#138 Fracture in the ball of the foot. Getting back to running with Coach Craig Moss - DOC

#138 Fracture in the ball of the foot. Getting back to running with Coach Craig Moss

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.


Dr. Segler: Today we’re talking about how a fracture at the base of the toe can resemble a stress fracture, a plantar plate sprain and a neuroma, but how one runner was able to deal with his injury and get back to running.

Dr. Segler: 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. Craig had an interesting injury were he actually broke the base of the second toe during a cool-down exercise. It was really just a small chip fracture of the base of the proximal phalanx bone where the toe connects to the foot. The reason I think this is going to make an interesting episode is that it dispels a couple of myths. #1. many people think that if you can walk on the foot it can’t be broken. That’s just not true. In fact Craig was not only walking on the foot, he went out and ran 16 miles before he started realizing that this was actually a significant injury. Myth #2. you have to spend six weeks in a fracture walking boot to heal a fracture in the foot. That also is not always true. If you have pain in the ball of the foot, you could have a neuroma. You could have a plantar plate sprain. You could have a stress fracture. But if you had any kind of trauma you could also have an injury like Craig’s where there’s a little chip in the bone where the joint capsule and the plantar plate ligament attach to the bone at the base of the toe. I think you’re going to find his story interesting. So let’s tune in…

Dr. Segler: Today on the Doc On The Run Podcast, we have Coach Craig Moss here who had an unusual injury while he was training doing a track workout.  Because this injury can be kinda confused with a lot of other things, including a plantar plate sprain or a metatarsal stress fracture or capsulitis, I wanted to have him on the show to share his story and talk about what was going on, how it happened, what it really felt like, how he figured out what was really going on and then how he got back to running and continued training. Craig, thanks for coming on the show. Thanks for being here and thanks for being willing to share your story today.

Coach Craig Moss: Oh, no problem. Hopefully, I can help somebody.

Dr. Segler: All right, so tell me the story. What happened with you? What happened initially when you had … or well, actually let me back up. What’s your running background? What kind of runner are you? What have you done historically and how long have you been running?

Coach Craig Moss: I started running when I was 18. I’m currently 46. I started when I was 18 to lose weight. I was 120 pounds overweight, so I started running to lose weight. Tried to run a marathon one day just a couple of long runs, months and months of running, I did a couple of 10-mile runs. I was like, “Hey, let me do a marathon just to see I can actually run without stopping. I actually finished the whole thing without stopping in a pretty decent time. Well, let me say, I was hooked four days later ’cause as soon as I was done, I’m never doing that again. And then four days later, I was like, I got to do this again. Ever since I’ve been 18 or 19 years old, I’ve been doing marathons. I’ve done 46 of them at this point.

Dr. Segler: Wow!

Coach Craig Moss: And I’m also a coach for a program called Students Run LA where we take at-youth risk and train them to do the L.A. Marathon every year.

Dr. Segler: Okay, all right, so obviously, by any measure, an experienced runner, so 46 marathons. I’m sure you’ve had some little things here and there which kind of resemble injury, but maybe haven’t kept you really out. You can’t train people or do that much without having something happen, right? But this was an unusual thing that happened. What were you training for when you got injured?

Coach Craig Moss: It was the summer of 2017. It was July 4th. I had just got done with the eight-mile run. I was just kinda training just to stay fit for the summer, not really focusing on anything, but you may want to keep your mileage up, so I got done with the run and I was doing a cooldown, so I was doing leg swings, straight-leg leg swings barefoot and I just lost focus and I basically just kicked the ground as hard as I could. My toes went straight into the ground and I have the Morton’s Toe where the second toe is bigger than the first toe, so that one took the brunt of the kick and at first, I was just like, “Wow, that hurt, no big deal. I got my cooldown,” stuff like that. And then we went to a 4th of July parade and I couldn’t walk real well. It felt like a bruise on the ball of my foot, so I’m like … The rest of the damn icing it, heating it icing and heating it back and forth, back and forth.

Coach Craig Moss: The next day, I had the day off ’cause it’s summer and I’m a teacher, I still had a run scheduled, so I go out and I run like a normal stubborn runner. I got to get my mileage and it just felt like a bruise on the bottom of my foot, but it wasn’t really bad where I couldn’t put pressure on it at first. I was like, “Oh, whenever. It’s just a bruise. I’ll go home and ice it,” so I got done running, went home and iced it. Took the next day off and then I had a 16-mile run planned the next day in the mountains on a Saturday, so I went up and did that and surprisingly, in a brand new pair of shoes up and down the mountain, eight miles up, eight miles down, I’d ran great, but my foot was a little sore and I kept doing this for a couple, three, four weeks and it just kept getting worse and worse and worse.

