races hold a lot of appeal. Awe inspiring scenery. Amazing cultural experiences. Fast, flat courses.
We spend countless hours and significant sums of money just getting to some of these destination marathons and triathlons.
Obviously, if you are heading to a key race in a far-away place, you want to have the best race possible.
Incredibly, many runners make one simple but crucial mistake that can truly hamper the chances of success in finishing under your goal time.
Today on the Doc On the Run Podcast, we’re talking about the one critical mistake runners make when flying to a race.
Every runner in training tracks progress to monitor for improvement.
Heart rate, wattage, mileage, pace, and perceived exertion are all commonly tracked by athletes in training.
So many athletes preparing for an event, so diligently track and record metrics which reassure us and provide visual confirmation that we are on track toward our goals.
Yet, many of these same athletes simply stop recording any data at all when they get injured and abandon their training plans.
You have to think of healing just like training. You need to see progress. You need to track improvement.
There are a few metrics which you should record on a daily basis when you're injured and trying to get back to running as quickly as possible.
Today on the Doc On Run Podcast we're talking about 4 trends injured runners should track.
A torn plantar plate can be one of the most frustrating injuries for a runner.
A runner who has been following many of the suggestions regarding ways to reduce the stress and strain on the plantar plate ligament, has been treating the injury on her own and was getting better.
Then she recently got a set back and understandably got super frustrated.
But like most strong runners, she is focusing on the possible solutions instead of wallowing in self pity.
She wrote in and said…
I am desperate to be able to even walk barefoot without pain, to be able to run on the treadmill and jump !! I am wondering whether it is worth trying the following :
-
Massage
-
Ultrasound therapy
-
Plasma Therapy
Today on the Doc On Run Podcast we're talking about 3 different torn plantar plate injury treatment options worth considering.
A runner and a listener to the podcast recently sent in a question regarding how long it takes to heal an old fracture versus a new fracture.
There are many risk factors for developing problems with healing a broken bone.
Each year there are about six million broken bones the United States. Somewhere between 5% and 10% of all of those fractures do not heal as quickly as we would hope and turn into what is called a fracture non-union or a delayed union.
A “fracture non-union" is just what it sounds like. It means to the fractured pieces of bone did not unite. They did not get back together and the fracture just did not heal.
A "delayed union" is a broken bone that isn't healing as quickly as we would expect.
Today on the Doc On Run Podcast we're talking about the difference in healing time of an “old fracture” vs a “recent fracture.”
I recently got a question from a runner with a partial tear of the plantar fascia who asked,
"I am struggling with a partial tear - going on 6 months of pain with running.I’ve tried everything - PT, rest, PRP, and most recently embryonic membrane injections.
This injection was four weeks ago - with crutches for 5 days after and boot for two weeks.
I’ve also had four weeks of no running at all and still have the pain. I would love to know what your “standard routine” is for this condition."
Today on the Doc On The Run Podcast, we're talking about the standard routine for healing a partial tear of the plantar fascia in a runner.
Is there a difference in healing time when there is a crack in the bone visible on x-ray, compared to when a runner has a “stress fracture” with no visible crack on x-rays.
What do you think?
Would it take less time to return to running if you have a stress fracture with no crack visible on an x-ray than if you do actually have a crack visible on an x-ray?
The answer surprised many doctors a medical conference where I as just lecturing and it may surprise you, too.
Today on the Doc On The Run Podcast, we're talking about how long it takes to heal stress reaction vs stress fracture in a runner.
Today on the Doc On The Run Podcast, we're talking about surgery for a sesamoid stress fracture in runners. If you're a runner and you start having pain under the big toe joint and you develop this thing called a sesamoid stress fracture, you may get really worried. In fact, if you go to see a doctor, you're probably going to get a lot more worried because the doctor's probably going to tell you these things can be very, very difficult to heal. Well, it is true. For years I've been lecturing to doctors at medical conferences about running injuries, and one of the things I often talk about is that sesamoid stress fractures are one of the very few problems a runner can get that really does warrant a serious dial back in activity to make sure that you can take the stress off of that sesamoid bone.
Oxidative stress is something that normally occurs in all runners.
But we know free radicals and the consequences of an imbalance of oxidative stressors can delay tissue healing.
Anytime you have an overtraining injury and you are trying to get back to running, you have to make sure you are healing as quickly as possible.
The big question is whether or not exercise, such as running, has a positive or negative affect on oxidative stress.
Today on the Doc On The Run Podcast, we're talking about whether running increases or decreases oxidative stress.
When you decide to sign up for a race, you start training.
You follow a specific plan that you know will get you stronger and stronger, day-by-day.
You make a plan to get to your race, prepared to achieve your goal time.
But what happens when you get injured?
You basically do something completely opposite, completely different, and not at all in alignment with the strengthening process that you know works when you're training.
Today on the Doc On The Run podcast, we're talking about why you need to execute your healing plan with the same tenacity you execute a training plan.
If you're a runner and you get injured, you're certainly going to be bummed out, and it is really, really easy to get frustrated.
In my experience when working with injured runners when I do consultation calls, is that most runners beat themselves up unnecessarily.
You have to look for every possible opportunity to view something as a success, as a victory, as a win when you are recovering from an injury and trying to get back to running.
You have to look for the wins when you're training and you're working toward a goal.
The same holds true for when you have a running injury.
Today on the Doc On The Run podcast, we're talking about why every step is a win when recovering from running injury.
Stress fractures are a common overtraining injury in runners.
But if you want to run on a stress fracture, you better be sure that choice is not going to ruin your ability to run in the future.
You have to figure out whether or not your stress fracture is low risk, or high-risk.
Today on the Doc On The Run podcast, we're talking about which stress fractures are low risk for a runner.
If you get a stress fracture your first question is probably whether not you can just keep running.
Before you can answer that question, you have to figure out whether or not the particular stress fracture you got as a consequence of over training is a high risk stress fracture or a low risk stress fracture.
If there's a high risk your stress fracture is going to break, you may not want to run on it.
If there is a high risk your stress fracture just won't heal if you run on it, and you probably want to back off.
Today on the Doc On The Run podcast, we're talking about what makes a stress fracture high risk for a runner.
Shin splints are a common overtraining injury among runners. That aching pain in the front of the leg can be really annoying.
Some common questions from runners with shin splints are…
Can I run with shinsplints?
Will I get a tibial stress fracture if I run the shinsplints?
Is it really risky to keep running if I just have shin splints?
Today on the Doc On The Run podcast, we're talking about whether or not it risky to keep running with shin splints.
It is widely accepted among athletes that our mindset, visualizing a specific outcome and working toward that specific outcome are all interconnected.
No one wins a race without believing they can win.
And I believe no one heals unless they believe they can heal.
Whether you have a metatarsal stress fracture or an Achilles tendon injury, you have to understand that your mindset will either help or hinder your recovery.
Being injured is not always the worst thing.
Today on the Doc On The Run podcast, we're talking about how there is no shame in a running injury unless you make it shameful.
Shin splints are common among runners your ramping up their mileage.
Unfortunately, stress fractures are also common.
If you have an aching pain in the front of your leg you may be misdiagnosed with shinsplints and later find out you have a tibial stress fracture.
If that happens, your doctor might panic and want to put you in a fracture walking boot.
But it may help you to understand why of fracture walking boot help some fractures and how a fracture walking boot might (or might not) help reduce the stress in your shinbone when you have a tibial stress fracture.
Today on the Doc On The Run podcast, we're talking about whether or not you really need a fracture boot for a tibial stress fracture.
One time I saw a guy who actually flew all the way from New York to San Francisco to see me.
He had seen a bunch of doctors, he'd seen very qualified people.
He had gotten an MRI, a CT scan, some x-rays, all kinds of different tests.
He had a number of different evaluations and none of his doctors made the correct diagnosis.
After I watched him run on a treadmill and did a couple of diagnostic injection, I easily made the correct diagnosis.
He became really upset and said, "Why can't my doctor in New York figure this out?"
Today on the Doc On The Run podcast, we're talking about why your doctor didn't have the right answer.
I was recently lecturing at The International Foot & Ankle Foundation's annual scientific meeting in Las Vegas, and that conference is all for podiatrists, foot and ankle surgeons, and sports medicine doctors, to figure out how to treat foot and ankle injuries better. I was doing a lecture on stress response, stress reaction and stress fractures in athletes, and one of the main points of that talk, one of the take home points for physicians, was about the hop test.
Some of those stress fracture classification systems use MRI, some use CT scans and some use X-rays to try to determine how bad your injury happens to be.
Of course, the point of a classification system is to help you decide when and how to get back to activity quickly by helping your doctor make decisions.
Is this stress fracture going to heal quickly?
Is this stress fracture going to heal slowly?
Is this stress fracture something that's high risk, or low risk?
Today on the Doc On The Run podcast, we're talking about how doctors classify stress fractures in runners.
If you have an accident and cut the front of your leg open, you may have to have stitches to sew the skin back together.
Of course, most doctors will probably tell you that you should avoid exercise until your skin fully heals and the stitches are removed.
Depending upon the location of the stitches, it could take two or three weeks for the skin to heal.
Most runners don't want to wait two or three weeks with no running while waiting for stitches to be removed.
Today on the Doc On The Run podcast, we're talking about when you can run if you have stitches.
Ingrown toenails can be painful. Particularly if you're getting ready to run a marathon or some other goal race.
I recently got a call from a runner who called and asked…
“Can I run my race with an ingrown toenail?”
It seems like wanting to know whether or not she should wait until after her race to have her ingrown toenail removed, was a reasonable question.
But the answer may surprise you.
Today on the Doc On The Run podcast, we're talking about whether or not you should wait until after your race to fix an ingrown toenail.
Plantar fasciitis is by far the most common cause of arch pain in runners.
Not surprisingly, most runners who get heel pain or arch pain think they have plantar fasciitis.
But sometimes runners have a more serious injury where there is actually a rip, a tear or what doctors referred to as a partial rupture of the plantar fascia ligament.
The problem with this more serious injury is that it doesn't get better with the same treatments that will help plantar fasciitis.
Today on the Doc On the Run Podcast, we’re talking about the top 3 clues of a plantar fascia rupture in a runner.
Today was on a consultation call with a runner who is had a long history of Achilles tendon problems.
She's recently tried some new things that made an improvement.
But the problem is she's not really certain the improvement is from the new treatments she's been doing. Because she simultaneously decreased her activity a bit.
So now she's in this place where she is trying to figure out what to do next.
Should she continue with some simple conservative treatments that aren't very risky?
Or should she try to just do something riskier to try to get it to finally heal, or heal faster?
Today on the Doc On the Run Podcast, we’re talking about or not a runner should try a more aggressive treatment for an aching Achilles tendon.
Some runners become concerned that if they run in custom orthotics they may become weaker and unable to run without the custom orthotics working as a sort of crutch.
Theoretically, if you have been running for a long time with custom orthotics support your feet may be accustomed to, or in some sense even dependent upon that external stability and support.
The question is…do orthotics provide relief from symptoms only, or do they support you so much you could actually get weaker?
Today on the Doc On the Run Podcast, we’re talking about how a runner can get from wearing conventional running shoes with custom orthotic inserts to running without orthotics in minimalist running shoes.
Running injuries only happen in two scenarios:
-
We do something stupid. We do something we know that was foolhardy and we shouldn't have done it.
-
We sustain an injury while pushing for progress. We are getting stronger. We are pushing ourselves to the limit. And we just push a little too far.
But anyone can get injured. In fact, for those athletes who do experience rapid success, it can even be more difficult to restrain yourself when you are getting subtle clues from your body that you may be heading for an over training injury.
Today on the Doc On The Run Podcast we are talking with Julia Curran who is an age-group National High Jump Champion about preventing running injuries as you experience rapid athletic success.
All overtraining injuries are the result of too much tissue damage, without enough recovery to fully heal, before the next workout “causes” a running injury.
My personal belief is that most running injuries are the result of failing to trust your training plan and your coach.
You need a coach to help you stay on track.
I think a coach is someone who can quiet your fears when its time to push the limits. Someone who truly know the difference between fear, pain and real danger.
But you have to trust your coach if you want to ride that line.
Today on the Doc On the Run Podcast, we’re talking about how failure to trust causes running injuries.
No one trains for long distance events, nor successfully completes a long distance event without a great deal of discipline.
Most experienced runners can run a long way, regardless of footwear. And it is mostly highly experienced runners to start investigating the idea of barefoot running or running in minimalist running shoes.
There are many reasons minimalist running shoes appeal to endurance runners.
But running in minimalist running shoes requires an advanced level of discipline.
Today on the Doc On The Run Podcast we're talking about why most runners lack the discipline required for minimalist running shoes
When a runner’s joint wears out, one option is to remove the damaged cartilage and replace the joint through artificial joint surgery. The problem is, artificial joints typically wear out a lot faster than normal joints.
The base assumption is the running will wear out an artificial total joint replacement.
More than 25 years ago an orthopedic surgeon told me that I should stop running.
He said if I didn't stop running I would have to have an artificial joint replacement. He also said if I ran on that artificial joint I would destroy the joint replacement surgery, ruin the implant and would have to have yet another surgery.
Can I run after total joint replacement surgery?
That’s a great question. Today on the Doc On the Run Podcast we are talking with the Bionic Runner about running after total joint replacement surgery.
Most runners wear running shoes when they run. And the type of shoes you choose can help protect you from the forces of running.
If you have high arches, in general at your feet are more stable and more rigid.
A rigid foot type generally translates to higher peak forces when you run, and particularly when you land as a heel striker.
Cushioning type running shoes can help protect your feet from the pounding forces of running, if you have high arches.
Today on the Doc On The Run Podcast we're talking about why runners who have high arches need cushioning running shoes.
If the running shoes are perfect for you, they will help provide support and cushioning to protect you from the pounding forces of running.In theory, running shoes should protect you from overloading structures in a way that could lead to an over training injury.
If you are a runner and your have flat feet, you need “motion control” running shoes. Motion control running shoes, pronation control running shoes, and stability running shoes are all basically the same thing. These are all shoes designed to stabilize unstable feet.
Every runner needs the very best running shoes. Every runner pronates. But it is when and how much you pronate that actually matters.
In general, people with flat feet pronate more than people who do not have flat feet. But not all runners need pronation control running shoes.
Today on the Doc On The Run Podcast we're talking about why flat feet need motion control running shoes.
Very few things are worse to a runner than a running injury.
When you run, pain is mandatory, but running injuries are optional.
If you have ever been injured it is devastating.
To add salt to the wound, while you sit on the couch recovering, but getting weaker, you realize it is preventable.
Today we talking with the RunRx founder Valerie Hunt about the importance of developing better running form and strength for runners to prevent running injuries.
Every cloud has a silver lining. If you're injured right now, you need to look for the value in the discomfort right in front of you.
If you have pain when you are exercising there is a risk you will do damage to the healing tissue. That's why doctors tell you to stop running. Doctors don't necessarily want you to lose all of your fitness, but they don't want you to make the injury worse.
If you have been injured you have probably done some exercises in the past few days or weeks that cause pain.
When you are injured you have the possibility of making assessments with immediate feedback.
Today on the Doc On The Run Podcast we're talking about how you can find the value of exercising with pain.
“All in moderation.”
I'm not sure who said that, but it definitely was not an endurance athlete.
Unfortunately the idea of training in moderation, treatment of running injuries in moderation and everything in between has infected the recovering runner's world.
We do our speed work too slow and our base training too fast.
As a consequence of that moderation of our workouts we do not reap the full benefit nor the intended purpose of either of those workout sessions.
Today on the Doc On The Run Podcast we're talking about how the gray areas in training and the gray areas in healing are what is really slowing you down.
"If you’re not training, you’re not getting more fit." - Mark Allen
The very best way to lose all of your running fitness is to get injured and be forced to stop training.
Today on the Doc On The Run Podcast we are talking with 6-Time Ironman World Champion Mark Allen about the importance of preventing preventable running injuries.
In this episode Mark is going to share with you three and truly useful ideas:
-
The keys to competing at a high-level for decades - and never have a serious injury.
-
The shift it takes to make a difference between losing and winning.
-
Simple changes any athlete can make today to stay healthy, get stronger and run longer.
A runner who was listening to the Doc On The Run Podcast asked about the association between low aerobic fitness and running injuries.
Any runner who gets an injury does so simply because the tissue has not performed the way it should.
The harder your tissues work when you exercise, the more oxygen they require. When you are working hard and simultaneously depriving your tissues of oxygen, you're putting yourself at risk in a number of ways.
Today on the Doc On The Run Podcast we're talking about how low aerobic fitness can lead to a running injury.
