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 the three times a runner should not get an MRI for a stress fracture.
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.
So at this conference, I was asked to give several different lectures, and one of those was stress response, stress reaction, and stress fractures in athletes, and the point of the talk is to basically explain to physicians what all these things mean, what it means when somebody really has a stress reaction and they want to run, what it means when they have a stress response and they want to run, and what it means when you actually have a stress fracture and you’re trying to heal it and decide when you can actually get back to running. Now, these are all things that I explain in the metatarsal stress fracture course for runners. It teaches you the same stuff I would do if I was sitting in your living room right now looking at your foot, explaining the differences between these things and then what you have to do in each scenario to take the stress off the bone and continue to maintain your activity and get back to running.
Now, when I talk to the doctors, one of the big important points is to try to make sure that they don’t unnecessarily waste your time or your money, and one of the best ways to waste time and money when you have a problem is to get an MRI. You often have to wait for some period of time before you can get it scheduled. Sometimes, you have to wait for your insurance to improve the MRI and give you prior authorization for the MRI, and then frankly, when you get the MRI, it can give you some information that might actually lead you off course and keep you off of running longer than necessary.
Obviously, if you have a broken bone, you don’t want to run on it and break it and move it out of position and wind up in surgery. But what I find more often is not that runners do that, that they end up getting an MRI that shows information that is deceiving and actually convinces you or your doctor or both that you’re worse off than you actually are. So there are three situations when I was explaining to these doctors that they should not order MRIs on their patients who are athletes and I want to explain those to you. So the first one is when you think you have a tibial stress fracture, so you have what you perceive to be maybe a tibial stress fracture or maybe shin splints, but you and your doctor talk about it.
It seems like you might have one of the other of those and you do the hop test. You actually hop on it and it actually hurts when you’re landing, that’s a positive hop test and is suggestive of a tibial stress fracture. So when I see athletes myself and I do the hop test with them and I know that they have a tibial stress fracture, not shin splints, there is way I’m going to send them for MRI because it’s just going to look bad, it’s going to freak them out, and I don’t think it’s necessary. So in that case, it’s a waste of time and money.
The next thing is if you go into the doctor’s office and the doctor does an X-ray of your foot and you have an X-ray that shows a visible crack in the bone, you do not need to get an MRI. It’s a total waste of time and money. You already know that there’s a crack in the bone. You need to treat it appropriately, and then based on what’s on the X-ray and what it looks like when the doctor’s poking around on your foot, then you have to make a decision about what to do. But you don’t need an MRI if you get X-rays and you can see that there’s clearly a crack in the bone.
The third time I was telling doctors that they should not order MRIs on people like you, runners, is unless they want to confirm a stress diagnosis in a runner in a way that would actually discourage you from doing activity. So I basically tell the doctor, I say, “Look, if you’ve got a runner who will not listen to you, will not calm down, will not follow your directions, will not stop running, then maybe you want to get an MRI.” But that is not usually the case. It’s rare, but it does happen. I mean, I saw a doctor one time who had what I suspected was a calcaneal fracture, a calcaneal stress fracture, I was worried that she had this as a real problem. She was a very active runner training for marathons. I set her up for an MRI.
She went and got the MRI, and then when I went to see her to look at the MRI with her, again, keep in mind, this is a doctor, she actually told me, I said, “What did you do today?” She said, “Well, it’s pretty sore right now.” I said, “Yeah, what did you do today?” She said, “Well, after I got the MRI this morning, I actually went and I did a 16 mile run.” I was like, “Why in the world would you go run 16 miles after you get an MRI on a day when we’re going to meet to read your MRI?” She said, “Well, I knew you were going to tell me to not run so I figured I should just go run.” Now, that’s crazy. Obviously, that is not a good idea.
So for somebody like her, it was useful for her as a physician to actually see the images on the MRI that really looked really bad, that convinced her, “Okay, I got to back off and take it easy for a little while.” So unless your doctor’s trying to do that to you, if they really think you just have a stress response or a stress reaction, I don’t really think you need to get an MRI in most of those cases. It’s only in the case when you’re going to basically put yourself at risk and the doctor might need to convince you that you should calm down, stop running less, that might make sense. But those are really the three times that I was telling these doctors they should not order an MRI in runners who are suspected of having stress fractures.
So if you want some more information about this, you can check out the runners. You can check out the stress fracture course. If you want some more information about this, of course, you can check out the stress fracture course for runners. It shows you all of the things you can do yourself to check and see whether or not you have one of these conditions, like a stress response, a stress reaction or a stress fracture, and the strategies you can do to actually see how bad it is on your own by removing some stress to the bone, decrease in the inflammation in your foot and increasing the pressure in other areas and taking pressure away from that injured bone so that you can continue to ramp up your activity, maintain your fitness and get back to running as quickly as possible. It will be available. It’s in the show notes of this episode, docontherun.com. Go check it out
Metatarsal Stress Fracture Rapid Recovery For Runners
If you have a stress fracture, you’re probably really freaked out right now and think you’re going to lose all of your fitness while you heal. But it doesn’t have to be that way. I teach doctors how to help runners heal and maintain running fitness.
If your doc said “Stop Running!” You don’t have to stop running. You just have to reduce the stress to the injured bone so it can heal. You just have to be thoughtful about how you maintain your running fitness so you can keep healing.
Run without making it worse. The worst thing you can do is sit still, stop exercising and lose all of your running fitness. It is possible to maintain your running fitness while you heal your metatarsal stress fracture. This course shows how.
Enroll in the Metatarsal Stress Fracture Course now!
If you have a stress fracture
You’re probably really freaked out right now and think you’re going to lose all of your fitness while you heal. But it doesn’t have to be that way. I teach doctors how to help runners heal and maintain running fitness.
If your doc said “Stop Running”
You don’t have to stop running. You just have to reduce the stress to the injured bone so it can heal. You just have to be thoughtful about how you maintain your running fitness so you can keep healing.
Run without making it worse
The worst thing you can do is sit still, stop exercising and lose all of your running fitness. It is possible to maintain your running fitness while you heal your metatarsal stress fracture. This course shows how.
Enroll in the Metatarsal Stress Fracture Course now!
If you have a question that you would like answered as a future edition of the Doc On The Run Podcast, send it to me. And then make sure you join me in the next edition of the Doc On The Run Podcast.