Coach Craig Moss: On that 16-mile run up the mountain … I’m a podcaster — I love listening to podcasts — I happened to catch your podcast. I had never listened to your podcast before. I happened to catch your podcast. I think you were actually a guest on someone else’s podcast. Let me put [crosstalk 00:04:14]. You were a guest on someone else’s podcast, so then as soon as I got home, I started looking you up and I was like, well, if things get worse, I’ll look into it more. So a couple of weeks later, things are worse and I started listening to your podcast, liked what you’re saying about continuing to run through injury and got a hold of you to see what we could do and figure things out.

Dr. Segler: Okay, all right, so to back up for a second. For most people to do drills, there’s all kinds of drills you can do and so the straight-leg swings, like why don’t you describe exactly what that is for the people who maybe have been running a long time. They really don’t do any kind of drills, and let’s face it, lots of people who run who don’t do drills. They don’t stretch. They just basically go run a lot and do that over and over, year after year, so what exactly … How would you describe that?

Coach Craig Moss: Well, I was one of those runners too. I had to learn the hard way to actually start stretching. Through a sacral fracture, I had to learn that you actually do need to loosen up your muscles before and after and get them warm. A straight-leg swing would be if you’re standing straight up, I support my left side with my hand on a rail, like a staircase rail or something like that or wall. The left leg is straight on the ground. You’re straight up and then you take your right leg and just swing it like you were kicking a football or a soccer ball as high as your hamstrings will let you go or your hips will let you go and you swing back the same way, keeping them straight just so you can work on your hip mobility and hamstring lengthening. It’s more of like a dynamic way to stretch your muscles out.

Dr. Segler: Okay, so you’re basically stationary, holding onto something with your hands for balance and just keeping your leg completely straight, one at a time, you’re just swinging it back and forth using the momentum of your leg to kind of pick up speed and at the end range of motion, kind of stretch things out. It’s really what it is, right?

Coach Craig Moss: You said it better than I did.

Dr. Segler: Okay, but you were doing it barefoot, right? After your run.

Coach Craig Moss: Yeah, yeah.

Dr. Segler: Okay, and you said, so when you were doing that, when your legs swinging through with all that momentum it, basically, your toes and the ball of the foot just smacked into the ground, right?

Coach Craig Moss: Yes.

Dr. Segler: Were you on a track or were you on a road? Where were you?

Coach Craig Moss: I was at my house standing on my wood deck.

Dr. Segler: Okay, so you hit would, right?

Coach Craig Moss: Yeah.

Dr. Segler: Wood’s still not really soft, right? In fact, one time, I was at a medical conference … This is like probably, I don’t know, 10 or 12 years ago and it was in New Jersey and I had on my schedule. I needed to do an 18-mile run and I ran like 18 miles on the boardwalk in New Jersey. Man, I swear I think you could run on marble and it would be softer. It was unbelievable how bad that beat me up. I mean the boardwalk there in New Jersey, it’s a solid boardwalk. I mean they drive police cars on it, so it’s lots of, I guess, concrete and steel underneath that thing and somehow, I just assumed it was gonna be fine and it wasn’t. Any hard surface can can beat you up, but obviously if you slept, swing your foot with full force straight into wood, it’s not very forgiving.

Dr. Segler: But a couple interesting things here, so in your story, you basically said you did this. You hurt it, and it obviously hurt at the time, but you were at the 4th of July parade. It really didn’t hurt that much. You’re walking around. I mean it sounds like you aren’t really protecting it. You weren’t on crutches. You weren’t really limping, enough so that you went for a run after that and then planned on doing this 16-mile run where it’s really arduous, I mean, not just like a simple run. It’s running the mountains, right?

Coach Craig Moss: Yeah.

Dr. Segler: You’re talking about a hard run and then you figured out something was wrong ’cause it was really hurting. Did you have any bruising or swelling or was it just uncomfortable?

Coach Craig Moss: It was just uncomfortable. There was no bruising. It really felt like if you touched it, if you put your finger on it and pushed, it felt like a big bruise on the whole ball of the foot, obviously more towards the two bigger toes in that area.