Runners want to run. Ballet dancers want to dance.
But runners just run. Ballet dancers, don’t just dance.
Ballet dancers practice the basic moments that make them better dancers.
I just recorded a new Doc On the Run Podcast interview with Valerie, the founder or RunRx.
That interview is coming out soon (so watch for it), but she made such a great point, I thought you should hear about her ballet/runner analogy now.
Today on the Doc On The Run Podcast we're talking about what runners can learn from ballet dancers to help prevent running injury.
I just got off a call with a runner who broke his little toe and he is trying to get back to running.
Pain when running is one signal that you are disrupting the healing process.
His main question was if he could run without pain, is it okay to run on the broken toe before it is fully healed?
He is concerned that if he runs and the broken toe doesn't heal, that would obviously lead to problems and he doesn't want to have a non-healed broken toe.
Today on the Doc On The Run podcast we're talking about what happens if you run and your broken toe does not heal.
When you get injured, you can lose ground very, very fast.
You don't have to lose all of your fitness just because you're in the recovery process.
Don't throw in the towel.
Don't give up.
Do something.
Stay fit through the injury recover process.
Today on the Doc On The Run podcast we're talking about the two rules from Warren Buffet that can help injured runners.
“Weakness causes running injuries.”
If you're a runner who has been injured, you probably feel that's a little bit like rubbing salt in the wound.
But make no mistake about this, if you get injured, it's because you are weak.
By definition, all over-training injuries are a result of weakness. Specifically, tissue weakness.
Today on the Doc On The Run podcast we're talking about how weakness causes running injuries.
Why do you wear running shoes?
Running shoes are supposed to cushion when you land.
Running shoes are supposed to prevent some of the damaging forces when you run.
Running shoes are supposed to supposed to support your feet when you run.
Running shoes are supposed to supposed to protect you when you run.
Today on the Doc On The Run podcast we're talking about how worn out running shoes cause running injury
Races really don't injure runners.
Any runner who gets injured in a race really did the damage long before the actual running event.
During the build phase, you actually feel really strong. Your muscles are getting stronger. Your aerobic fitness is in good shape.
But your tendons, ligaments and bones don’t build strength as fast as the muscles.
They are all actually more prone to injury during that phase. The big build phases of training are also where you happen to ramp up your workout intensity and your running volume.
And that's when most people get injured, not surprisingly.
Today on the Doc On The Run podcast we're talking about how races don't cause running injuries.
I believe in research. I am absolutely convinced that if the study or clinical trial shows a high likelihood you will have an adverse event like a heart attack or stroke when you take a medication, you probably should not take that medication.
Clinical research can show you very clearly what you should not do.
Clinical research however does not always show you so clearly what you should do.
And that is where things start to get cloudy.
Today on the Doc On The Run podcast, we’re talking about why runners should not look for a cure through a clouded lens.
Toenail fungus is gross!
And believe it or not, toenail fungus, the stuff that causes athlete's foot, it's all the same, and it lives in your home.
If you get toenail fungus or if you get athlete's foot and you're treating either of those fungal infections on your feet and you're a runner, you have to make sure that you get rid of all of the fungus in the areas in your home where it accumulates if you really want to get rid of it for good.
Otherwise, if you spray some stuff on your skin, if you apply some stuff to your toenails, if you get laser treatment for your toenails or any of those things, and you don't eradicate all of the fungus from your home, you're just going to re-expose yourself to it, and you're way more likely to get reinfected later.
Today on the Doc On The Run podcast, we're talking about the 8 places where runners foot fungus lives in your home.
When plantar fasciitis first starts, doctors call that an “acute case” of plantar fasciitis.
Acute plantar fasciitis (which just started) should be treated differently than chronic plantar fasciitis (that has been around for months).
There are 2 common mistakes runners make with plantar fasciitis.
There are also 3 things runners should so do right when plantar fasciitis begins if you really want it heal and get back to running as quickly as possible.
If you do everything right, you should notice a huge improvement in just a few days.
Today on the Doc on the Run podcast, we're talking about first aid for plantar fasciitis in runners.
If you run and ignore that aching pain in your foot it could be a metatarsal stress fracture.
If you're strong as an ox and half as smart and you keep running, and ignore the pain, you could actually break the metatarsal bone.
If the broken metatarsal bone moves out of position your doctor may recommend surgery to put the bone back in its proper position and stabilize it with pins, plates and screws.
The big question is whether or not you should be able to run after you heal.
Today on the Doc on the Run podcast, we're talking about whether or not you're going to be able to run again after broken metatarsal surgery.
Most of the time when runners go to the doctor with a running injury, the doctor tells you to quit running.
The doctor is simply trying to pick the simplest fastest way to reduce the stress and strain on the injured tissue.
But of course, runners want to run. Whenever runners call me for a consultation and it is always because they really want to know the answer to one specific question:
“Can I run with this injury?”
The answer is never as simple as either yes or no.
Today on the Doc On The Run podcast, we're talking about the difference no, maybe and probable, an injured runner and you're trying to figure out whether or not you can run and still heal.
If you a runner in training and you break one of your toes, or snap a metatarsal bone, you may worry about hoe long you need to stop running.
When you are get a fractured bone, you probably want to know what it will take to heal the bone and how quickly it is going to heal.
One of the ways doctors classify broken bones in the feet and toes is whether it is a “displaced fracture" or a “non-displaced fracture."
Today on the Doc On The Run podcast, we're talking about the difference between a a displaced vs non displaced fracture, and what it means if you are a runner.
Yesterday I was talking to a runner who had an ankle sprain that didn't improve. After about a year of not be able to run, having pain when walking and becoming really frustrated with not being able to run, he called me for a second opinion.
During that discussion he asked me whether or not it would be better to get an MRI or a CT scan to evaluate the bone, joint and surrounding soft tissue to determine what was really going on and preventing him from getting back to running.
Today on the Doc On The Run podcast, we're talking about whether an MRI or CT of your foot is better when you have a running injury.
Anytime you make a mistake in training, push a little too hard and get injured, you have pain. That pain creates an urgent need for answers. Specifically a need to answer three specific questions:
-
What is causing this pain? What is the diagnosis?
-
What is the treatment? What can I have to do to heal it?
3. How fast is it going to get better?
Basically you want to know what happened, and how quickly you can fix it. You want to put a name on the problem, start the correct treatment and have an expectation of how quickly that treatment will give you the result you want.
Above all else, you want to know when you can run.
Runners often get dark discoloration in the toenails. That discoloring can happen after long runs, trail runs, wearing ill-fitting running shoes or trauma.
The question is whether or not the dark brown, blue or black area in the toenail is just a bruise or something more ominous.
If you get a bruise under the toenail, it will gradually get better.
If you get toenail fungus, it will gradually get worse.
Today on the Doc On the Run podcast we're talking about how a runner can tell a bruise under the toenail from toenail fungus.
If you're a runner and you've been injured, you need to challenge your doctor to do better.
You are going to probably feel like challenging your doctor would have to be somewhat confrontational.
That doesn't mean you have to be offensive.
But you have to do something different if you really want to get your doctor on board with a rapid return to running.
Today on the Doc On The Run podcast, we're talking about how you should challenge your doctor to better when you are a runner.
Everybody wants to believe that there is some best practice, some standard of care, some safest way for you to heal when you get a metatarsal stress fracture or achilles tendinitis or peroneal tendinitis or plantar fasciitis or any other common overuse training injury when you're a runner.
But there is nothing that is risk-free.
Nothing is free in medicine.
It's not free in terms of costs, and it's not free in terms of risk. And for most runners, the risk part is the bigger part of the equation.
Today on the Doc On The Run podcast, we're talking about how there’s is no healing for a runner without risk.
How much time do I need to take off from running after my race?
The time you need to take off from running after race all depends on how long the race is and how hard you ran.
How much time do I need to take off from running if I get a running injury?
That depends upon your physiology and the status of your healing machine today.
You need to think about how fast you think you can heal, based on your fitness, physiology and level of training.
Today on the Doc On The Run podcast, we're talking about how long you should take off running to recover.
A runner with a metatarsal stress fracture recently asked…
“Isn’t it true that a fracture walking boot and crutches is the risk-free way to heal a metatarsal stress fracture?"
Although I hope you won’t tell my daughter, there are no unicorns.
And there is no risk-free way to heal a metatarsal stress fracture.
Today on the Doc On The Run podcast, we're talking about how the risk free way to heal a metatarsal stress fracture and other unicorns.
This weekend I was rock climbing in Joshua Tree National Park with my son. At one point he started climbing up to a point where we were going to practice rappelling.
He chose to climb up a way I knew was more difficult than necessary. But he wanted to proceed, so I let him.
You have to know whether or not you can proceed with the given activity without getting hurt.
Today on the Doc On The Run podcast, we're talking about how rock climbing is a lot like sports medicine.
Toenail fungus may be gross but it's common, especially in runners.
Running shoes are perfect little incubators for foot fungus.
The inside of shoes are hot, dark and moist. Running shoes can be the ideal environment for fungal infections. And you want to make sure you don't get a toenail fungus infections, you need to make sure you keep the fungus out of your shoes.
But there are three simple precautions you can take to make sure you don't have a fungus farm in your running shoes.
Today on the Doc On The Run podcast, we're talking about the 3 most important ways runners prevent foot fungus.
Many years ago I heard a quote from Tony Robbins. He said, “Remember, a real decision is measured by the fact that you've taken new action. If there's no action, you haven't truly decided.”
When you're an injured runner you can't just wait for it to heal like a normal patient because the whole time you're waiting, things are getting worse. You are losing your aerobic fitness, you are getting weaker, you are losing your neuromuscular connections. Your form is falling apart.
If you have an overtraining injury and have decided you want to heal faster than the average patient, you have to take action.
Today on Doc On The Run Podcast we're talking about how if you haven't taken an action, you haven't made a decision.
If you are a runner and you have some pain, and maybe a little bit of swelling, in the ball of the foot under the toes, you might be concerned you have a plantar plate sprain.
Maybe you were diagnosed with “metatarsalgia.” Maybe you thought you had a metatarsal stress fracture.
But maybe after listening to one of these talks on plantar plate injuries, you started to think you might have plantar plate sprain instead.
Obviously if you are treating the wrong condition, you are not likely to improve very quickly. If you want to maintain your running fitness and get back to running as quickly as possible you have to have the correct diagnosis and start getting better.
In the simplest sense, there are basically three ways to tell for sure whether or not you have plantar plate sprain.
Today on the Doc On The Run podcast, we're talking about 3 ways a runner can confirm a self diagnosis of plantar plate sprain.
I just got an email recently from someone who is a runner and one of the things he asked, he said, "Should I be patient, and are the chances good that the pain will subside after four to six weeks on its own, of just not running?”
Well, that's a good question, but that depends.
The first thing that you have to think about when a doctor tells you, you just should take off running, and stop activity, stop doing everything for four to six weeks, you have to ask yourself several questions.
Today on the Doc On The Run podcast, we're talking about whether or not an injured runner should just be patient.
If you go to the doctor, and you tell the doctor that you run on trails, you've sprained your ankles before, and you seem to roll ankles frequently, the doctor will tell you that you are suffering from “chronic ankle instability.”
If your ankle just feels unstable when you're on uneven ground, when you step on a root, or rock, or something, if your ankle sort of flips out from under you a little bit, it seems like you're spraining your ankle (but it doesn't even hurt), well that's something that we call “chronic ankle instability.”
Today on the Doc on the Run Podcast, we're talking about how trail runners get chronic ankle instability, and what you can do if you have it.
Training for a marathon is an active process. You have to think about what you're going to do, you have to come up with a plan.
You have to design a training program that will get you stronger, get you faster, get you more fit and better prepared for your event, if you're going to finish your race on time.
When you get injured, healing itself from that injury is an active process, but unfortunately by default, people revert into a passive process.
Today on the Doc On The Run Podcast, we're talking about how healing a running injury is an active process.
There are only two cases in which a metatarsal stress fracture needs surgery.
Before we get into that, I want to stress one point.
If someone tells you you need surgery, you need a second opinion. Never, ever, ever have surgery when only one person tells a runner should have metatarsal surgery!
Today on the Doc On The Run Podcast, we're talking about the only 2 times a metatarsal stress fracture needs surgery.
Today on the Doc On The Run Podcast, we're talking about how lack of discipline causes running injury.
This episode is probably going to rub a lot of runners the wrong way. No runner wants to think they lack discipline. Running is all about discipline. Running is about getting up early in the morning, about going for long runs in the dark, running when it's raining, running when it's hot, running when you just don't feel like running. For most people who are runners, we feel like and we believe that we have lots of discipline. We do what most people will not do, and that's why we can run and we can do events and finish them successfully.
Lots of runners who are in the midst of training, for some reason, they want to get custom orthotics.
I know that we, as runners, we're always looking for the tools, the latest training techniques, the newest, coolest shoes, the best kind of socks, the newest heart rate monitors, whatever...to help us train better and be faster.
There are a lot of misconceptions about custom orthotics and there are a lot of things that you should understand before you get custom orthotics.
Today on the Doc on the Run Podcast, we're talking about what runners should do before getting custom orthotics.
A few days ago, I got an email from a runner who wanted to know whether or not he should have surgery to fix his Jones fracture.
Well, the first thing you have to know about this is that you should only have surgery if you believe that is the only way you're going to heal appropriately.
When you're a runner, you really have to think about surgery very carefully. Because when you have surgery, your healing actually doesn't begin until after you're done with surgery. The healing process is always taking place, and you don't get any credit for anything that happens before the time you have surgery.
Today on the Doc On The Run podcast, we're talking about whether or not a Jones fracture needs surgery when you're a runner.
A couple of days ago I saw a runner who started having some arch pain in his left foot after he was did a run.
After he noticed this arch pain, he got some arch supports, and they actually made his arch hurt a lot worse.
Arch supports are supposed to take pressure off of the arch.
They are supposed to support the arch. They are supposed to make you feel better. But sometimes, arch supports can actually complicate another problem and make you feel a whole lot worse.
Today on the Doc On The Run Podcast, we're talking about why arch supports might actually make your arch hurt worse.
It's that time of year, and here in California there is tons of poison oak out on the trails!
I recently ran the American River 50 mile Endurance Run, and I got poison oak on that run.
Now, I've had many episodes with poison oak. I also see lots of runners who get it on these long events, I see lots of runners that get it on their normal trail runs on Saturday or Sunday.
In the first place, you don't have to get poison oak. But you can also do something about it if you do get poison oak.
Today on the Doc On the Run Podcast, we're talking about the top 3 weapons against poison oak for trail runners.
For about 15 years now, I've been teaching other doctors about running injuries. Every time I speak in a medical conference now, I ask doctors why they don't like treating runners.
I know some runners are actually surprised to hear this, but if you are a runner, yourself, and you've been to the doctor and you've had some doctor look at your intake form or some nurse look at your intake form, and said something like,
“Do you really run that much?”
“Why do you exercise so much?”
“Are you obsessed?”
“Are you some kind of exercise addict?””
Well if you've heard any of these things, you probably understand not all doctors like to see runners.
But when I am at medical conferences, I always ask doctors, “Why is it that you guys don't want to treat runners? What's your problem with them? Why is it that you think it's difficult to treat them? Do you think they're unreasonable? What is it?”
Today on the Doc On the Run Podcast, we're talking about the top 3 reasons doctors hate treating runners.
A plantar plate sprain is actually one of the worst possible injuries for an injured runner. They can be notoriously difficult to heal quickly if you don't do everything right.
Plantar plate sprains also have a tendency to evolve into a chronic nagging pain that just keeps you off of running and training for months. Even worse, if you don't treat it correctly, the plantar plate ligament can get so weak and degenerated from all of that chronic inflammation that you even get a hammer toe.
Unfortunately, one commonly recommended treatment for plantar plate sprains is a fracture walking boot.
Even though fracture walking boots are a mainstay of treatment, many runners will be horribly disappointed to find out how long it really takes to heal a plantar plate sprain if relying solely on the boot for the healing process.
Today on the Doc On the Run Podcast, we're talking about why fracture walking boots fail to heal plantar plate sprains in runners.
If you are runner and you started having pain in your foot and you concerned you have a metatarsal stress fracture, you may think you need to get an x-ray of your foot.
But why?
You probably want to know how bad it is!
You probably also want to know whether or not you can run, right now.
But you may be surprised to hear that x-rays of your foot will not really help answer either of those two questions if you are a runner and suspect you have a metatarsal stress fracture.
