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.
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.
Now there are other things you can do to help the repair process accelerate, too. But step one is to get the stresses applied to the injured bone down below the physiologic threshold for repair so it can heal.
When a runner develops a stress fracture, the story goes some thing like this…
One day as you are ramping up mileage, your foot hurts when you are out on a long run. It aches, just a little but not with every step. It doesn’t really hurt that evening, nor the next day.
The next time you run during your short recovery run, it feels fine. You forget about it.
Then you do a speed session and it starts aching half-way through. By the end of your workout, you can feel an aching pain with every single foot strike. During your cool down, you feel nothing. You think, “Maybe my laces were a little too tight.”
Over the course of the next couple of weeks, the pain comes and goes. You miss a long run because of a busy work project. You go days without any pain at all. Sooner of later the pain gradually starts to increase in both frequency and intensity.
You talk to one of your running buddies, who says, “Maybe you have a stress fracture.”
Now a little concerned, you cut back some workouts. You slow down. You run a little shorter. Those changes slow the progression, but eventually the foot starts to get worse anyway. Once you finally start to admit it is hurting with every run, and sometimes when you are just walking, you decide to schedule an appointment with a doctor to get a second opinion from an expert.
The unfortunate reality is that many runners are actually very rarely even aware of the pattern of pain as it develops. You track your workouts, mileage, pace, heart rate and possibly even perceived exertion.
Most runners are not in the habit of tracking pain. As runners getting stronger, we must train ourselves to ignore the pain during workouts and so we ignore this pain as well. Not only do we measure, grade nor record our pain levels, we do the opposite. We try to deliberately ignore it.
The reason that matters is that none of what actually happened during the gradual growth of the stress fracture gets communicated to the doctor as you sit on that cold examination table.
Doctor: “Why are you here today?”
Runner: “My foot hurts and I am worried I have a stress fracture.”
Doctor: “How long has your foot been hurting?”
Runner: “I don’t know really. Maybe a few weeks.”
Doctor: “Does it hurt every time you run?”
Runner: “Yes.”
Doctor pokes around on foot and finds the sore spot.
Doctor: “You have a stress fracture caused by too much running and you have stop running. You’ll need to wear this boot for 4-6 weeks, too.”
What is missing in this discussion is the pattern of injury, the progression of pain. The doctor is not privy to the details of pain advancing insidiously over the course of many weeks. The doctor doesn’t know that the bone didn’t ache on a short, easy recovery run. The doctor doesn’t realize that it was only in the past few days that the pain became constant during running.
The doctor doesn’t now because you didn’t tell her. You didn’t tell the doctor for two reasons.
Most of what I teach at medical conferences when I lecture to physicians is actually about getting them to try to slow down enough to get those sort of details from you, the injured runner. I encourage doctors to try to determine something better than a diagnosis. Not just a stress fracture, but a stress fracture vs. a bad stress response, or even a stress reaction.
The grading of a metatarsal stress fracture is what helps you minimize the time in the boot, instead of taking a 4-6 week “vacation” from running. If you know the details of your pain, you have something to go on. You can make decisions based on the patterns.
The fact is most of the runners who call me for a telemedicine visit did not record the pain from the stress fracture at all, as it began. You cannot go back and remember it accurately now.
But what you can do, that is equally as important, is to measure your pain and track it now. The trends of pain, increasing or decreasing as the most effective tool to gauge your recovery. If you want to get out of the boot sooner, if you want to get back to running faster, you have to realize you can control some of the variables. You must take an active role in the recovery process.
In the Metatarsal Stress Fracture Course for Runners I show everything I would do with you, if I was sitting in your living room looking at your foot, trying to help you figure out what to do right now. And in the free Fast-Track Recovery Challenge I show you how you can use the pain and discomfort in you foot as a tool to determine the severity and Fast-Track the recovery.
If you do nothing else today, you should take the first step in tracking your pain. Think about how much it hurts. Right it down. Begin.
Join me in the Fast-Track Recovery Challenge. It’s free. Give me 3 days and I’ll give you a better understanding of your injury and what it is going to take to get back to running faster.
sign up for the Fast Track Recovery Challenge. It’s free.
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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.
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