Dr. Segler: Yeah, yeah, so that’s one of the things is that … On a scale of one to 10, if you had to think back … I know there’s a couple of years ago, but if you had to think back and try to rate that pain on a scale of one to 10, one being you can barely feel it and 10 being somebody chopped off your leg with a dull ax, what would you say it was? What would you call it?

Coach Craig Moss: It’d probably be in the six-to-seven range probably, but that’s a runner six-to-seven so on a normal person, it’s probably like a nine.

Dr. Segler: Exactly, exactly. I was just actually writing some material for an episode this morning about pain levels and I was thinking about how … That’s the thing is, so you have like what you call maybe a six-out-of-10 pain and you are going to still run 16 miles in the mountains on it and that seemed completely reasonable. You didn’t have any bruising and didn’t have any swelling, but part of the problem with the ball of the foot, is that you have this big thick fat pad that cushions you and so you can kind of get a lot of inflammation that kind of gets hidden ’cause it’s deep in that tissue and it just feels like a little uncomfortable. It feels a little bit like a bruise or whatever, but it can be misleading, so obviously, you didn’t think this was a serious thing. You were still running on it, still thinking it would be fine to go for all the long workouts that you can obviously enjoy a lot more being a teacher, being off in the summer. It’s a lot easier to do that in the summer and it’s nice running in the summer, right? Let’s just be straight about it.

Coach Craig Moss: Oh, yeah.

Dr. Segler: But then when you really started figuring it out, you look at it, try to figure it out. We talked about it and you got an X-ray. What’d you find?

Coach Craig Moss: The X-ray was negative. It was inconclusive. It didn’t show anything so there was no-

Dr. Segler: Okay, but you’d expected something would show up, right? If something’s wrong. You think as runners, we always think if you get an X-ray, something’s going to show up and most of the time, when people have pain in the ball of the foot and nothing shows up when they go and get an X-ray.

Coach Craig Moss: Yeah, and then trying to get a CAT scan or a CT scan to find like a micro-fracture, I mean that’s hard going through insurance and stuff like that and that’s a two, three-month process if you’re going to see a doctor and then get the referral, then try and schedule the appointment, those types of things.

Dr. Segler: Right, and so that can be very difficult. Yeah, that’s the whole thing is that, you know, it’s interesting, I often would get … I do these calls with doctors to try to get something preapproved through an insurance company and most of the time, they’ll send some ridiculous letter that says, well, we’d like you to do a boot and crutches for four to six weeks before we authorize this and most things are gonna heal in four to six weeks. They’re just trying to avoid the diagnostic cost, but if you can rule out something like a fracture, then you can get back to running a lot sooner, a lot safer, so it’s just … I mean, let’s face it. When you get insurance, what you do is you sign a contract and agree to pay a certain amount of money every month and the insurance company gives you an outline of the stuff they will do their very best to not pay for. That’s what you’re buying. But that’s the way it is and so then how did you figure out what was really wrong? What was it that finally, conclusively showed what was really wrong?

Coach Craig Moss: As I kept running on it, it kept getting worse and worse and worse. It was just hurting more and more and more and it was aching all throughout the day and then it was starting to be where I couldn’t put as much pressure on it.

Dr. Segler: Okay, so that’s a bad sign, right? Obviously.

Coach Craig Moss: Yeah, so at that point I reached out to you, and I think I reached out to you on a Saturday and you got back to me on that same Saturday. We started talking about Saturday evening, I want to say, or the Sunday, one or the other, but it was almost immediate and you and I had a Skype session and you made me go through a lot of pulling my toe this way, that way, touching this area, touching this area, that type of stuff. You diagnosed it over Skype with what you thought it was, so my doctors didn’t do it. You did it via Skype.

Dr. Segler: Yeah, so but then so what was the issue? What was really wrong?

Coach Craig Moss: The second toe from the big toe, when I pulled it back, it would hurt really bad and if I pulled it all the way down, it hurt really bad. When it was straight and stationary, it wouldn’t hurt too bad, so it was almost like the toe extension pushing off the toe when you’re walking was obviously the painful part ’cause you’re extending that toe and using that toe to push off and stuff like that.

Dr. Segler: Right, so that implies then that you don’t have something like a metatarsal stress fracture because when you have a metatarsal stress fracture, if you move the toe around, it really doesn’t cause any discomfort. It really only hurts if you try to bend the metatarsal or push right where the fracture is on that metatarsal, so it kinda ruled that out, right?