Today on the Doc On the Run Podcast, we're talking about the only 2 reasons you should get an x-ray for a metatarsal stress fracture.
When you've been injured and you are starting to run again you have a very delicate balance to maintain.
Your number one goal is to increase your fitness without stressing the injured tissue enough to inhibit the recovery.
The goal is to get stronger without slowing the healing process.
That healing process is always in motion. Every day the healing tissue gets stronger. And every day for healing tissue can withstand a little bit more activity than the day before.
Today on the Doc On the Run Podcast we’re talking about the slope of 2 lines you need to compare when you’re returning to running after an over-training injury
A metatarsal stress fracture, is probably one of the most common running injuries that you could get when you're training for a long distance event like a marathon, or an ultra marathon or if you're relatively new to running.
But the problem, of course, is that not all running injuries that seem like stress fractures are actually stress fractures.
Today on the Doc On the Run Podcast, we're talking about the top 3 conditions misdiagnosed as a stress fracture in a runner.
For most runners, when they're training for a marathon training program, or an Ironman the period of growth is usually about three weeks.
You take a period where you are increasing your activity, then you back off and start increasing again from a lower point, to allow yourself to recover fully and decrease your risk of sustaining an overtraining injury.
You should do a similar thing when you are recovering from a running injury, but that period can be much shorter because your increases are happening during a period where you're actually healing and recovering from a running injury.
Today on the Doc On the Run Podcast, we're talking about periodization in recovery and healing running injuries.
Sometimes it's hard to do a trail run and have that run be only on a trail surface.
You can't always run a trail run…entirely on a trail. What I mean by that is that you have some pavement, some asphalt, some road, or whatever, that you have to run on in order to get to the actual trail part.
It ends up being a mixed trail run.
Mixed trail runs can put you at risk of an over-training injury.
Today on the Doc On the Run Podcast, we're talking about avoiding injury on mixed trail runs.
The worst thing you can do after you've been healing with a stress fracture is to re-injure the bone.
Obviously when that happens, you have a huge setback, you've just lost weeks of training, you're going to lose more fitness, and in some cases you might have to start over again with the fracture walking boot. You don't want to do that.
Today on the Doc On the Run Podcast, we're talking about why the “Hop Test” is the worst test for a runner with a stress fracture who thinks the metatarsal bone has healed enough to run.
If you think about most of your runs, you do a warmup, you do the body of the workout, and then you do a cool down.
One thing that is interesting is I have recently noticed a number of runners who have gotten injured by doing runs where they're finishing on the hardest part of their run.
That can put you at risk of an over-training injury.
Today on the Doc On the Run Podcast, we're talking about why you should put the trouble in the middle of the run.
The harder you train during your big build blocks just before a marathon, the more risk you will sustain an over training injury. Because that’s when you are using harder. The more activity you do when you are healing an injury, the more risk you will slow the healing process. Because you might stress the tissue too much. But some activities inherently have a lot more risk than other activities. Today on the Doc On the Run Podcast, we're talking about the #1 riskiest running activity.
I get calls all day from people who do a lot of stuff and push the limits a little too far on the weekends. But if you do some simple things to accelerate your recovery right after those big running workouts, it can make a huge difference to avoiding an over-training injury.
Today on the Doc On The Run Podcast we're talking about the Legs Up The Wall Pose to speed your recovery after your weekend run workouts.
Once your injury is clearly improving, you will want to run. I know you want to run. You are runner! I get it!
Many recovering runners blow it and get a set-back just because the very first run is too much.
Before you can resume training and ramping up your running, you have to make sure running will be safe. That's where the "test run" comes in.
Today on the Doc On The Run Podcast we're talking about how to do your first test run outside.
When you get a metatarsal stress fracture, and you want to get back to running, you have to make an assessment on how bad it really is. The only other options is to stick with the standard treatments of “don’t do anything for 4 to 6 weeks.”
To do to figure out how bad your stress fracture really is.
Today on the Doc On The Run Podcast we're talking about 4 critical steps to deciding how bad is my stress fracture.
Resting is not all healing. If you rest too much, you’ll get weaker.
If you want to get back to running, as soon as you're healed, you need to do something to prevent all of the changes that can slow you down and put you at a higher risk of re-injury once you actually do get back to running and training.
Gravity and the pounding forces associated with running…that's only one of a half a dozen contributing factors that can prevent healing of a running injury.
Today on the Doc On The Run Podcast we're talking about cycling workouts for recovering runners
The Achilles tendon is the largest tendon in your entire body, and if it gets injured, you've got a real problem.
The Achilles tendon is what allows you to pull your heel up, off the ground, push off and accelerate when you run.
What many runners don't understand is that the Achilles tendon also helps slow you down and decelerate when you’re trying to slow down, absorb force as you're landing while you're running.
Today on the Doc On The Run Podcast we're talking about tendon Achilles early warning signs in runners.
I received and email from a runner who wrote, “I ran today and my foot hurt when I ran. What should I do right now?"
You want to take the quickest course of action that you can when you get an injury, and most people miss this.
Many times what we do instinctively is we stick our head at the sand. We just could say, "Okay, well I'm just going to wait and see how bad it is tomorrow." But when you do that, you're actually missing some crucial steps. There are really a few things you need to do right now.
As an athlete I'm sure you know that it's important you believe you can accomplish your goal.
What's interesting to me is that many patients, many injured runners don't really think that much about how important it is that you actually believe in the treatment you're being offered.
If you feel uneasy about the treatment, you don't think it makes any sense and you don't think it's going to work for you, even if you trust the doctor, you shouldn't do it.
Today on the Doc On The Run Podcast we're talking about how if you don't think it will work, you shouldn't do it.
There are lots of things that you as an injured runner may hear in a doctor's office that really can be false evidence. Something that the doctor presents to you, that you then accept as fact.
"All fractures take six weeks to heal."
"You just have to take this pill, if you want to get better."
Or, my favorite, "You have to stop running to heal."
Today on the Doc On The Run Podcast, we're talking about how runners should take note of Doctor's F.E.A.R. False Evidence Appearing Real.
“First, do no harm.” This basic idea is at the foundation of medicine. Doctor’s are sworn to the Hippocratic Oath, and they want you to get better. Even if that means preventing you from harming yourself when you are injured.
As a runner you may feel like the very treatment offered to you will permanently harm your ability to train, run and perform…forever.
But there is way to turn this idea around and get the doctor to buy-in to your concerns.
Today on the Doc On The Run Podcast we're talking about how the Hippocratic Oath can help you get back to running sooner.
Two very common causes of foot pain in runners are neuroma and capsulitis. Some treatments help both conditions. But some treatments will only help one and not the other.
If you have pain in the ball of the foot when you run, you need to do do 3 things to heal quickly; accurate treatment, accurate diagnosis, and aggressively do the things that help and avoid the things that slow your recovery.
Today on the Doc On The Run Podcast we're talking about pain in the ball of the foot in runners and why the right diagnosis matter.
Running injuries aren't caused by running too much!
Running injuries are caused by applying too much stress to specific structures when you're running on a slope or changing direction.
If you want to reduce the risk of getting over training injury, mix things up.
Today on the Doc On The Run Podcast we're talking about about why you should reduce your risk for injury and run the other way.
Which is more likely to cause an injury....running fast, or running slow?
Explosive speed workouts can put you at risk of injury. Running at your limit can put you at risk of injury. But believe it or not, if you spend too much time running slow, you may actually increase your risk of an overtraining injury.
Today on the Doc On The Run Podcast we're talking about about how slow may be your injury speed.
Morton’s neuroma is a common cause of pain in the ball of the foot in runners. Doctors often tell runners to stop running when when they get a neuroma.
But don’t be confused. Runners should always figure out how to keep running!
This episode is inspired by Cathy, who sent a comment which all runners with Morton’s neuroma should find encouraging.
Today on the Doc On the Run Podcast, we're talking about how you should not let Morton’s neuroma stop you from running.
Lots of running injuries are aggravated by bending of the toes. Plantar plate sprains, sesamoiditis, and Morton’s neuroma all get irritated when you bend the toes too much while you run. If you have any of these conditions it may help if you add some stiffness to your running shoe.
One way to add stiffness and help decrease pain in the big toe joint and the ball of the foot is too add a carbon fiber insert to the running shoe.
Today on the Doc On the Run Podcast, we're talking whether or not you should add carbon fiber stiffening insoles to your running shoes.
When you get an over training injury, what happens? It's too much stress applied to one structure over too shorter time without enough recovery to actually let it fully heal before the next workout.
There are a few things that you can pay attention to that often signal the possibility of an injury that's coming on.
Today on the Doc On the Run Podcast, we're talking about signs to look out for that may signal you are heading for a running injury.
Are your running shoes the best for your run today?
There are all kinds of running shoes, and they are all built for different runs, different foot types, and different runners. Every shoe has its place.
Every runners longs the one perfect running shoe. Everybody wants the best running shoe…built just for you.
Today on the Doc On the Run Podcast, we're talking about how to choose the best running shoes for the run.
Are your current running shoes putting you at risk for a stress fracture?
One common reason for too much bone stress is that a runner didn't have enough cushioning because they were using a shoe that was too stiff, or wasn't padded enough, or soft enough, and they were running on concrete or asphalt.
That run, in those particular running shoes, beat up the bone too much and then the bone started to crack and develop into a stress fracture.
Today on the Doc On the Run Podcast, we're talking about what the worst running shoes for stress fractures.
I was recently at a medical conference and I asked all the doctors in the audience ... I said, "What causes stress fractures?"
A doctor raised his hand and the very first thing he said is, "Running too much." Well, that is not true. That's the default answer, but that doesn't make any more sense to me than telling you that not running will cure your stress fracture.
Today on the Doc On the Run Podcast, we're talking about what really causes stress fractures.
If you really think about it, the number of hours that you sleep really has a direct correlation with your risk for running injury.
Running injuries never happen because you ran too far. They always happen because you loaded one structure too much, you beat it up too much, and you didn't let it recover enough before the next workout.
You don’y have to run less. But you have to rest more.
It’s not necessary to spread your workouts farther apart. But you must maximize the recovery.
Today on the Doc On the Run Podcast, we're talking about how much rest your running body really needs.
Metatarsal stress fractures are one of the most common running injuries.
If you are runner and suspect a metatarsal stress fracture, you have to use some common sense, do everything that you can to heal it as quickly as possible and then get back to running.
But there really are three mistakes I see runners make over and over and over, even when I see runners with stress fractures.
Today on the Doc On The Run podcast we're talking about the 3 crucial mistakes that runners make when they get metatarsal stress fractures.
Barefoot running injuries don’t happen to novice runners.
Most runners who decide to run in minimalist running shoes or run purely barefoot, they don't take up running and decide to do that in minimalist shoes or barefoot right out of the gates.
Most of the people I see, most of the runners I talk to, most of the runners who call me for a consultation and want to ask questions about their barefoot running injuries, they are experienced runners.
Today on the Doc On The Run podcast we're talking about the number one mistake runners make when running in minimalist running shoes.
Broken toes are common, but they can really hamper your training when you're getting ready to run a race. If you break your toes a few weeks before a big race the question is always whether or not you will be able to run your race.
Today's episode is based on the questions sent in for a runner who fractured a couple of toes and wants to know whether or not she's going to be able to run her race in a few weeks. This episode will help you understand the questions to ask if you break your toes and you still want to run your race with broken toes.
It's no big secret that I really don't like fracture walking boots for runners.
I think doctors over-prescribe them. When you use fracture walking boots for too long, it causes weakness, stiffness, decreased bone density, loss of neuromuscular connections, and a whole bunch of unnecessary increased risks where you getting another different overtraining injury when you're actually back to running and full training.
Today on the Doc On the Run Podcast, we're talking about the 3 times you really might need a fracture walking boot if you’re a runner with a metatarsal stress fracture.
Achilles tendinosis can be a tough problem. If you're a runner who gets tightness in your calves and then develops Achilles tendinosis, it can be very difficult to get it to heal and it can be very frustrating.
Today on the Doc on the Run Podcast we're talking about Achilles tendinosis that has failed multiple attempts at treatment.
If you have pain and swelling in the toes after a run, you might be worried you have a stress fracture in the toes. But you have to figure out if the injury is in one of the bones of the toes, or if you have a metatarsal stress fracture instead.
But you also have to make sure you don't have a plantar plate sprain.
Today on the Doc On the Run Podcast, we're talking about toe stress fractures from running.
If you are running with pain in the ball of the foot that seems like a stress fracture, it could be a plantar plate sprain. If you get a plantar plate sprain right before a race, the obvious question is whether or not you should do the event.
If you have a sprain of the plantar plate ligament, you may still be able to do your race. You just have to decide how bad the injury is, what your long-term goals are, and how badly you want to to participate in the event.
Today on the Doc On the Run Podcast, we're talking about whether or not you can race with a plantar plate sprain.
Hydration is one of the limiters for many runners. It seems like often-missed, low hanging fruit that has the potential to boost performance in long events like marathons and ultra-marathons.
I know as runners we all want to focus on working harder, suffering more and trying to come up with some new technique or training plan that's going to get us faster and stronger. But in many cases when we are already training at a high-level there are very few gains to be made by working harder. Some of the biggest gains actually come from small changes in other areas, like improving nutrition, improving the quality of our sleep or by maintaining a state of optimal hydration.
Today on the Doc On The Run Podcast, we are talking about staying hydrated during your long runs with Josh Sprague, endurance athlete, and founder of Orange Mud.
How often should you get new running shoes? That depends on how quickly they wear out! Some runners get new running shoes every few months. Some running coaches tell runners to replace running shoes every 200 to 500 miles. If you keep running in worn out shoes, you may be putting yourself at risk of an over training injury.
But a lot of different variables can affect how quickly your running shoes wear out. If you understand the variables that can affect how long your running shoes last, you can make much better decisions about how frequently you need to replace your running shoes.
Today on the Doc On the Run Podcast, we're talking about how often you should replace worn out running shoes.
Do you really need custom orthotics if you're a runner?
If you're a runner and a doctor suggests custom orthotics, you may need orthotic inserts, but you may not. At least not forever. Many runners just need custom orthotic therapy for a short time to help heal an injury and keep running.
Today on the Doc On The Run Podcast we're talking about whether or not you really need custom orthotics for running.
When we run, we feel better. But what happens when you get busy, or even worse you get injured and you're not really able to run. Do you get bummed out? Do you get anxious? Do you get depressed?
In this episode we have a fantastic interview with William Pullen who literally wrote the book on Dynamic Running Therapy.
Today on the Doc On the Run Podcast we are talking with William Pullen the author of Running With Mindfulness about how Dynamic Running Therapy can improve low mood decrease anxiety decrease stress and help depression.
If you are a runner with a metatarsal stress fracture, you can simply stop running and wait for the bone to heal. The other option is to figure out how to heal it faster and keep running while the stress fracture is still healing. If you do that, you can get back to running a lot faster!
Today on the Doc On The Run Podcast, we're talking about the 12 Steps to healing and running with a metatarsal stress fracture.
If you are running and you get plantar fasciitis, you probably want to get back to running as soon as possible. Many doctors will tell you to quit running. Doctors may also recommend lots of other treatments for plantar fasciitis like cortizone injections, custom orthotics, icing, elevation, supportive shoes, physical therapy, non-steroidal anti-inflammatory drugs, and even surgery.
Most runners with plantar fasciitis simply don't need most of these treatments.
Today, on the Doc On The Run podcast we're talking about the single best treatment for plantar fasciitis in runners.
Medicine is all about risk versus benefit. Everything in medicine has risk.
There's risk with everything. There is risk with running with a stress fracture. There is risk with using a fracture walking boot when you get a metatarsus stress fracture. You're actually going to be more at risk of other over-training injuries later. So there's risk even with not running.
Today, on the Doc On The Run podcast we're talking about how running with a stress fracture is all about risk management.
Should you ramp up your running training when your healing injury doesn't feel like it does not hurt much worse while running?
As soon as the healing stress fracture gets a little bit stronger, you should start ramping up your fitness so you don't just lose all of your running fitness.
The big question is, is whether or not it's okay at that point to really ramp up training, keep running longer, keep running harder when it seems like the very mild, barely-noticeable foot pain isn't really getting worse.
Any over-training running injury is caused by too much stress applied to that one structure. Once it starts to heal and you are trying to return to running, you have to keep the overall amount of stress applied to that one healing structure low enough so it can continue to heal even while you ramp up your activity and run.
Today on the Doc on the Run podcast, we're talking about how much stress reduction you need in your foot to heal while you continue to run.