Coach Craig Moss: Yeah.

Dr. Segler: But that implies more of something like the plantar plate being injured or the joint capsule surrounding the plantar plate where it attaches and pulls on the bone, either the base of the proximal phalanx or the metatarsal bone, like at the metatarsal neck, one of those areas which might be injured. And so what was your actual injury?

Coach Craig Moss: I couldn’t even remember what you called it.

Dr. Segler: Okay, so basically, if you sprain all that stuff and you pull off the attachment where it attaches to the bone because you smacked into it or it chips off a piece of bone where the joint capsule and the plantar plate attaches to the bone, what did it take to heal it?

Coach Craig Moss: Well, my doctor … at the same time, my doctor, after I got the X-ray, told me to go see a podiatrist, so as I was scheduling that, I was talking to you. You suggested that I tape my second toe to my third toe and then you showed me how to cut the insoles of my shoes a special way, which obviously, we couldn’t really show via podcast. You’re going to have to link it in the show notes somehow.

Dr. Segler: Yeah, yeah, I could do that. Yeah.

Coach Craig Moss: That was the game changer, the cutting the hole in the insole the correct way to allow it to have a little flex in it. That worked out a lot, and actually after you did that, told me to do those two things and then stick with the heat/ice where you ice for five minutes, then you heat for three minutes, ice for three minutes, heat for three minutes and then ice for three minutes.

Dr. Segler: Yeah, the contrast bath routine, yeah.

Coach Craig Moss: Yeah, doing that three times a day, those three things seemed to help me get back out on the road and then I went to go see my doctor, my podiatrist, he suggested a boot, which I know you’re vehemently against and then he actually … And this is a funny story. I walk in there and I show them the way I was keeping my foot with KT Tape and he was like, he’s like, “That’s interesting. Where did you see that?” And I told him about you and then I showed him my insoles and he was like, “That’s interesting. Where did you learn that?” I almost knew more than the podiatrist just off of a couple of Skype sessions and phone conversations with you. It was kind of actually disheartening. They gave me the boot anyways and I took it, but I didn’t wear it. I wore it out ’cause they gave it to me and I stuck it in my car and it just sat there for … It’s still actually there.

Dr. Segler: Well, right, so here’s the thing though, is the standard treatment for all these kinds of injuries, even when an insurance company doesn’t want to pay for an MRI or something, they’ll say, “Well, we think you should use a boot for four to six weeks.” Well, the fact is is that if the only goal is to get that pain to go away and heal that injury and that’s the actual only goal, that if you do not walk on it for four to six weeks or if you use a fracture walking boot for four to six weeks, the overwhelming majority of injuries in the foot will heal during that period of time.

Dr. Segler: The problem is that if you’re a runner and not a normal sedentary American, there’s gonna be a problem later because you’re gonna go running again. I mean, let’s face it, you were injured and you went and ran 16 miles, so if you use a fracture walking boot, you get weakness, stiffness, all the loss of neuromuscular connections, all the bad stuff and that one injured thing does heal. But also what a boot does is it holds you still and it protects and supports that injury, but it decreases the pressure across the entire ball of the foot because of the curvature under the boot and the way that it forces you to walk.

Dr. Segler: In my mind, if you can not have all of that weakness and stiffness and everything else, but you can still figure out a way to support that injured part and remove some of the stress, then it will still heal the same way without all the trouble of a fracture walking boot. By taping your toe to stabilize it and keep some of the stress off of your injury where you slammed into the deck and to remove a little pressure by simply cutting a hole in the insert to take pressure away from that injury, it achieves the same thing.

Dr. Segler: You could have worn a fracture walking boot you, but truthfully at this point, year and a half later or whatever it is, you’d probably have had a number of other injuries, Achilles issues or some other stress fracture or something just because of the price that you pay for being in the boot, so that’s the thing is it really is that simple and so even if you don’t know exactly what the injury is, if you know where the trouble is and you can figure out what causes pain and what doesn’t cause pain and how to decrease the tension to that structure by taping it and decrease the pressure by either using pads to put pressure somewhere else or cut a hole in the insert to take pressure away directly under that injury, most of the time, that’ll be a way to reduce the pain and pressure so you can start healing.