The reason I like out in back runs for long runs is it makes me committed. I can’t quit. But out and back runs can actually put you in a really vulnerable position when you've been injured. If something starts to hurt during your run, if you've noticed some new odd sensation, you still have to get home.
Today on the Doc On The Run Podcast, we're talking about why injured runners should avoid the out and back.
A pothole is a classic road hazard. It is an obstacle in the road that can cause trouble. If you're going fast in your car and you hit a pothole, it can actually blow out your tire. If you are running and you step in a pothole, it can break your foot.
Road hazards are avoidable dangers in your path that cause trouble. This is true for drivers of automobiles and it's true for runners as well. Today we are going to talk about the top three road hazards for runners.
A tight Achilles tendon can cause a variety of problems for runners. A night splint is a brace that is supposed to help stretch a tight Achilles tendon by holding the foot in a corrected position while you sleep.
A night splint is often recommended to runners when they get plantar fasciitis or Achilles tendonitis.
But there actually is a brace that I think is really much better than a night splint. It is not actually a night splint, but it is something called the “Equinus Brace.”
As soon as you sign up for a marathon you start to think about what it will take to finish it. You come up with a plan. You design a series of of workouts. And you realize you are going to have to suffer.
Before you even begin you first workout, you convince yourself that success will require pain and suffering.
But if you maintain your marathon mindset and you just tell yourself you're supposed to suffer you will suffer yourself right into an over training injury. And then you won't have days of workouts to reorganize. You may wind up with weeks or months of completely avoidable time on the couch.
Last week I was lecturing on running injuries at a medical conference. A doctor in the audience asked, "What do you do exactly when a runner tries to renegotiate their activity level with you, the doctor?”
When you're injured, you have to face it. You have to shift your mindset. The most important thing you can do as an injured runner is to remember that your actual most important goal is to finish your race on time.
Let me explain the one goal you should have when you get a running injury.
How long before I can run on a metatarsal stress fracture?
The short answer is this, you can run as soon as the metatarsal bone has healed enough, becomes stable enough, to withstand the stress you apply to that bone when you run.
Today on the Doc on the Run Podcast, we're talking how long it should take before you can run on a metatarsal stress fracture.
If you want to get back to running sooner, you have to figure out a way to maintain the maximum level of activity your healing tissues can withstand without causing any further damage and without impeding the healing process. There is a fine line between healing while your running fitness diminishes and healing while simultaneously advancing your fitness.
When it comes to healing and trying to figure out the line between too much activity and not enough activity, pain is your guide.
Today on the Doc On The Run podcast, we're talking about how pain can be used as a tool to recover faster from running injury.
Is it dangerous to run on a stress fracture? Stress fractures are one of the most common problems runners get when over training. When injured, stress fractures can keep you off running for a really long time.
Runners are often running on stress fractures. Sometimes knowingly, sometimes unknowingly. You have to figure out whether or not you're going to cause any permanent damage to the bone, or disrupt your long-term goals, before you can decide whether or not it's dangerous to run on a stress fracture.
Today on The Doc On The Run Podcast we're talking about whether or not it's dangerous to run on a stress fracture.
If you get pain and swelling in the ball of the foot you might become worried you have a fracture. Let's face it. When runners get an aching pain in the foot at the first thing we worry about is probably a stress fracture.
The good news is that in the overwhelming majority of cases where you have pain in the ball of the foot at the base of the toes, it is not usually a broken bone. But it can happen. In today's episode we have an interview with Coach Craig Moss who is a 46-time marathon finisher.
Today on the Doc on the Run podcast, we're talking about a fracture in the ball of the foot and what it takes to get back to running with Coach Craig Moss.
You get a running injury because you made a mistake in over-training. You tripped over something. You did just a little too much in your workout. Something went wrong. It was an accident.
But healing does not happen by accident. Healing a running injury has to be intentional, just like your training.
Think about what you do in training. You have a very, very specific plan to make sure you stay on track, but it is not by accident.
And it's the same way with the healing process after you have an over-training injury. Don't forget, when you get an over-training injury, all it really is is an exaggerated form of the same tissue damage that you get in normal training when you're running.
So, you can use that same sort of active plan being very intentional about when you're going to heal, and how quickly. All of that must be deliberate, but you can't have mistakes in healing the same way you can't have mistakes in your workouts
Today on the Doc on the Run podcast, we're talking about how healing a running injury does not happen by accident.
If you're not moving, you're more injury-prone. If you got an over-training injury from running, and you're not moving, if you're not exercising, things are actually getting worse for you. You are actually getting more injury-prone, not less.
This is the misconception: if you get injured, you have to sit still. You have to rest. You have to ”take care of yourself,” and you have to heal. And that is what physicians feed runners most of the time; this idea that they should just calm down, sit down, chill out, relax, recover, take it easy…whatever. But you know as an athlete, there are only two possibilities: Either you're getting stronger, or you are getting weaker. And if you're getting weaker, you're actually more injury-prone.
Today on the Doc on the Run podcast, we're talking about how if you're not moving, you're actually getting more injury-prone.
Faster means faster! It means making decisions quicker. Forward means you and your doctor are making decisions more frequently so you can shorten the recovery time and make it to your next race.
So how does that really work?
Today on the Doc On The Run podcast, we're talking about how runners fast-forward healing.
The key with recovering from running injuries faster than normal patients is to identify what it is helping your healing, and what may be hindering your recovery. Runners don't choose the rate of recovery. Runners choose our habits, and our habits choose our rate of recovery.
Today on the Doc On The Run podcast, we're talking about why you shouldn't have high hopes for healing if you have downhill habits.
How does healing change on a weekly basis? It's going to continue to change throughout the healing process from day to day. No, it's not going to change a great deal in one day, but it's going to change a lot in a week, and it's going to change a whole lot more in two weeks.
Everything's getting stronger: your muscles, your tendons, your bones, your ligaments, everything. You're getting stronger and stronger the whole time you're training and the whole time you're healing.
Today on the Doc On The Run podcast, we're talking about how last week's healing won't heal you today.
Why do runners heal faster? Simple...You are not a normal patient if you're a runner.
Not only do you exercise more, you eat better, you sleep better. You as a runner are a well-primed healing machine and this is the bottom line. If you think about it, if you've been a lifelong runner, what have you been doing? You go out and you train. You do tissue damage and then your body rebuilds it. So you have been teaching your body, physiologically priming that system, to heal. Your body knows how to heal.
Today on the Doc On the Run podcast, we're talking about why runners heal faster.
Today on the Doc on the Run podcast, we're talking about the number one book every runner should read in 2019.
I may be going out on a limb here, but I'm going to recommend the number one book you need to read if you are a runner. I think this is going to be the best book for runners in 2019. And truthfully, it's not actually just a running book. The book is David Goggins', "Can't Hurt Me."
I actually met David Goggins about 10 years ago or so. And he probably won't remember me because I'm just a run-of-the-mill runner. But I met him at this event. It was a race in Chattanooga, Tennessee called the Wauhatchie Trail Race. Since that time, David Goggins has gone on to do some pretty amazing things! But, the truth is, what most people don't know is he did lots of amazing things before that...And that is what this book is all about.
If you want to achieve big things this year, read this book. Get it wherever you get books. You've gotta read, "Can't Hurt Me."
In "Can't Hurt Me", Goggins talks about his whole history. You are going to love it and you need to get this book!
Today we're talking about whether or not you should run when you have pain about 10 days out from a marathon.
This morning I got a call from Amy in Houston, and she's running a marathon in 10 days. She's doing the Houston Marathon. Today is Thursday, so a week from Sunday she is running the marathon. She has pain, and she's 10 days out, and wants to know if she can run now. That's the thing. She says, "I got this new pain, and I wanna run and finish my training." She admits that she didn't really train effectively, so she didn't train as much as usual. She normally is prepared for the marathon, but this year a bunch of stuff happened, just didn't get to train as much. Her plan was to try to run 10 miles today, on Thursday, and then maybe do a final 18 mile run on Saturday, and then maybe a few runs next week, you know, five, seven miles, or six miles, or whatever a couple of times next week, leading up to the marathon next Sunday.
So, her question is whether or not she should run. You know, she has this weird pain, this weird soreness. She's not sure what it is. She's done a bunch of marathons, but she doesn't know what it is. Is it a good idea to run or not? All right. So, just to back up, let me tell you, the first thing you have to know is that if she goes and sees a doctor, they're almost certainly gonna tell her to not run. Right? Why? Well, doctors tell you to not run, because they assume you wanna heal. Now, that sounds kind of simple, but that's the thing. When you're a runner, we know that that's not always the only consideration and certainly, in many cases, not even the primary consideration. They're not assuming your goal of finishing a marathon, an ultra marathon, an Ironman Triathlon, anything. They're not assuming that that goal of finishing is actually more important than your overall goal of making sure that you don't make your injury worse. Listen and I will explain...
Today on the Doc On The Run podcast, we're talking about whether or not you should taper or just continue training when you have soreness right before your marathon.
The purpose of a taper, is to really get prepared physically to do your best, actually perform your best, on race day. You should always taper if you have been sticking to your marathon plan, if you're fully trained, if you're fit, if you've really got all of your training in, then you can taper with confidence. But if you've done less than optimal training, i you didn't stick to your plan, well what are you going to taper from?
And somewhere in between there is where most people fall in. They missed a couple of workouts here and there, they want to extend the training period into that taper period, and that's where you start getting into trouble. And if you had any kind of injury and you extend your training into your taper period, you are really playing with fire. That part I don't think anybody would disagree with.
So you just have to decide, given your scenario, how much training you did and how closely you stuck to your plan, whether or not you can push your taper a little bit, or if you should skip it all together. But that's something you've got to talk with your coach and you have figure out what to do.
Remember, the goal is to make it to the race, make it through in one piece, and then continue resuming in whatever training is and you have to think about what your goal is after that event to really make a clear decision.
I’m recording this episode right around the start of the New Year, and this time of year everybody starts talking about their goals. Most people talk about where they want to be. What they want to accomplish, where they want to be, but I what I really think you have to think about is who are you going to be. Who are you going to be in one year, because … You know, it’s interesting.
You would never expect your son to go into third grade and come out of third grade without having changed tremendously both physically, socially, athletically, intellectually…in every way. That kid’s going to change a lot in one year. We expect our kids to change a lot all the time. They’re growing, they’re changing, they’re improving, but then we grow up and what do we do? We get a house. We get a job. We have kids. We get locked into a job, and then some of that development stops, right? Now, if you’re a runner that’s probably not true. You probably have goals that you’re trying to improve on all the time. If you’re a doctor and you have a practice you’re probably trying to improve your practice in the way that you take care of patients through the value that you’ve provided them. You’re probably trying to prove all of that at the same time.
Today on Doc on the Run podcast we’re talking about who you’re going to be one year from now.
The idea that one given treatment will work for one condition, when the people are different is absurd.
Runners are different than normal people.
Risks of certain treatments are much higher for runners then they are for other people.
Some treatments that are not risky at all for a runner, might be very risky for the average non-runner.
Today on the Doc on the Run Podcast, we're talking about if a treatment is best for most people, is it best for a runner?
This question comes up a lot for runners with Achilles tendon injuries. But it can happen with any kind of tendon. The difference between an injury to a tendon which has been labeled "tendonitis" versus "tendinosis" is really a difference in the amount of time that you have the condition and the amount of damage to the tendon itself.
There’s been a long running debate about this. I was lecturing at a medical conference in Iceland this the summer. Specifically, it was a lecture on tendon injuries in athletes. One of the key points was that the old research claims inflammation does not play a role in the development of tendinosis is wrong.
In this episode I will explain the difference between tendonitis and tendinosis.
Let me ask you a question. Do you set goals when you are training for a race? What about when you are injured? I mean let’s face it, if you are training for a marathon you probably have a really specific goal right?
You want to do a specific race on a specific day. You want to start at a specific time and you want to end at a specific time. So then you have a whole bunch of goals to try to get you to that particular outcome.
But how about when you get injured? I see runners all the time and they seem to just completely get off track when this happens. All of their goals go out of the window. They cancel the race, they don’t have any goals for their next race and many times they have no goals at all for their healing.
Today on the Doc On The Run podcast we’re talking about goals for healing your running injury.
The number one question I get from runners is "How long is it going to take me to heal this injury?" It could be a metatarsal stress fracture, it could be plantar fasciitis, it could be an Achilles tendon injury. Then the follow-up question is always "How soon will I be back to running?" The whole underlying premise of those questions is completely absurd. All of us want to believe it takes some certain given timeline for every given injury to resolve. And that’s just crazy! I get this question from doctors at medical conferences and they’ll ask me,"How long does it take for a fourth metatarsal stress fracture to heal in the average runner and how long would it take for them to get back to running." But that doesn’t make sense. It’s not that simple... In this podcast episode we’re talking about how long it will take to heal a running injury.
Today on the Doc On The Run podcast we’re talking about the 5 causes of big toe joint pain in runners.
If you are a runner and you have pain in the big toe joint, the first step in treating it is figuring out what is actually causing the problem. There are lots of different causes of pain in the big toe joint, but there are really five that affect runners most often. These are the most common that I see in runners, so I’m going to explain all 5 of the conditions to you.
But not all these conditions mean you have to stop running. There’s whole range of conditions in the big toe joint, but you have to figure out which one of these is most likely to be causing your pain, to decide whether or not you should stop running, or whether or not you can keep running and get it to calm down while you’re still running. You just have to make sure you know which is causing the problem to figure out if you can keep running.
I know I talk about this a lot but collagen is one of the most critical things when you’re healing any running injury. If you have a tendon, ligament, fascia that’s injured. All that stuff is made of collagen.
If you get an ankle sprain, you get an Achilles tendon tissue, you get a peroneal tendon tissue, you get plantar fasciitis. Any of those things, it’s all an issue with collagen and all of those structures have to heal.
If you think all you need to do is form collagen, that’s not really the whole story. The fact is that when you get one of these injuries, the collagen and the formation of collagen in your body to try to heal that tissue can actually be working for or against you when you’re a runner.
Today on the Doc On The Run podcast we’re talking about Collagen- is it working for or against running injury.
In an ideal world, we would have research that actually studies everything, every variable, every possible scenario and then helps you know conclusively what will work and what will definitely not work. The problem is that research studies really don’t work out that way. There’s almost never a study that shows that something is 100% effective for everybody, all of the time, given all of the variables that can go into a patient’s given circumstances.
When you’re a runner, that’s even way more complicated because you don’t just get injured and want to heal a specific injury like a metatarsal stress fracture or Achilles’s tendonitis. You want to run. You don’t want to just heal the thing, you want to run. You want to heal it as quickly as possible, so you can keep running. And you want to figure out why the injury happened in the first place so it doesn’t happen again.
Unfortunately, there are many doctors who hide behind their stack of research articles and they don’t really help you understand what the real possibilities are for you. When you’re a runner you have to look at every possibility.
In this podcast episode we’re talking about the difference between a doctor and a librarian.
You’re never staying the same. You’re never the same person. You’re not the same person you were a year ago, and you’re not the same person now. You’re certainly not the same person you were 10 years ago either. And what you’re doing professionally, you’re probably not the same sort of person you were a year ago or 10 years ago with that either. The truth is pretty much nothing stays the same in life. And running injuries, they have a life of their own. But they’re never staying the same either. And today we’re going to talk about that.
Now the other day somebody called me and they said, “You know, my injury just isn’t getting better. I have a metatarsal stress fracture and it’s pretty much just staying the same.” But the deal is is that, again, your injury is never the same. So you have to think about what’s changing, what’s getting better and what’s getting worse.
Today on the Doc On The Run podcast, we’re talking about how your running injury is never staying the same.
Can I run with a split peroneal tendon? Well, yes. There are two cases in which you can run with a split peroneal tendon. Number one. If you’re certain running will not make the peroneal tendons worse or if you can accept that you may make the injury worse and it’s worth the risk to you, given your specific goals. Today, we’re going talk about what all that means if you’re a runner with a longitudinal tear or a split in the peroneal tendons.
This whole episode is basically based on a couple of questions that a runner sent to me on Twitter. The first question was, “Is surgery the only option for runners when they have a split peroneal tendon?” And second, “If it’s possible to run? What a runner must do after running?” And then third, “What kind of exercises are good? ”
So, based on those questions, we’re going to put together this episode to help you understand split peroneal tendons and what that means for you as a runner.
Today on the Doc On The Run Podcast, we’re talking about the seven steps a runner should take when you’re not healing.
You’re probably a runner and you’ve probably been injured for some time. You probably just didn’t get injured last week when you were running a race, but you probably got injured a while back, and then a lot of things happened. You probably took a little bit of time and kind of took care of yourself, took off a few days from running. Maybe you iced it. Maybe you changed your routine a little bit, tried to do a little bit shorter runs, tried to in some way kind of slow down your training, slow down the intensity, and see if you could just get back on track.
But, something didn’t work. You didn’t get better. You maybe started to improve, felt like you were getting all better. Maybe even got to the point you were pain free, but then you started running again and the pain ramped back up. And now you’re sitting here wondering why it is that you’re not better and trying to figure out what to do next, and you’re probably incredibly frustrated because all of your fitness has dwindled away over this whole course of really half training and not really doing what you need to be doing in order to maintain all your running fitness.
So, there are always things you can do, but you have to really figure out what you can really do if you’re not healing. And today we’re going to talk about that.
Today on the Doc On The Run podcast, we’re talking about the top 10 myths about plantar fasciitis in runners.
There are a lot of myths surrounding plantar fasciitis, and plantar fasciitis is common, but you have to understand when you’re a runner that not all the stuff you read is true.
You can check out the course on runner’s heel pain if you’re really worried about this or you really want to keep running, you really want to figure out how to take care of it, everything’s in there. We created this monster course, it’s like two and a half hours of videos and it walks you through every step of the process of self diagnosis and self treatment of runner’s heel pain.
I recently went to pick up my 10 year son Alex from an after school program. He and all his classmates were playing on the playground. The camp administrator that runs the program actually approached me as I was walking across the playground.
He said, “Alex doesn’t make good decisions for his safety.”
I looked over and Alex who was standing up on the tire swing. He was swinging so high that he was almost horizontal at the top of the arc.
I looked at the Camp instructor and said, “That may be true. But it looks to me like he makes awesome decisions in terms of adventure!”
I will openly admit that I may be defined or labeled as a “risk taker.”
I raced motorcycles professionally. I fly a paraglider. I’ve climbed mountains in Alaska. I have done lots of solo big rock climbs in Yosemite and Zion national Park. I've even free soloed routes, climbing over a thousand feet off the ground, alone, with no rope.
When Alex was little we used to ride motorcycles together. He would often ask me to ride wheelies while he was on the motorcycle with me. Does that seem risky to you?
A lot of people think that motorcycles in and of themselves are risky or dangerous. But is riding a motorcycle dangerous?
What about someone riding a motorcycle on a road, somewhere in the countryside with no other traffic or no cars around. Does that really seem risky to you?
Look, the point here is that some things are just more risky than others.
If you are a runner and you've been injured you have to think about risk. There is risk in everything! Is running risky?
I recently got a great question from a runner in San Francisco.
“I just want to make sure that I’m not heading for an over training injury and want to make sure to reduce the inflammation. When I have soreness following a hard workout, should I apply ice?”
Overtraining injuries happen because you have too much tissue damage, and not enough healing of that injured tissue before your next workout.
If you want to make sure you never get an over training injury all you have to do is make sure that all of your soreness completely subsides before you do your next workout. Obviously that just makes sense. But it’s also an absolute impossibility for any training endurance athlete.
I would be willing to bet that almost all actively training and racing endurance athletes are almost always in some state of soreness. You’re going to be stiff. You’re going to be achy. That’s a normal consequence of the normal tissue damage sustained during a workout. You’re always going to be healing and recovering. That’s part of getting stronger.
Today on the Doc On The Run Podcast we’re talking about whether or not a runner should apply ice to treat soreness.
Today we’re talking about how inflammation management can make you slower.
After giving my lecture in Las Vegas a couple of weeks ago I’ve had so many different questions about inflammation that I thought we should doing an entire series of episodes about inflammation management in runners and other athletes.
There are lots of things you think about inflammation and one of the things you have to understand first and foremost is that you don’t always have to prevent inflammation. Runners think that inflammations is bad. We hear all this stuff about inflammation, about how it causes chronic Achilles tendon problems and chronic disease. But inflammation is just the thing that happens when you train. It’s a normal consequence of training.
You run, you train and when you do that you get tissue damage. That’s part of the process. You damage the muscles, you get little micro tears and then your body repairs them and you get stronger.
Inflammation is the very first step to repairing any tissue damage when you’re training and is the first step to getting stronger. So you have to have the inflammation as that initial response to the injury that you inflict on yourself when you’re training.
So today we’re going to talk about some basic guidelines about inflammation management.
Just about a week ago I was giving a lecture in Las Vegas at the 24th Annual Scientific Program of the International Foot and Ankle Foundation and this is a medical conference where podiatrists, foot and ankle surgeons, sports medicine doctors go to get their continuing medical education credits.
One of the lectures I was asked to give there was entitled “Inflammation in athletes – The good, the bad and ugly” and in that talk I was trying to go through and explain to doctors what really happens and why is inflammation such a big problem.
There’s lots of stuff written now and it’s been going on for a long time in way back in 20014 there was the cover of Time magazine. It was the secret killer and this link between inflammation and all these other chronic diseases that really cause trouble.
We think of inflammation as this inherently bad thing. In fact if you do a search and you’re looking up inflammation, you’re trying to learn about inflammation, you can actually find where doctors have written that inflammation is a pathology that has to be treated. And that may seem like its true because there’s so many different things related to inflammation and particularly in chronic inflammation.
Today on the Doc On The Run podcast we’re talking about inflammation, sometimes it’s good and sometimes it’s bad so you don’t always have to treat the inflammation.
Today I was out on a run and it was a great day. I was running in the sun and I was just trying to think about like what are the things that really slow runners down in terms of healing because the whole key with training efficiently is to avoid an overtraining injury and to really train as hard as possible, to do as much tissue damage as possible and then rebuild that tissue before you do your next hard workout so that you can actually increase your fitness, increase your strength, increase your speed and continue training.
All of that back fires when you get injured. So if you listen to this you may be one of those runners who is actually recovering from an actual overtraining injury. But if you’re not then you’re probably recovering from the last workout.
The whole point here is that there are really a bunch of things that we can do. I’m thinking about the really simple limiters. The things that we all do that we can easily capitalize on that. We can easily take into our training, into our daily routine and actually recover faster.
And that is true for you whether you have a true overtraining injury that sidelined you or if you’re actively in training and you’re trying to make sure that you avoid one of those overtraining injuries by making sure that you recover before your next key workout.
In this episode we’re talking about seven healing limiters that slow runners down.
An MRI is an interesting diagnostic tool and we often think that an MRI is the best thing to show you what’s going on inside your body when we suspect you have some kind of injury and your doctors have a difficult time making a diagnosis. But the truth is there are two really good reasons runners shouldn’t just jump to an MRI and try to get an answer when they’re injured we’re going to talk about that today.
Today we’re talking about 2 reasons you may not want to get an MRI if you’re a runner.
In this podcast episode we’re talking about sub-fibular impingement syndrome.
Why do runners get sub-fibular impingement syndrome? How can you tell if you have sub-fibular impingement syndrome?
That may sound confusing to you but I am going to explain it. I’m going to talk about what this condition is, the signs and symptoms, what you can do about it.
What is sinus tarsi syndrome? I mean it sounds like a complicated name but it’s not really a complicated condition. The “sinus” means basically like a tube or a passageway and “tarsi” refers to the rear foot bones in your foot. So the tarsal bones are the big bone in your rear foot like the calcaneus heel bone or the talus that sits on top of the heel bone and sits underneath your tibia and your ankle joint. Those are the greater tarsal bones.
Sinus Tarsi is actually a tunnel that runs between the talus and the heel bone. Your subtalar joint, the joint under which is important and runs under the neck of the talus in your subtalar joint and it’s a little cavity that has some fat, it has some nerve endings and it has some fluid that lubricates the joint.
But sometimes you can get inflammation on the tissue that lines that joint and when you get inflammation of the lining of that joint and it hurts, that’s sinus tarsi syndrome.
Today on the Doc On The Run podcast were talking about Sinus Tarsi syndrome on runners.
Why runners get extensor tenosynovitis?
Basically what happens is that you get this problem from a number of things. The most common thing is overuse. When you get inflammation of the tendon sheath injury it’s usually because you work the tendons too hard. But with the extensor tendons, it really doesn't happen that much unless you do a lot to hill repeats. But it’s not the tendons that get injured, it’s the inside of the tendon sheath that becomes inflamed and that's what causes pain.
The first thing is what exactly does that mean? All these medical terms you hear like extensor tenosynovitis, they all sound very long and they sound very technical or important but I think that's because most doctors just want to charge you by the syllables.
In this episode we're talking about Extensor Tenosynovitis.
Today on the Doc On The Run podcast we’re talking about why doctors misdiagnose runners.
All I do is talk to runners who are injured and want to run and ninety nine percent of the time when a runner calls me for advice is because they aren’t getting better and they want a second opinion.
Well much of the time the runner has been misdiagnosed. If you don't have the right diagnosis, you will be doing the right treatment for the wrong problem and you're not going to get better.
In this session we’re going to talk about the top six reasons doctors come up with the wrong diagnosis when you're injured.
I spend a lot of time talking to runners who have metatarsal stress fractures. Let’s face it, they’re common. And a metatarsal stress fracture may be one of the most disruptive injuries to you as a runner can encounter.
The reason metatarsal stress fractures are so worrisome to you is that most doctors will tell you it takes six weeks for bone to heal. And whether or not that’s actually true is entirely different episode.
I was recently in Reykjavik Iceland giving a talk on stress fracture healing strategies in runners. All of the people in the audience were physicians.
The main point of that lecture was to help doctors understand not everybody needs six weeks to heal a metatarsal stress fracture. And every single patient has the potential to significantly accelerate the healing process depending upon a number of factors.
What you eat, how much you sleep, what you’re doing to activate the recovery process can all influence the rate of healing when you have a stress fracture.
One of the super tools I recommend doctors consider for their patients is a bone stimulator. And in this episode I’m going to help you understand how a bone stimulator might help, if you get a metatarsal fracture.
Let’s Face it…Crutches Suck!
It’s still hard for me to believe that the same crutches, the same design that doctors hand out to patients today are more or less the same kind of crutches handed out to injured soldiers during the Civil War.
And although crutches are truly terrible, they can be a useful treatment to help any injured runner heal faster.
But you as a runner have to understand there’s a very high price to pay for using crutches. With one week of immobilization and non-weight-bearing on crutches you will have a 17% reduction in the muscle diameter size in that lower extremity. At six weeks, the damage is 60% and you actually can wind up with permanent atrophy as a result of being on the crutches too long.
That’s right. You can actually get permanent weakness as a consequence of using the crutches.
Today on the Doc On The Run podcast we’re talking about 3 keys to less time on crutches.
Yesterday I was talking to my sister, who is of course, also a marathon runner. She has been running marathons way longer than me and she is always fit.
She runs in the morning and then swims later in the day.
Swimming is a great way to cross train, supplement your aerobic fitness, strengthen your core fitness and frankly stay cool and relax in the summer.
But I got an email from a runner who had a bout of toenail fungus that was severe enough to need laser treatment to kill the fungus in the toenails.
After the treatment she said:
Now that I’m feeling “fungus free” – new mindset, a few days on the oral meds, new shoes, new yoga mat, flip-flops for the health club – I’m wondering: Is it OK to go back to swimming? This is one of my favorite leisure and workout activities at my health club (Club Sport). I take it that I should wear flip flops to and from the pool, etc. Any other advice or precautions?
Yes! You can swim.
You just have to make sure you don’t pick up any more fungus.
The fungus doesn’t just jump up and attack your toenails. Runners and triathletes can get it, first in the form of athletes foot.
Today on the Doc On The Run Podcast, we’re talking about how to avoid getting infected with foot fungus from swimming pools.
I actually did some research recently in preparation for a presentation I was going to be giving on running injuries at the International Foot & Ankle Foundation medical conference in Seattle.
When I went to Medline, which is the search engine that catalogs medical research articles for the National Center for Biotechnology Information, I entered the search terms “running” and “injury.” That search produced 5,093 articles that were published in authoritative medical journals around the world. So not only do a lot of runners get injured, apparently a lot of researchers are writing scientific articles about running injuries.
The primary objective of that research study was to figure out the true incidence of lower extremity injuries among distance runners. Basically they wanted to figure out how often runners really get injuries like shin splints, stress fractures, Achilles tendinitis, and plantar fasciitis.
In this episode we’re talking about why you aren’t healing like a professional runner.
Today on the Doc On The Run podcast we’re talking with Christiann Arbini about injury, recovery and what it takes to bounce back to national championship racing after a doctor told her she was done.
For years I’ve been saying you should fire your doctor when they try to rob you of hope and Christiann was a great example of how are you can succeed even if the conventional medical wisdom is not really on your side.
Christiann qualified for the 2018 USA Olympic distance national championship triathlon race and that’s not really the awesome part. The best part is that she did that after she suffered a serious injury while skiing and was told she might have to hang up racing altogether. Not only is she racing but she also has a thriving coaching business for athletes.
Christiann Racing is both a wellness coaching business which is dared to be fit for life and through that Christiann encourages athletes to reach for big goals, inspires them to succeed and helps you to become the best version of yourself.
A plantar plate sprain is an overstretched, possibly even partially ripped ligament on the bottom of one your little toe joints in the ball of the foot.
When you get a plantar plate sprain, there are really 3 issues:
- Inflammation
- Tissue damage
- Stress preventing healing
You have to address all three if you really want to get better quickly and get back to running.
Today on the Doc On The Run podcast we’re talking about how a runner can heal a plantar plate sprain.
Are you recovering at 100% capacity?
Are you doing truly everything you can to maximize your capacity for healing after your workouts? If you’re not, you’re wasting a lot of time when you’re training.
On Friday I was lecturing at the International Foot and Ankle Foundation meeting in Seattle. This is a medical conference where foot and ankle surgeons, podiatrists and sports medicine physicians go to get their continuing medical education. One of the lectures I was giving was on recidivism in runners and what doctors can and should be doing differently to help reduce the risk of re-injury.
One of the concepts I was trying to explain to doctors is the idea that there is no overtraining, there is only under-recovering.
Today on the Doc On The Run podcast we are talking about how a runner can heal a stress fracture.
When you get a stress fracture, there are really 3 issues:
- Inflammation
- Tissue damage
- Too much stress preventing healing
You have to address all three if you really want to get better quickly and get back to running.
Today on the Doc On The Run podcast we’re talking about whether or not you should run when you have a stress fracture in the heel bone.
The first thing to think about is like what is a stress fracture in the heel bone. The heel bone is an irregular bone. It’s an odd shape. It’s not tubular. It’s not square. It’s very thin on the outside and it’s sort of squishy on the inside. It’s kind of like a sponge. It’s really kind of like a hard boiled egg. A hard boiled has a hard shell on the outside and if you drop it cracks but it does not really deform and that’s usually what happens with heel bone when it actually fractures. If you drop it hard enough it will completely explode and the shell bursts outward in a bunch of little pieces and then we have to go and try to put it back together.
What we do is we actually put a plate and a whole bunch of screws to suck all those pieces together but it is never perfect. It is never the same again like a real fracture in the heel bone like that where it exploded is no good.
In this session I’m going to explain to you about whether or not it’s a good idea and how you might be able to run with a stress fracture in the heel bone.
Today on the Doc On The Run podcast, we’re going to talk about whether or not you can run with a partial rupture of the plantar fascia.
Can I run my race if I have a partial rupture of the plantar fascia? Well that’s a question I’ve got in a number of times from runners who’ve been to the doctor, they thought they have plantar fasciitis, they were told they had a partial rupture or a tear in the plantar fascia and then they want to know if they can do their race.
In this session we’re going to explain how you can decide whether or not you really can or should run when you have a partial rupture in the plantar fascia.
That may seem like a silly thing like you think if you’re wearing a fracture walking boot, there’s no way you're going to run a hundred miles. But there is a patient I just had a consultation with yesterday on the phone and we were talking about this because she's actually signed up for a one hundred miles trail race, she wants to do this ultramarathon and she's having a problem.
The task is to figure out really is it safe for her to do this run which is a hundred miles basically a month away or not. So we have a long talk about this and it was really interesting because she's very smart. She's had a couple of injuries over the years. She totally understands running. She’s a multiple sort of level endurance athlete. She has had a number different races, she has done lots a races and all kinds of races, strictly running, triathlon, all kinds of events and so she knows a lot about the process.
In this lesson we’re talking about how a couple of days in a fracture walking boot can actually help you decide whether or not you might be able to run a hundred miles.
Stress fractures are extremely common. But first thing is that if you’re going to figure out how to run the race, if you should run the race, whether or not it’s a good idea to run a race, you have to really understand what really is metatarsal stress fracture.