Dr. Segler: With your story, when you have a discomfort, you feel this bruise, but you can walk on, it’s not really that bad and you run a little bit and it doesn’t get any worse, that’s actually a really, really good sign because you’re always … Just like your fitness. You’re a coach, right? When you see people, they’re either always getting stronger or they’re getting weaker. Nobody is ever staying the same is what I think. I mean, would you agree with that?

Coach Craig Moss: It appears that way, yeah. Even just during maintenance phase.

Dr. Segler: Right, right, so even in maintenance phase, exactly. When you’re trying to maintain just a level plane of fitness, you’re still really either improving or you’re getting worse. This is totally true of all physiology and healing. You’re either getting better or you’re getting worse and so if you basically tell me like, “Okay, well, I did this thing. I slammed my foot into the ground and it really hurt, but now it just feels kind of bruised. I can walk on and whatever. It’s not getting bruised. It’s not really that painful. It’s not getting more painful. It’s not swelling anymore,” then that’s a good sign because what that means is that you’re effectively staying the same, so what you’re doing is you’re walking on it, putting pressure on it and moving it, and that’s irritating the tissue, but the tissue is not so unstable that it’s actually getting progressively worse. So then if you can do something really simple, like decrease a little pressure or tape it to add a little stability, it implies that you could then increase your activity significantly, like running without getting worse and while continuing to heal.

Dr. Segler: But when you go and you do a short run, it’s not worse, but then you’re on 16 miles and it actually gets worse and you run a little bit more, it gets even worse then you know you got to take action. You got to do something to reverse that process. How long did it take you to actually get back to where you felt like you could run without worrying about it?

Coach Craig Moss: That’s a month, but I was still running through it because after you told me what to do, I waited a couple weeks to run and then I went on soft surfaces, like doing grass at a soccer field, so I’d run like a mile or two around the soccer field, but I went by feel, like if it wasn’t getting worse ’cause you know it’s going to feel a little bad, obviously [crosstalk 00:20:46] injured area, so I could feel it and I’d be like, okay, it’s two or three or whatever like that on the pain scale and it would stay there and then I get done. I’d take a day off and then wake up that next day, so the day after the day off, see how it felt and if it felt okay in the morning, I’d still go test it again on the soccer field.

Coach Craig Moss: I was putting in, like two, three miles at a time, two or three days a week on soft surfaces just to give it something really soft to land on and then maybe, I want to say so two weeks off, then two weeks of that and then that fifth week, I tried a regular sidewalk through the neighborhoods type of run. That was a shorter one. This time, I actually ran to a park and did the grass in the park and then ran home so it put a little bit more pounding on it on the concrete and then that was fine. Then I progressed and I want to say I stayed a four miles, four days a week for another month just to … ‘Cause I was in no rush [inaudible 00:21:47] to train for anything, but I wanted to keep running just mental fitness, feeling fine, feeling good ’cause you enjoy running and stuff like that.

Coach Craig Moss: Luckily, I wasn’t really training for anything where I felt like I had to get it super big miles and stuff like that, so the four miles a couple of days a week, three or four days a week was fine for me, so it took me maybe to … ’cause that was in July. I was running in August, so I want to say like mid-September I started going up into the six, seven, eight-mile range and then just staying there. Once again, I wasn’t training for anything. I just wanted to get a little more miles once in a while.

Coach Craig Moss: Right around September I want to say, so maybe six, eight weeks post injury or post talking to you, not post injury, but post talking to you was probably when I started to feel a little more confident on it and didn’t worry about it so much. You get done with the six-mile run, it’s not nearly as painful when it was a month ago and you’re walking on it and it hurts. That’s when I started to realize that it was okay, and I think I want to say maybe three months, right around 2½, three months, I got rid of the insole, the extra insole and stopped taping the toe to see if it would feel fine on its own without the actual, quote, unquote crutch of the insole underneath it to help it out, so that was about the timeframe of it all.

Dr. Segler: Yeah, okay, so a couple of important points here. One of those is that you were like doing these short runs, but persistently paying attention and trying to assess is this feeling the same while I ramp up my activity or is it getting worse? So you’re paying really close attention to that and yeah, these are probably a lot shorter runs than what you would have had on your schedule, right?

Coach Craig Moss: Exactly.