Doctors want to put everybody in the same little bucket of “You have a metatarsal stress fracture. You can’t run.” That’s not true at all. In fact I have had lots of patients who have actually had not only done an Ironman but I had one that actually had her fastest Ironman ever, four weeks after she was diagnosed with a metatarsal stress fracture and she was told to wear a boot for six weeks.
Today on the Doc On The Run podcast we’re talking about whether or not you can run your race if you have a metatarsal stress fracture.
Can I run my race if I think I have plantar fasciitis? That’s a good question. In this session what we are going to talk about is whether or not you can or should run if you think you have plantar fasciitis.
A lot of doctors tell you stop running if you have plantar fasciitis. Well, the idea is that you’re stressing the plantar fascia when you’re walking on it and of course when you’re running.
Today on the Doc On The Run podcast we’re talking about whether or not you should run when you think you have plantar fasciitis.
Today on the doc on the run podcast we’re talking with Patrick about how to stay on track when you see a doctor or physical therapist and make sure that they focus on your running goals.
The main reason I wanted to have him on the podcast today is he actually had this experience with physical therapy that can help people understand how to better get your physical therapists and doctors more on track with your goals instead of just focused on the injury.
One of the million dollar questions I get from runners is whether or not you can run when you have this specific injury. Just today I was on a remote consultation call on Skype with a runner who is an ultramarathoner. He is training for a huge trail race in the Dolomites and he wants to be able to run.
Well it turns out that he got a little bit peroneal tendonitis, he got some pain and swelling around the ankle and it was starting to bug in. So his big question is “Can I do the race if I have peroneal tendonitis?”
Today on the Doc On The Run podcast we are going to talk about whether or not you should run with peroneal tendonitis.
I think when a doctor tells a runner to quit running it doesn’t make any more sense than telling an accountant to quit working with numbers. Running is what we do. And running should be the goal. You have to work with a doctor who will help you get back to running. And no matter where you are, you should be able to find a doctor who will help you heal AND get back to running.
I talk to runners all over the world. Of course most of them are injured runners. The main reason injured runners call me when they want to get answers to all of their questions is they are frustrated by doctors who tell them to quit running.
In this podcast we’re talking about the five main reasons doctors tell you to stop running.
Healing takes time. The longer you take to recover the more fitness you’re going to lose. But when you’re an injured runner the less time you spend healing the sooner you are going back to running. So we all want to heal as quickly as possible.
When doing virtual doctor visit consultations with patients over the phone or via webcam, just about every patient who comes to me for running injury advice is trying to figure out how to get better faster.
After many years of working with runners I have identified a few types of runners who seem to take a lot longer to get better. So it may help you to think about each of these different types of runners who don’t get back to running as quickly as possible and see if you have any these characteristics yourself.
In this episode we are talking about 4 types of injured runners who won’t get back to running quickly.
If you are a runner with plantar fasciitis, you don't need to watch hundreds of different videos to get better. You just have to do some simple things at home consistently and your heel pain will go away. If you do the right things, but you’re not getting better, then the chances are good you probably don't have plantar fasciitis and have been misdiagnosed.
Runners are so frequently misdiagnosed with plantar fasciitis that I even wrote an entire book on Runners Heel Pain that you can get on Amazon. Even after I wrote the book on heel pain, runners kept calling to schedule virtual doctor visit consultations on Skype where they can actually talk to me and ask me questions. I pretty quickly realized they were all asking the same questions about what I do to diagnose and treat runners when I see them in person.
In this podcast episode we’re talking about 5 Plantar Fasciitis Treatments Your Doctor is Selling that Runners DON’T Need!
Today on the Doc On The Run Podcast we’re talking about the only three steps runners need to heal plantar fasciitis.
You don’t need to watch a hundred of different videos to get better. If you do these three things and you really have plantar fasciitis you should start getting better. In this episode we’re going to talk about the only three treatments needed to heal plantar fasciitis in almost every runner. If you’re not getting better, then the chances are good that you probably don’t have plantar fasciitis and have been misdiagnosed.
This problem is so common that I even wrote an entire book on Runners Heel Pain and you can get it on Amazon. Even after I wrote the book on heel pain, runners kept calling to schedule Virtual Doctor Visitconsultations on Skype where they can actually talk to me and ask me questions. I pretty quickly realized they were all asking the same questions about what I do to diagnose and treat runners when I see them in person.
So then, we even created an online course on Runner’s Heel Pain that teaches runners like you how to do their own self-diagnosis and make sure your are doing the correct treatment once you know which condition is really causing your heel pain. We’ve put links to the book and the course at the bottom of the show notes for this episode. Check those out if you’re confused about whether or not you actually have plantar fasciitis.
But you don’t really need the book on Heel Pain or the course on Heel Pain if you just have plantar fasciitis. Let’s talk about what plantar fasciitis is, and what you as a runner have to do to get rid of plantar fasciitis.
Today on the Doc On the Run Podcast were talking about how runners can get the very best second opinion.
The other day I had an interesting conversation with a runner who has had a really difficult time recovering. The bottom line is that she had a couple of surgeries that didn’t work out exactly the way she expected and now she is still having trouble.
So we were having a conversation about how she can make sure that her current treatment plan is the best plan to get her back to running. We talked about all different kinds of surgical options, different approaches and how the doctor’s decision making process works. And through the course of that conversation I realized that many runners just don’t understand how they should approach a doctor when they’re getting a second opinion.
Your goal when you are getting a second opinion is to make sure you are getting an unbiased perspective on where you are right now and where you want to end up.
Have you ever had a race that you really only made it through just because you believe you can do it?
Sometimes you get to a place where it seems like all you have left is hope and when you get to that place it seems like hope is really all that you need.
Today I was doing a remote consultation call with a frustrated runner in Texas. We worked through her problem and came up with some options that should help her figure out what’s really going on and get her back on track.
After the call, she sent a really nice email to me in which she said,
“Thank you also for the understanding and hope… an under-appreciated but invaluable commodity.”
That was a really nice thing to say but it really brought up a lot of things for me because I realized a lot of doctors do not offer hope. In fact, they do quite the opposite.
Today on the Doc On The Run podcast were talking about hope an underappreciated, but invaluable commodity.
Today on the Doc On The Run podcast we are talking about how you can use the power of meditation to relax and heal.
Jason Stephenson has been involved in the meditation and relaxation field for over fifteen years and he even has a YouTube meditation sleep music channel that has over 700,00 subscribers with over 90 million views.
For whatever reason when runners become injured they don't really seem to recognize the value of meditation. Maybe it's just that they've lost their focus and they kind of forgot about it. Maybe they're distracted because they're kind of upset that they signed up for race they don't think they're going to get to run it. But in this episode Jason's going to help us all understand a little bit more about meditation, living in the moment and how meditation has helped him and how it maybe can help us runners as well.
Every day I talk to runners who tell me their doctor said they have to stop running. Just stop and think about that for a minute. A runner is told to stop running.
A runner has pain in her foot. Maybe it’s a metatarsal stress fracture. Maybe it’s a plantar plate sprain. Maybe it’s plantar fasciitis. But the runner wants to run and not have foot pain.
So the runner makes an appointment with a supposed expert (a doctor), sits in a waiting room, then sits in a second waiting room waiting for the doctor to actually come in to do something.
Finally, the door swings open and you tell the doctor that you have this pain in your foot when you’re running. And then the doctor tells you to stop running.
So what just happened? Did the doctor not understand that you’re a runner? Did the doctor not understand you actually want to keep running? Does the doctor think running is not important to you? Or does the doctor really think you showed up to have somebody in a white coat tell you you should trade your running shoes for a bike helmet or a pair of swim goggles.
That doesn’t really sound like much of a solution to you, does it?
In this episode we are talking about how not running is optional.
Today I was on a 15 minute Virtual Doctor Visit call with a runner who has been trying to get over a nagging case of Achilles tendinitis and still wants to do well in the Boston Marathon.
It may not surprise you to hear that he is worried about how skipping long runs to protect the Achilles tendon will make it very difficult for him to have a good run in Boston.
He’s been doing all the right stuff. He has taken the right steps to remove the inflammatory fluid around the Achilles tendon. He’s been doing the right supplementation routine to help rebuild the collagen. He’s been doing the right workouts to help break up cross-linking and reorganize the collagen alignment in the Achilles tendon.
He has been improving but, he had very mild setback, got a little swelling and it made him worried. So, he just wanted to have a quick call to talk about his progress and figure out whether or not he needed to stop running or shift to some different activity.
In 15 minutes we were actually able to come up with several different ways he could augment his training to add some longer workouts that wouldn’t put as much stress on the Achilles tendon.
This episode is based on a question sent in from one of our listeners and she actually wrote in and said “I mistakenly had “plantar release” done to my right foot 16 years ago. I am no longer able to run because my arch has collapsed and my foot now rolls inward significantly with every step. I’m in constant pain in both of my knees (because of the change in my gait) as well as my foot as a result. A Mayo Clinic orthopedic surgeon recommended fusing the first and second metatarsals above my arch to reduce pain affected by the release but who knows if I’ll ever run again, which is what truly breaks my heart. My main questions are could stem cell therapy help me run again and can it decrease pain in the long term? Long shot question- is it remotely possible to “replace” (using that term very loosely) the cut ligament or it’s role in the foot, also allowing me to run again? (which is most important to me honestly).”
Today on the Doc On The Run Podcast we’re talking about what a runner can do to help the plantar fascia after plantar fascia surgery.
Today on the Doc On the Run Podcast we’re talking about the special considerations overweight runners need to think about when they want to get to their goals without getting injured.
I am really excited to have Gary Stotler on the show today and Gary is a guy who is truly inspirational. He actually went from 400 pounds to running 100 miles.
I’m really excited to have Dr. Stephan Guyenet as a guest expert today. Dr. Guyenet spent 12 years at the University of Washington as a neuroscience and obesity researcher. Much of that time he was studying the role of the brain in eating behavior and body fatness. His publications have been cited more than 1,400 times by other scientists and in peer-reviewed scientific publications. He is the author an intriguing book entitled “The Hungry Brain” which explores the neuroscience of overeating, focusing on the following perplexing question: Why do we overeat, even though we don’t want to?
One of the reasons I wanted to have him on the show is that I have noticed many injured runners and triathletes let their diets slide a little bit when they get hurt. When we talk about this it quickly becomes apparent that these athletes understand nutrition. They understand the value of quality ingredients going into their system. They know what they need to eat to recover from hard workouts.
Today on the Doc On The Run Podcast we’re talking about Stress Related Eating and the Consequences for Injured Runners.
Today on the Doc On The Run podcast we’re talking with Linda Hall about meditation and how to focus on the mind-body connection and stress management as a tool that runners can use to recover faster, decrease the risk of running injury and hopefully even recover from overtraining injuries.
This week I got a couple of calls from runners who had various different forms of foot pain and they both said the doctor they saw said they had a condition called synovitis. They were both understandably confused because neither one of them really understood what “synovitis” really means.
Synovial tissue is the tissue that makes the fluid that lubricates your joints. The fluid on the inside of your joints is called “synovial fluid.”
This is the stuff that lubricates and nourishes the cartilage on the inside of your knee joint, your ankle joint and all the other joints in your body. This fluid not only helps to lubricate the joint it also nourishes and keeps the cartilage healthy.
On the inside of the joint you have this soft squishy tissue, called synovial tissue, that makes that lubricating fluid. Sometimes you may hear it called synovium. Synovium and synovial tissue are synonymous. They’re both the same thing but they are different terms your doctor may use interchangeably to further confuse you.
Today on the Doc On The Run Podcast we’re talking about synovitis in runners.
Today on the Doc On The Run Podcast we’re talking about muscle atrophy after recovering in a fracture walking boot, and what runners can do to prevent it.”
I recently met Kim and she was explaining to me that she had an Achilles tendon rupture and then developed this same kind of muscle atrophy we all become concerned about. Fortunately for all of us, she was willing enough to come on the show and share her experience.
We are also going to talk about some strategies for avoiding all of the weakness if you ever have to wear fracture walking boot.
Sleep may be the most valuable, most abundant, least expensive, and yet most underutilized resource available to a recovering or injured runner.
If you are a runner, you are always recovering. You do tissue damage every time you run. If you run a little too much, or you run a little too far, you might get an over training injury. That overtraining injury is really nothing more than an exaggerated version of the intentional injury you are attempting induce when you are training.
Sleep Helps You Heal, Running Doesn’t Help You Heal.
Sleep is crucial for proper immune function, tissue healing and consequently healing after any hard workout or running injury. Sleep disturbances reportedly occur in one third of the U.S. population. Problems with sleep are so pervasive and detrimental that the Centers for Disease Control has declared insufficient sleep as a public health problem.
Interestingly, elite athletes have actually been cited as a group having poor sleep quality and reduced quantity of sleep in comparison to the general population. Why is that?
Today on the Doc On the Run Podcast we’re talking about how sleep is the recovering runner’s secret weapon.
The problem with running injuries is that they are easy to ignore. A little tightness here or little achiness there is nothing compared to the pain you feel in those final few miles of a marathon. Runners are used to ignoring pain. One of the most important elements of training for endurance sports is learning how to endure. After all, enduring is the name of the game. You have to learn how to keep running when your quads tell you to quit. You learn to ignore the burn, tune out the noise and keep going. You have to learn how to suffer.
It is just not surprising that runners ignore the early sensations they can signify the start of a running injury. What we have here, is failure to communicate. Your running injury didn’t start the day you called a doctor for help. Your running injury started weeks or months before you told anybody about it.
But I would be willing to bet that you knew it was there. Deep down inside, you knew something was wrong. Maybe you didn’t want to see it. Maybe you didn’t want to feel it. Maybe you didn’t want to acknowledge it. But I’ll bet you had some subtle clue trouble was brewing.
Today on the Doc On The Run podcast we’re talking about how communication can help prevent running injuries and help running injuries heal faster.
A goal is not a fantasy. A goal is not a dream. It’s a place you clearly want to end up. If that goal is important to you, I believe you can get there. No matter how far-fetched, outlandish, or seemingly difficult to achieve, there is always a way to get there.They set all kinds of goals for themselves, their families, their finances, and of course, their athletic goals as well.
For most people the process of goal setting includes some analysis of the past. Maybe your just look at how fast you have run historically. Maybe you look at how much money you made last year. Maybe you look at how much time you spent with your family. In all likelihood your goals are partly based upon your past performance.
Part of the reason we base or future upon our past achievements is that we want to make sure that our goals are achievable. After all, no one enjoys failure.
Today on the Doc On the Run Podcast we’re talking about how injured runners should focus on the goal.
Over and over patients tell me their doctor has told them to quit running. The doctor has said that running is at the root cause of the running injury. B.S.!
Breathing doesn't cause lung disease. Eating doesn't cause stomach upset or heart disease. Driving doesn't cause automobile accidents. Spending money doesn't cause bankruptcy.
Running doesn't cause running injuries. Running isn't the problem. It's the choices we make when we are running (and recovering) that leads to a problem.
If you're a runner it's important you understand first and foremost that running does not cause running injuries. And if you happen to get injured and you seek treatment for your running injury it's important you understand how to talk to your physician and convince your physician that running is not the problem.
Rodney asked about a non-displaced fifth metatarsal fracture. He said “Hi, it’s been 8 weeks and my orthopedic doctor says it’s healed. Even though the x-ray doesn’t look like it’s healed. There is still a black in the gap where it was broken. He says that line will be there. Is this possible?”
Metatarsal fractures are extremely common. In fact metatarsal bones are fractured more often than any other bones in the foot among runners. Because these little bones happen to be the longest bones in your foot they’re also crucially important to the stability and structure of your foot. So you have to make sure they heal before you can get back to running with confidence.
X-rays are the most frequently used diagnostic tool to evaluate the positioning and state of healing of fractured metatarsal bones. But there’s a lot of variability in the appearance of a fractured bone when you’re looking at it on an x-ray.
In this week's podcast were talking about how x-rays show metatarsal fracture healing.
Today on the Doc On The Run Podcast we’re talking about how you can tell when it’s okay to resume running with a stress fracture. A runner named Whitney recently sent a great question to me on Twitter. Whitney asked “if you suspect a stress reaction/fracture how do you know when it’s healed enough to resume running? Thanks for your podcast!” As we all know stress fractures in the foot are one of the most common overuse injuries among runners. But just because stress fractures are common, it doesn’t necessarily mean that every runner who gets an aching, throbbing pain in the ball of foot has a stress fracture. And even if you do have a stress fracture you have to figure out what that really means. So, here are the 10 steps to use when you’re trying to figure out whether or not your stress fracture has healed enough to resume running.
Today on the Doc On The Run Podcast I’m really excited to have Marla on the show to talk about her experience with recovering from a running injury.
Running injuries can be really difficult for lots of reasons and one of the reasons I think they seem to be so difficult is that the standard of approach in medicine is to first tell you to “stop running”. Sometimes the standard medical approach, or the “standard of care” as we like to call it, can send you spiraling down this path of frustration and despair and it becomes more and more difficult to actually get yourself out of that spiral.
But Marla has a really great perspective on everything involved and trying to navigate the whole medical system and actually recover, not just using the standard approach which is usually offered to us when we get injured, but really trying to step back and look at all these different components of recovery from an injury and then try to really change what she was doing, assess what she was doing and make changes as she went throughout the course of recovery to try to really get the best improvement as quickly as possible.
Today on the Doc On The Run podcast we are going to discuss how Paternalism fails runners.
During a sermon one Sunday morning in 1896 in Dayton, Ohio, Bishop Milton Wright said, “If man was meant to fly, God would have given him wings!”
Lucky for us, his sons didn't listen. Had Wilbur and Orville actually taken their father’s admonitions to heart, it would certainly take us a lot longer to get from San Francisco to New York.
As a father myself I cannot believe the good bishop was hoping to crush his children's dreams. I can only assume he wanted to protect his boys. He wanted to protect them from what, to him, seemed to be a foolish idea of propelling themselves through the sky. He didn't want them to die in the process of seeking an adventure.
In retrospect, it is clear Bishop Wright had the wrong idea. His kids wanted to fly. And so they did. The doctor wants to protect runners from further injury. It's part of the Hippocratic Oath: “First, do no harm.” It's part of what they have sworn to do. But doctors should also encourage you to fly. They should look for new ways to get you from point A to point B. They shouldn't look at the old methods of healing and recovery and think it's enough for an injured runner.
Nobody wants to ride a donkey from San Francisco to New York. It's the doctor's job to help you look to the sky. It's the doctor's job to help you fly.
Stress fractures are one of the most common running injuries. And every runner who gets a stress fracture has to, at least in same capacity, reduce their activity to heal. Sometimes the runner has to stop running for a brief period of time. Sometime you can just run less, modify the way that you run, or come up with some creative strategies to keep running.
You never get a second chance to do your first marathon, so you certainly need to do everything possible to stay fit and not lose all that effort you put into training. You also need to make sure that your injury is not just healed enough that you can start running, but then get sidelined a few weeks before the race. Obviously that would be heartbreaking.
Today on the Doc On the Run Podcast talking about whether or not runners need to get an MRI when they think they have a stress fracture and want to get back to running.
Pain is a part of running. There is a saying often lauded by athletes and we have all heard, “Pain is just weakness leaving your body.” We affectionately call our training studios “Pain Caves.” We bask in the discomfort of pain, knowing it will make us stronger. In training we embrace pain as an ally.
But when you get an over-training injury, pain when running is no longer your friend. The pain forces you to run slower or run shorter distances. Pain forces you to skip workouts. Pain is wrecking your training schedule. Pain is in the way. Pain is your enemy.
In this episode we’re talking about how a pain journal can help you get back to running sooner.You can keep track of that pain and use it as a tool to recover as fast as possible and get back to running.
A few days ago a guy named Vito sent in a great question.
“I was in a walking boot for 6 weeks due to ankle fracture, no surgery. I am out of the boot and doing physical therapy to restore flexibility and strength. Can I safely being running again after a period of time?"
This is a very common question I hear from runners simply because one of the most common treatments for running injures like stress fractures, stable ankle fractures, Achilles tendinitis, peroneal tendinitis and even chronic plantar fasciitis is a fracture walking boot.
The truth is that a fracture walking boot is very effective at immobilizing the foot and ankle. That immobilization can certainly help many common running injuries heal faster.
Today on the Doc On the Run Podcast we’re talking about when you can start running after wearing a fracture boot.
Today on the Doc On The Run podcast I’m really excited have Dr. Vinh Ngo from Smart Medicine San Francisco. Doctor Ngo is going to explain hormone replacement as a way to make sure your training at full capacity and at lowest risk of injury. Dr. Ngo is a UCSF trained physician and he is an expert in men’s health and hormone optimization. So today I’m really excited that he’s here to share his integrative approach which can help athletes train harder by looking at hormonal limiters to identify changes that can be managed to improve the overall health and resilience of an athlete’s body.
A few days ago I was doing a phone consultation for a patient who had a fracture in his fifth metatarsal. I was trying to help him understand how important it is to reduce inflammation to speed healing. During our call he asked a great question.
“Should I wear compression socks if I have a running injury?”
In this episode were talking about whether or not you should wear compression socks when you have a running injury.
Today on the Doc On The Run podcast we have Tina Deane who is the owner of Massage Works in Los Gatos. This episode will help you understand how runners and triathletes can use massage as a tool to simply run more, train more, train harder, workout more, build your fitness more with a lower risk of injury.
Discipline is the difference between choosing what you want now and what you want most.
The problem with discipline is that most runners often seem to perceive discipline and hard work are synonymous. After all, it does take lots of discipline and hard work to become a strong runner. We learn to suffer. Through discipline we learn to put on our running shoes and run in the dark. We run in the rain. We run through aches and pains because we have, through years of training, developed discipline.
So it’s not really surprising that when an overuse injury stands between where we are now and where we had planned to be, many runners think they can just tough it out, power through and keep running anyway.
In today's podcast, we’re talking about discipline and what it takes to recover from running injuries.
My ankles pop and click all the time. They have for years. I am going to help you understand whether or not you might have subluxing peroneal tendons and whether or not it’s a problem.
If you think you have peroneal tendon subluxation you probably have some popping or clicking sensation or maybe even pain at the outside of the ankle. So what causes all of that noise?
Today on the Doc On The Run Podcast we’re talking about peroneal tendon subluxation in runners.
Today on the Doc On The Run Podcast we’re talking about peroneus longus tendonitis, and what runners can do about it.
Whenever I do consultations for runners who have peroneal tendinitis, they seem to be confused. Even though many of them have already been seen by an emergency room physician or their primary care doctor, they seem to be really unclear about what exactly is going on in their foot and ankle. If you aren’t clear on what is wrong, it’s hard to be clear on what you need to do to heal, and run without further injuring the tendon.
Part of the confusion lies in the fact that there are two different tendons (the peroneus brevis and the peroneus longus) which both run down the side of the leg and then attach to your foot. But they attach to your foot in different locations and they both do different things. Because they have different functions, they can become injured in different ways.
If you want to get back to running as quickly as possible it’s extremely important to figure out exactly which one of the two tendons is bothering you. Understanding which one is injured will give you a better chance of getting the tendon to heal faster, and get back to running sooner, without re-injury.
In the earlier episodes we explained that peroneal tendinitis is just inflammation of one of two tendons on the outside of your ankle: peroneus brevis and peroneus longus. In most runners these are overuse injuries.
Although they have similar names and they’re both in a similar location they each have very different functions when you run. In the simplest terms, they work together to act as your landing gear when your foot hits the ground and you decelerate. They both stabilize your foot.
But these two tendons stabilize your foot in very different ways. In this episode we’re going to focus specifically on the peroneus brevis tendon, how it works, how it becomes inflamed, and what you can do to make sure that you calm it down. We will also discuss how you can strengthen the peroneus brevis so it doesn’t become a problem again that could disrupt your running in the future.
If you are listening to this, you’re probably a runner and you probably also have pain on the outside of your ankle. You may have already been to see a doctor, or you may just be trying to figure this out on your own. Either way, either you or someone else has suggested that you have a problem with the peroneal tendons. And you’re probably worried that it’s going to screw up your ability to run at least for the next several weeks.
Your doctor may have told you, or you may have read, continuing to run with peroneal tendinitis can result in permanent damage to the tendons. So a diagnosis of peroneal tendinitis can and should be concerning. The most important thing is to figure out whether or not you actually have peroneal tendinitis or you have another condition that might be easier to treat, like peroneal tenosynovitis.
Today on the Doc On The Run podcast we’re talking about peroneal tenosynovitis in runners.
I recently had the honor of being interviewed by Runner’s Connect to contribute my thoughts on peroneal tendinitis in runners. This live recording was part of the 4-Day Injury Prevent Summit where Runners Connect interviewed 25 of the world’s most renowned running injury experts.
This episode is going to be an overview on peroneal tendon injuries in runners. For most of you listening this, it will give you all the information you need to figure out what’s going on with your peroneal tendons and get back to running. Make sure you go to the show notes page and I’ll explain how you can also get access to the corresponding video lecture that was presented during the 4-Day Injury Prevention Summit.
In Part 1 of our series on Achilles tendinitis we talked about how runners with mild forms of Achilles tendon injuries can decrease the inflammation, decrease the stress and tension on the Achilles tendon, get better and keep running.
But we also talked about the unfortunate reality of some runners having a tendency to ignore these injuries when they are in there earliest stages. Because many runners have a high pain threshold you may not even notice the first stage of Achilles tendinitis.
If you don’t notice there is a problem, it’s unlikely you will treat the problem. So you may be one of those runners who just really didn’t realize you were developing a problem with the Achilles tendon. You might have noticed some weird sensations that went on for months.
If so, you may have developed one of the more severe forms of Achilles tendon injury.
In today's podcast we’re talking about how runners with severe cases of Achilles tendinitis keep running without surgery.
Today on the Doc On The Run Podcast we’re talking about how runners with Achilles tendinitis skip the doctor visit and keep running.
The Achilles tendon is the biggest tendon in the body. So when the Achilles tendon gets injured, the runner has a really big problem. If you neglect the early sign of problems with the Achilles tendon and develop a severe form of Achilles tendinitis, you can be crippled temporarily and have your running form altered permanently. In short, you may never run the same way again.
If you’ve been running with an aching pain in the back of your leg down near your heel and you worry you have Achilles tendinitis you’re probably freaked out and concerned that you’re going to have to stop running. But don’t worry. I’m going to explain to you exactly what runners do that helps them get over those early forms of Achilles tendinitis without ever seeing a doctor.
Today on the Doc On The Run Podcast we’re talking with legendary orthopedic surgeon Kevin Stone, M.D. about runner’s knee and knee preservation strategies for runners.
Dr. Stone gets invited to travel to medical conferences all over the world to teach other orthopedic surgeons the specifics of his joint preservation research and knee surgery techniques. And in this episode he will share some strategies runners can use to keep running longer with healthy knees.
Today on the Doc On the Run Podcast, we’re talking about what a runner should do if you’re worried the pain under the big toe joint might be a sesamoid stress fracture.
Sesamoid stress fractures may be one of the very worst injuries affecting runners. In fact, of all overtraining injuries that could actually seriously put your future of running at risk, it may be the sesamoid fracture that has the potential to ruin your ability to run forever.
Pain in the ball of the foot under the big toe joint can have a few causes. The key of course is to make sure you know which condition is causing the trouble.
So first and foremost, you want to make sure that you don’t miss a sesamoid injury.
Summer has a dirty little Secret…
If you get injured and wander into the hospital in the summer months you are more likely to end up with a bad result. Believe it or not, statistically, you are even more likely to die.
Your chances of dying in a hospital are highest in July. A study published in 2010 in the Journal of General Internal Medicine exposed one of medicine’s dirty little secrets. All medical internships, surgery residencies, and fellowships begin on July 1st every year. Because of this, July is simply the riskiest month have foot surgery or any other surgical procedure associated with hospitalization.
This is not complicated. After eight years of sitting in college classrooms and medical school lecture halls, the wet-behind-the-ears medical intern is just itching to try out all of those skills he or she has read about. The problem is, they have a lot of learning left to do.
You don’t really want to be the first person when a new foot doctor tries to make a surgical incision on your foot. You also don’t want that new, nervous, over-worked and sleep deprived intern fumbling through a Pharmacy handbook while writing your medication orders at 4:00 a.m. You are far more likely to have a bad outcome in July for several reasons.
In this episode, I will discuss the 5 tips to avoid surgery complications common in July.
If you’re a runner, the chances are good at some point in your running career you have had an aching, throbbing sensation in the front of your shins. And chances are also good if you talk to your running buddies they would quickly explain to you that you have a case of shin splints.
Shin splints may be common, but they can also be confusing.
As I have said in many other episodes, you have to know what you are treating, before you can treat it correctly. If your doctor has misdiagnosed your condition, or if you have misdiagnosed yourself, you may be using the “right treatment” on the “wrong problem.” Of course if you do that, it’s unlikely you will improve.
In this episode we are going try to eliminate some confusion so you can know what to do if you get a case shin splints that doesn’t seem to go away.
Is over-resting slowing your recovery? It might be. Sitting still is a killer for athletes. Not only does it bum you out, but a long period of immobilization can actually increase your chances of having another injury later.
A few days ago I got a call from an athlete who had been unfortunate enough to have a serious injury that required surgery. So when he called me, he already had surgery and was well on the way to recovery.
After six weeks of rest he felt like the rest was killing him. And he had just been told by his doctor that he needed another month or so of rest before he could start regaining strength and becoming active again.
Understandably, he became frustrated.
Today on the Doc On The Run Podcast we’re talking about how over-resting can actually slow down your recovery from a running injury.
Let's face it, the primary tool used by runners are running shoes. Although we often think about heart rate monitors, GPS watches and all sort of fancy fabrics for our running clothes, nothing will affect your performance as much as the very best, properly chosen running shoes.
Given I am a sports medicine podiatrist with a practice catering solely to helping runners run, and I like to run, you can rest assured I always run in the very best running shoes.
And not surprisingly, other doctors, and lots of runners ask me which running shoes are the best. That's not an easy answer. Of course the short answer is that the best running shoes are the ones that work best for you. But you have lots of variables. Your foot type is probably different than mine. Chances are good that you're a faster runner than me. You also probably have a different training regimen and set of goals for this year. Your running shoes are supposed to help you run further, decrease your risk of injury and protect you while you train.
The very best running shoes are always an accurate reflection of the runner’s particular biomechanics, running form, training regimen and particular goals. So in this episode we're going to talk about some of the ways you might want to reconsider your running shoe choices.
Whether you’re training for your first 5K, a half-marathon, Ironman triathlon or 100 mile ultramarathon, you have to put in lots of miles. To keep logging miles, increasing your speed and building your strength…you have to avoid injury.
The real game with building strength and fitness in long distance running is to systematically stress your tissues so those muscles, bones, tendons and ligaments all have to rebuild themselves and become stronger.
So whether you are self-coached, you purchased an online training program, or you have hired a professional coach to help you, the task is to help you choose workouts that will deliver the maximum amount of tissue damage that your body is capable of rebuilding before your next key workout.
But if you do more tissue damage than your body is capable of rebuilding, and then you do another hard workout, you get an over-training injury. In this podcast we’re talking about overtraining myths, and other B.S. that you need to know to avoid an overtraining injury.
This week I was invited to lecture on Runners Heel: Pearls for Podiatric Physicians at the International Foot & Ankle Foundation Meeting at the Swedish Medical Center in Seattle, Washington.
The attendees to this conference included podiatrists, foot and ankle surgeons and sports medicine specialists. The lecture was on runner’s heel pain and I was discussing the differences between plantar fasciitis, infracalcaneal bursitis, neuritis and stress fractures of the heel bone.
The goal was to try to explain to doctors the ways that they could tell the difference between all these conditions in runners how they can help their patients continue running even if they have a partial rupture of the plantar fascia or plantar fasciitis.
As a runner, you will find the main lessons of this talk helpful...
Today on the Doc On the Run Podcast we have a truly inspirational guest: the Iron Cowboy, James Lawrence who is famous for settling two world records: both the number of Half Iron Distance triathlons done in one year and then in 2012 he also set a new world record for the number of full Iron Distance triathlons done in one year. But then, he did 50 Ironman distance triathlons in 50 days, and in all 50 states!
The very first step in healing a plantar plate sprain is to make sure that you don't make the condition worse. Because it's a tiny little ligament and it's easy to make it worse!
In many cases you can continue to run and still heal a sprain of the plantar plate. But this depends on many different factors. However, there are some exercises which I believe are much more stressful than running when it comes to the stresses applied to the plantar plate. If you do these exercises you can rest assured that a tear in the plantar plate is going to continue to get worse.
So without further ado here are the top five worst exercises for a plantar plate tear.
One of the less common ways you can get pain in the ball of the foot is if the cushioning within the foot becomes diminished. If that happens it can feel like you’re walking on rocks or standing right on the bones on the ball of the foot.