Dr. Segler: But that’s what you have to do to assess it, so it’s a process of just maintaining, like you said, some of that mental fitness and some activity so that you don’t go nuts and you don’t lose all your fitness and assessing is it improving or not as you ramp up. And then the other thing is that you said, it was like around six to eight weeks that you really felt confident that you were on the right track and if you’d been given a fracture walking boot, the standard is about six weeks in the boot. So at six weeks, instead of feeling confident that you’re basically healed enough to really move forward and really keep going, at that point you would have been getting rid of the boot and going to physical therapy to learn how to walk normally again.

Coach Craig Moss: Exactly.

Dr. Segler: The other thing is that it’s very different when you get injured when you’re paying attention to the pain because I would imagine as somebody who coaches high school athletes, if you take a kid, for example, who decides they want to run and they want to do a marathon. They want to the L.A. Marathon and they’re basically sedentary, well, the initial phase, it’s like you give them a schedule and you’re like, “Here’s your schedule. You’re going to walk, run this, and you’re going to run a mile, then you’re going to run two miles, then you’re going to run this and it is going to be painful and uncomfortable. You’re gonna have to learn how to get past that,” and so you tell them very specifically that this is going to hurt. This is your schedule. Don’t worry about it. Just stick to the schedule.

Dr. Segler: As runners, when we get injured, it kind of works against us because we still think in the back of our mind what our next race is, what we really want to do, what our schedule should be. Instead, you had to do the opposite where like, okay, no schedule. I’m gonna run a mile on a soccer field or I’m gonna run a couple of miles here. I’m gonna run three miles to the park. I’m gonna do something really short and see what happens and then I’m gonna make a plan the next day, you know? so it, it is a very difficult thing to make that shift from just ignoring discomfort to really reevaluating on a daily basis to figure out what you can do next. How did you get through that? Was that a tough process for you?

Coach Craig Moss: Well, I don’t want to say, fortunately for me, ’cause having sacral stress fracture is not the funnest thing in the world but two years prior, my … I’ve only had like two really … prior to this foot, I only had two really big running injuries. I had IT band issue one time and then I had a sacral stress fracture. That sacral stress fracture took me out of the running for six months. I could not run for six months and then I had to get back into running. It took another four months of just going to the park and running for five minutes and then walking for five minutes and running for five minutes and that was it for the day and then you take a whole week off.

Coach Craig Moss: Since I had already done that process, it was a little bit easier to tolerate this one ’cause I’m like, okay, I know that if I go slowly, I take the time to actually slowly get back into running, it’s better than trying to rush into it and getting into the whole injury cycle ’cause then all of a sudden, you’re like, now my foot hurts. Well, now I’m changing my stride a little bit. Okay, so now this ship’s going gonna hurt on this side. Okay, so now I’m going to pull the muscle on this side. Now my IT band on this side is going to react a different way. I knew going in that I had to be really, really, really patient or I was gonna be in the injury cycle for months and months and months and not get out of it successfully most likely.

Dr. Segler: Okay, great, all right, so listen, I know you’re a coach, so you have a unique perspective. You have a lot of experience and as a coach, you wind up not just with the experience of having run 46 marathon, but you run … I think coach is wind up like you, you don’t have 46 marathons worth of experience, you have hundreds of marathons worth of experience because you’ve helped in trained all of these people to make it to an event and get through the event.

Coach Craig Moss: Yes.

Dr. Segler: For you, that may be a bit easier to kinda look at it from this different perspective, but for the normal runner, somebody who’s been running for years and then they get injured, what advice would you give them in terms of assessing the pain and really paying attention to what’s going on? How would you tell them to look at that?

Coach Craig Moss: Well, one, I’d say be honest with the pain. Don’t say, in your head, that it’s a two when it’s really a six just because you want it to be a two so you can head out the door, then while you are running, be honest with yourself. Don’t have a mileage stuck in your head where you’re saying, today, I planned on six miles, so you get to miles three, kind of starts to feel a little off, but you’re like, “Hey, I’m halfway through my run. I can get to the next mile. It’s no big deal, then I’m pretty close to the six because I’m at four, so I might as well just finish it.” That kind of thing is not beneficial to you.

Coach Craig Moss: The way you got to look at it is, ‘kay, I’d rather take them two, three, four weeks off now or back off for two or four weeks right now so I can be successful the rest of the year as opposed to two or four weeks of running, kind of through an injury and then taking two to four months off ’cause it turned into something bigger.

Dr. Segler: That’s right.