If you think about it, when you stand up, your skeletal system, primarily the bones and everything that hold the bones together is what supports you. Obviously, you have a lot of bones in your foot. The bones are resting on top of the skin. So if you think about all that weight pressing down on the skin, what is it that prevents the skin from hurting?
Well, it’s your fat pad. It’s the natural cushioning or padding between the bones and the skin at the ball of the foot.
Today on the Doc On the Run podcast we’re talking about fat pad atrophy in runners.
Is your doctor on your team?
If you’ve been training for a marathon or any other event and you suffer a running injury the first thing that happens is that you become concerned that your foot is going to hurt and slow you down during your training. But then as things get worse you actually realize it may not just hurt when you’re running. You may have to change your training schedule or even stop running to get it to heal.
If you’ve ever suffered this sort of contemptuous delivery of healthcare, you may have become concerned your doctor really doesn’t have your best interests at heart. Maybe she just doesn’t understand you or fully appreciate how important running is to you.
There are many reasons why doctors will tell runners to stop running. And although sometimes it is necessary to briefly pause your training when you get injured, you have to be on guard for those times when it seems like your doctor really isn’t on your team.
Today on the Doc On The Run podcast we’re talking about 5 signs your doctor may not be on your team.
Ankle sprains are one of the most common injuries that brings an athlete to the emergency room. Of course, as we talked about before, the emergency room may be the very worst place to go when you actually have an ankle sprain.
Since many runners are starting to learn that they don’t need to sit around all day in the emergency room it’s important to understand what is a myth and what is reality when it comes to a sprained ankle.
If you understand a few simple things about ankle sprains you can make the best decisions about how to care for your ankle so you can get back to running as soon as possible.
In previous episodes we talked about the different causes of pain in the ball of the foot in runners. We talked about the differences between Morton’s neuroma, plantar plate sprains, and osteochondritis.
But a great question occurred to one of our listeners. Why didn’t you include metatarsal stress fractures in this series of discussions? After all, the metatarsal stress fracture can also cause pain in the ball of the foot in runners.
So today we’re going to talk about how you can tell the difference between metatarsal stress fractures, Morton’s neuroma, plantar plate sprains and osteochondritis.
If you are a runner and you have pain in the ball of the foot there are really only a few conditions that could be causing the trouble. This episode is the third of a three part series that explains what you need to think about if you’re a runner seeking treatment for these problems. Previously we talked about pain in the ball of the foot caused by plantar plate sprains and neuromas. Today, we're going to talk a little bit about another condition which is in a similar location in the ball of the foot and can also cause pain in runners.
In this episode we’re talking about pain in the ball of the foot in runners caused by a condition called "osteochondritis."
If you are a runner and you have pain in the ball of the foot there are really only a few conditions that could be causing the trouble. This episode will be the second of a three part series that explains all of the things you need to think about if you’re a runner seeking treatment for any of these problems. Last week talked about neuroma treatment in runners. Today I’m going to explain a little bit about another condition which is in almost the exact same location as a neuroma.
The plantar plate is a small ligament on the bottom of the joints located in the ball of the foot. It is really just a thickening of the joint capsules. Because the plantar plate is located between the heads of the metatarsal bones and the ground, you’re basically standing on the plantar plate whenever you walk or run. If the ligament comes sprained it can be very painful. Often times, runners and even some doctors confuse a plantar plate sprain with a Morton’s neuroma.
If you are a runner and you have pain in the ball of the foot there are really only a few conditions that could be causing the trouble. This episode will be the first of a three part series that explains all of the things you need to think about if you’re a runner seeking treatment for any of these problems.
The most common cause of pain in the ball of the foot is most likely a neuroma. So in this episode we’re going to talk about neuroma treatments and give you some things to think about, and to discuss with your doctor…before you receive any potentially damaging treatment.
Overtraining injuries come in lots of different forms. Metatarsal stress fractures, Achilles tendinitis, peroneal tendinitis, and plantar fasciitis, they all may affect different structures but what they all have in common is an impending inflammatory response.
When you feel any aching sensation in your foot or your ankle and you think you have an overtraining injury, you want to take steps to control the damage and prevent things from getting any worse. Believe it or not there are a lot of simple things you can do to speed the healing and then get back to running as quickly as possible.
In this episode we're talking about the first steps you should take when you think you have an overtraining injury.
If you are a runner and you start having pain in the ball of your foot, you might be worried that you have a stress fracture. So you have a couple of choices. One option is to go see your local orthopedist or sports medicine podiatrist. The second option is to stop running and see if the pain gets better.
If you’re listening to this podcast right now you are likely not very interested in option number two. After all, most runners want to run. So you might try to figure out a third option such as trying to treat the problem yourself. Although I believe it is truly possible and reasonable for most runners to figure out the problem and attempt to address it themselves, this episode is going to discuss what happens when you actually go to a doctor with pain in the ball of your foot and you are diagnosed with a condition called “metatarsalgia.”
The unfortunate reality is that every single day, over 10,000 suspected ankle sprains show up in the ER. While an emergency room may be the best place for someone with a heart attack, it isn’t the best place to get treatment for a sprained ankle.
Today on the Doc On The Run podcast we’re going to talk about the first things you should think about if you believe you need treatment after you sprain your ankle on a trail run.
Today on the Doc On The Run podcast we’re talking with sports nutritionist and triathlete Heidi Buttery about Good Fat, Bad Fat and Fat Fueling as a way to fuel better and avoid running injuries.
She will discuss what she knows as a nutrition coach, how that's all tied together and to give idea of her approach, where she came from and what she's up to now.
Last night I did a remote consultation for a patient who had a broken toe and wanted to get back to running. That discussion generated several thoughtful questions that I have heard before. These are all excellent questions for an injured runner!
So we’re going to talk about all of the things that you should consider if you’re a runner and you break one of your toes, but want to keep running.
Minimalist running shoes, maximalist running shoes and barefoot running, they’re all some of the more recent trends in running and running shoe technology. There's a lot of debate around these different kinds of running shoes as well as different running forms and I was recently invited to give a lecture at the International Foot and Ankle Foundation meeting in Lake Tahoe on February 17, 2017.
Today on the Doc On The Run podcast we're talking about the differences between minimalist and maximalist running shoes.
If you are a runner, and you got a running injury, you may have been to the doctor. And let me guess, your doctor told you to stop running.
Today on the Doc On The Run podcast we’re going to talk about the way stopping running can place you at higher risk of running injuries down the road.
Today on the Doc On The Run podcast we're speaking with Brad Beer, legendary physical therapist and Amazon best-selling author of “You Can Run Pain Free! A physio’s 5 step guide to enjoying injury-free and faster running”.
In this episode you're going to learn about Brad's approach to decreasing overused injuries that plague endurance runners and long-distance triathletes.
If you are runner, you probably like to run. If your get injured, you probably still want to run. You need a doctor who will be on your team, not the other way around.
Times in medicine have changed. It used to be that there was this very paternalistic attitude among doctors. Whenever the patient would seek treatment, the doctor would simply tell the patient what to do. The patient was expected to do as he was told.
But in the last few decades the power has clearly shifted back toward the patient. Patients expect good customer service, expert advice and expect to get better. The advent of the internet has done more than any other single factor to shift the power of healing back toward the patient.
In today's podcast, I will discuss the top five reasons runners should fire their doctor.
Today on the Doc On The Run podcast we’re talking with Darin about his history of issues with the plantar fascia and being an athlete and what it takes to get back to training and recovery and survive these types of injuries.
He shares his experience as a runner with a partial rupture of the plantar fascia who was able to get back to running and training.
The other day I got a call from a patient who had an injury and briefly she explained her scenario and then she asked me the million dollar question, “Do I really have to stop running to get better? More importantly, is it possible that I might actually have to stop running forever because of this injury?”
That’s the big concern we all have as runners. It is a pretty common question when runners get injured. So today I’m going to share my opinion about when people should stop running and not stop running.
All of the information I’m going to present to you today is based upon on a lecture that I first presented to doctors at the International Foot & Ankle Foundation meeting at the annual medical conference in Lake Tahoe.
Today on Doc On The Run podcast we’re talking about everything that runners should need to know about surgery on the plantar fascia.
It’s really important that you understand what all the different surgical procedures mean in terms of the procedures themselves but also what that mean to you as a runner. I personally believe that my entire job is to help runners continue running and so I have a perspective that’s a little different than some other surgeons. So we are going talk all of the special considerations that you need to take into account if you’re considering surgery on the plantar fascia.
Which is better…clear healthy toenails or thick, yellow, black and blue or missing toenails? Running can be hard on the feet. We all know that lots of runners bash their toes. But neglected tootsies can lead to discolored toenails and even lost toenails if you’re not careful.
In today’s podcast, I will discuss the Top 5 Mistakes Runners Make with Their Toenails.
Jess is an amazing athlete. She got a Kona slot in only her second Ironman and then in 2011 became the 2011 70.3 Ironman World Champion and since that time she’s been racing Pro.
On the past year Jess has had some major life shifts and I think that her experiences can help all athletes understand the importance of priorities and focus as life unfolds. She recently started coaching full time, she had a baby and then she got right back to racing. So if anyone knows how to keep the fitness while making major life transitions is Jess.
In this podcast, Jess is going to discuss about all the special consideration surrounding running, training and maintaining fitness before and after pregnancy.
Dr. Mayo holds a Ph.D. in Exercise Physiology and is a registered dietitian (RD). He is an associate professor and has published close to 50 articles in lay and scientific journals regarding various aspects of fitness and nutrition.
Also, Dr. Mayo has been quoted in magazines such as Men’s Health and US Weekly. Don’t worry, he doesn’t just write about this stuff…he walks the talk, too. JJ has done ultramarathons, he qualified for the Boston Marathon and he has finished 10 Ironman triathlons. He knows what it takes to use nutrition and apply it directly to putting miles on the road.
Today, he shares his expertise about nutrition and what it takes to fuel athletes not only in races, but in the recovery process.
One of the biggest concerns of injured athletes returning to activity is whether or not they should be concerned about pain when they start to run. This is a great question and certainly a valid concern.
Pain is your body’s indicator that something is not right. But you have to figure out which pain is acceptable and which pain is unacceptable. In this episode, we are talking about how to discern good pain from bad pain when returning to running after you heal an over training injury.
Today we’re talking with nutritionist and PRO triathlete Kim Schwabenbauer about the importance of a nutrition assessment for runners as well as tips for enjoying the holiday season without guilt.
Kim is a long time athlete. She ran cross country in high school, she was Team Captain of both her cross country and track teams at Penn State. She has been doing triathlons for over 10 years. She’s won lots and lots of races. She was the amateur champion at Ironman Cozumel and Ironman Lake Placid. She’s even raced at the Ironman World Championships in Kona Hawaii 4 times. And she is fast, fast fast…she actually clocked a 3:01 Ironman Marathon time.
Every day I get calls from injured runners. Whether their foot is aching when they run and they think they have a stress fracture or if they twisted an ankle on a trail, the number one question I get is, “should I get an x-ray?” Whether or not you need an x-ray depends upon several things.
But x-rays don’t always tell the whole story. And there’s also a widespread misconception that if an x-ray doesn’t show anything then you need an MRI or Ultrasound to figure out what is going on with your foot. Frankly there’s just a lot of misunderstanding about X-rays and running injuries. So in this episode we’re going to talk about all of the myths about x-rays and running injuries.
Last week we talked about how you can choose a running surface that will decrease the stress and strain on your foot. The one component of running surfaces that we did not address in that episode was how hard a certain kind of surface can be on your feet.
Today we’re going to talk about concrete, asphalt, grass, sand and all the different running surfaces. Considering the different traits of the path you choose is important if you are hoping to avoid injury, or return to running after an injury and make sure you don’t get re-injured.
If you are a runner with an injury that affects one side of your foot more than another, like plantar fasciitis, picking the right running surface can make the difference between being able to run and still heal, or running and making your plantar fasciitis much worse.
This episode will help you understand how you can pick the best running surface to decrease the stress and strain when you are trying to keep running with foot pain.
Today we’re talking about how runners use stem cells to get back to running faster.
In this episode I am going to discuss how stem cells have the potential to transform into any and all of the cells necessary to help speed the healing process.
Today we’re talking about the 5 biggest mistakes runners make when they think they have a neuroma. We’re going to discuss the most common mistakes I see runners make when they start to develop a neuroma in the ball of the foot.
Today we’re at A Runners Mind speaking with Dawson, who is a true running shoe expert. We’re going to discuss the ways that runners can troubleshoot these injuries and keep running.
Today we are featuring a recorded portion of an interview with Dr. Segler for an injury prevention seminar for RunnersConnect. In this episode you’ll learn about the importance of vitamin D as it relates to muscle strength, not just bone density. You’ll also learn about strategies for listening to your body that will help you when you might be developing a running injury.
Today we are featuring a recorded portion of an interview with Dr. Segler for an injury prevention seminar for RunnersConnect. In this episode you’ll learn some strategies to modify bad habits so you can heal faster and get back to running.
To most runners an over-training injury is their worst nightmare. The reason that these injuries are so terrible to most runners is that they happen at the worst possible time.This often happens 4 to 6 weeks out from your race. So just as you start to see the light at the end of the tunnel, just when you start dreaming of your taper, disaster strikes. You get injured. But all is not despair.
Today we are talking about why runners have an unfair advantage when it comes to healing an injury, and how those advantages can help you recover faster than the average non-runner.
Fracture walking boots are one of the most often prescribed treatments for running injuries such as stress fractures and tendinitis. But runners have a much higher price to pay for immobilization.
In this episode we are going to explain why fracture walking boots are one of the worst treatments possible for an injured runner.
Today on the Doc On The Run podcast we are at A Runner’s Mind speaking with Dawson Alexander, who is a wicked fast runner and a bona fide running shoe expert. In this interview you get the dual perspective which will combine Dr. Segler’s knowledge of running injuries with Dawson’s experience and knowledge in running form analysis and running shoe selection.
Together they will help you understand how your running form and proper running shoe selection can help you continue running even if you have plantar fasciitis.
Felicity Joyce is a well known inspiring endurance athlete. She was the youngest female to win the Australian National 24-hour Track Championships and earned the young Australia Rising Star Award from Athletics Australia and Sports Person of the Year. She also knows how to overcome injuries. Early in her career she had a terrible bike crash that left her almost crippled and unable to walk. Yet she was still able to qualify for the 70.3 World Championships in 2011 and 2012. Then in 2012 she won her age group at Ironman Louisville and qualified for Kona.
In today’s podcast, Felicity shares her experience and mindset in racing, coaching and getting back to racing shape after injury.
In today’s podcast, she shares with us her motivational story on her experience and mindset in racing, coaching and getting through her injuries.
In today’s podcast, she shares with us her motivational story on her experience and mindset in racing, coaching and getting through her injuries.
Barbara Peterson’s story is truly inspirational! Less than a year after she broke both heel bones (bilateral calcaneal fractures), she was out of her wheelchair and on the starting line in Hawaii at the XTERRA World Championship where she won yet another title. Today she shares how that experience shapes her approach in racing, life, and her work with other athletes.
Metatarsal stress fractures are common in runners, and so are the myths that surround them. Do I really need X-rays? Do I really have to stop running to get a stress fracture to heal? Does it always take 6 weeks? Can I keep training? Doc On The Run debunks the metatarsal stress fracture myths.
Ice is often used by runners to decrease inflammation. Learn best strategies for icing and how Doc On The Run uses specific contrast bath, routines to remove swelling from the foot and ankle and speed healing after a running injury.
If inflammation is part of the problem, why not take ANTI-inflammatory drugs? Learn why, when and how runner’s use anti-inflammatory medications to get relief…and perhaps even more importantly, when runners should NOT take these drugs.
Did you know that in the overwhelming majority of cases doctors will recommend that you perform simple home treatments before they prescribe medications or consider more invasive procedures like injections or surgery? This podcast explains how doctors (or even a runner who hasn’t been to the doctor) can treat heel pain with simple treatments that can be performed at home without ever seeing a doctor.
Plantar fasciitis may be the most common cause of runner’s heel pain, but it is not the only cause. Many runners think they have plantar fasciitis but they actually have another condition entirely. As a result, they may not get better. This podcast explains the main reasons runners with heel pain don’t get better, even when they think they have the correct treatment.
If you have runner’s heel pain that’s interfering with your training, don’t worry, there is help! Runner’s heel pain can be treated and you can run. Discover the approach that helps elite athletes get better even while they keep running. This podcast will explain how to get started on the right foot.