Coach Craig Moss: But that’s such a hard thought for people that have never been through it or the stubborn runner or the person that wants to get to the race that they signed up for. I had never missed a race before and I started missing races obviously because when the sacral fracture happened and then I signed up for races after I had recovered, I’m like, okay, in this race is three months off. I’m gonna sign up for this race and do it. I wasn’t training well and actually scrapped a couple of races and mentally, that was hard at first.

Coach Craig Moss: But now it’s like, okay, I’m glad I didn’t do those races and forced my 13 mile half marathon and maybe hurt myself. I’ve missed a couple of races and I’m fine with it now ’cause I know that in the big picture of running for the rest of my life, it’s better to miss a couple things here and there than it is to miss months and months and months of training due to major injury.

Dr. Segler: Yeah, absolutely, when you were talking about that, one of my ways that I sort of stay on track with training is I almost always, even with doing Iron Man training, doing long swims and stuff like that, I always try to do out and back, so even if it’s like a swim in a lake or the ocean or whatever, I’d rather swim one mile out, so I know I have to do the other mile coming back. I don’t really like doing loops ’cause I don’t like to count and it’s boring. But if I’m gonna do 18 miles and I run nine miles out, I have to do nine miles to get home, you know?

Coach Craig Moss: Yeah.

Dr. Segler: Doing loops like somewhere where you can go run, even if it’s at a park where it’s like a mile and a half around the park, it may be boring, but if you do a mile and a half and it feels okay, you go another mile and a half and if you get to three and it’s starting to hurt, like you said, and your plan was to go six, it’s a lot easier to say, you know what, I’ll just get in the car and go home, whereas if you’re going three miles out the door … Most people are not gonna say, okay, well it’s only three miles. You’re not going to take Uber home, you know?

Coach Craig Moss: No.

Dr. Segler: But that’s what you should do, but most people are not gonna do that, but when you’re like running right past your car doing a loop over and over at the park, it’s a lot easier to sorta rein it in and listen and like you said, be honest with yourself and realize, look, this is hurting. Continuing to run on it when it’s hurting is never a good idea if you’re trying to heal.

Coach Craig Moss: I agree 100%.

Dr. Segler: All right, Craig, so any other tips for people for the new year when they’re setting their goals? They’re trying to figure out how they’re going to make all their goals this year? Anything that you as a coach would tell ’em? What’s the golden piece of advice?

Coach Craig Moss: Well, if their goal is to run healthfully and successfully for the year and they’re not doing dynamic warmups or cool-downs, that’s where you should start. Secondly, they should find their muscle imbalances and work on some strength training. I know people don’t like it. A lot of runners don’t want to do some single-leg squats or some single-leg lunges and stuff like that, but 10 minutes of that post run a couple of days a week makes the biggest difference in your running performance.

Dr. Segler: Yeah. That’s interesting. That’s a good point. Yeah, there was, I think it did an episode on looking for your limiters. Let’s face it, if you’ve been running a long time, you’ve done a bunch of races and you’re what you think of is as close to your physiologic capacity and fitness that you can get, you cannot just put in more hours. But if you can find these little, like you said, these imbalances, little weak spots here and there and if you strengthen the weak spots, you get huge gains by comparison to putting in more time, so I think that’s great advice. Well, Craig, if people want to get ahold of you, they want to talk to you, how can they reach out to you?

Coach Craig Moss: I’m on Twitter. I’m cmoss23 and then if they want to email me ’cause I do offer coaching, it’s crm6283@lausd.net.

Dr. Segler: Okay, so if it’s cool with you, we’ll put those links in the show notes for this episode so people can get a hold of you.

Coach Craig Moss: Oh, 100%.

Dr. Segler: Craig. Hey, thanks so much. I appreciate you coming on the show, appreciate you sharing your story and appreciate you being willing to kind of share your insight with all of our listeners today.

Coach Craig Moss: No problem and good luck with your racing the season! Appreciate it!

Resources and Links to connect with Coach Craig Moss:

Twitter:  @cmoss23

Check out Coach Craig’s Blog: http://cmoss-thankgodiwasfat.blogspot.com2

Send an email to Coach Craig Moss: crm6283@lausd.net

Follow Craig on Instagram: @cmoss23

Follow Craig on Facebook: Craig Moss:


There are several question you need to ask if you think you have a stress fracture and want to get back to running as quickly as possible. I’ll walk you through them.

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Top 10 questions to help decide when you can run if you have a stress fracture.

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Top 10 questions to help decide when you can run if you have a stress fracture. Watch this video now!