#438 Can I just keep running and see if it gets better? - DOC

#438 Can I just keep running and see if it gets better?

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.

Today’s episode comes from 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.

Now, all the runners on these group coaching calls have been injured and they’re getting back to running, and all of them are trying to figure out which pain is a problem, what pain really matters, and which pains can be ignored. Now, 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. Check it out.

Dr. Segler:
What are the questions that you have?

Runner patient:
Well, I guess, I was just wondering if I just keep… I mean, I sort of feel like I should keep running so that I kind of get my foot used to that position. I didn’t know what you thought about…

Dr. Segler:
Let me ask you the million dollar question, are you tracking your pain right now?

Runner patient:
Not really. I mean, not on paper.

Dr. Segler:
Okay. Have you trained for a marathon before?

Runner patient:
Oh yeah.

Dr. Segler:
Okay. Do you track anything when you’re training for a marathon?

Runner patient:
I do. Yes.

Dr. Segler:
What do you track when you’re training for a marathon?

Runner patient:
Just mileage and paces and how I feel and things like that.

Dr. Segler:
If you felt bad, would you change something?

Runner patient:

Dr. Segler:
What if you’re tracking all of these things and you notice that no matter what you do, your mile repeat times are actually declining throughout the course of your training? I mean, that would signal a very, very clear problem. If you’re training and you notice that your heart rate with exactly the same pace months into your training program, your heart rate is actually creeping upward instead of downward, that would give you a sign that something’s wrong, right?

What blows me away is that I do these things all the time and it is incredible that I see some people, even professional athletes who are not actually tracking their pain. You got to track your pain. I mean, you have to track your pain. This is crucial. In fact, I tell doctors this. I was lecturing in Seattle on running injuries like a week ago, and I was explaining and said, “Look, all runners have pain. And the problem is we come in, we give you this pain scale.” They just ask you one time, how much does your foot hurt on a scale of one to 10?

Well, that depends. Are you talking about right now while I’m sitting in a chair doing nothing after been waiting for three hours to see you, or are you talking about while I’m running? Are you talking about the day after I run, like Chris mentioned? His discomfort is going to be different the day after he runs with this recovering stress fracture than it will be at the time that he just was running or even while he’s sitting still. He might have zero pain while sitting still. But those are the things that you have are these numbers to go on and that’s really it.

If you’re not tracking that, you don’t know what’s reasonable in terms of making a decision, right? I mean, that really is a thing. It’s like, I do frequent follow-up. This is one of those things I always offer on these things. One of the things is to have frequent follow-up. I don’t really care if you sign up for it or not. I don’t necessarily think you have to.

You have a doctor and all that, but basically, for anybody on these calls, if you go and you book a one phone call, one hour phone call, then you get basically access to whichever course you need, if you need one of the courses, the Rapid Recovery Journal. You get a one-hour webcam call where I talk about these little things about how to try to reposition your foot, how to remove some of the stresses, and so on.

Much of that, frankly, is in something like the Metatarsal Stress Fracture course, where I actually show you how to use pads and inserts and all that to move stresses from one place to another, and then following up a week later. But I can tell you that during the first part of that call, during the webcam call, I do this over and over and over with these athletes, and I’m like, “Are you tracking your pain?” The answer most of the time is no. And then I say, “Okay, well, let’s talk about how to do that.”

I swear, I spend like a quarter of the calls with these people who book these things and we talk about, okay, well, how much does it hurt right now while we’re talking? If the answer is zero, you need to write that down. How much does it hurt while you’re running? If the number is a four out of 10, you got to put a number on it, so you can compare it to something later, the same way you would your heart rate or your perceived exertion.

And if you have pain when you run, then you also want to pay attention to whether or not you have pain at the end of the day doing simple things and whether or not you have pain the next day doing simple things. And what I mean is that even though most people aren’t tracking it, they’re sort of vaguely aware of it. I will say, okay, when you wake up in the morning, what is your routine? And most people say, “Well, I’ll wake up. I go make coffee.” Okay. Are you wearing shoes? Are you barefoot? What are you doing? I’m barefoot. Okay.

Does it hurt when you walk from your bedroom to the kitchen making coffee in the morning? And they’ll often say, “Well, only the day after I’ve done a long run or the day after I did speed work.” Okay. Well, if that’s true, then what is the number that you would put on that? You start tracking these things. The pain journal that I made, you can get it on the website. It’s on there somewhere. I don’t know where, but it’s there somewhere. You can just download it and print it out. But that’s one of the pages in the Rapid Recovery Journal, because you got to know your numbers.

If you take these little simple things that you do, like walking upstairs, walking downstairs, walking around barefoot versus wearing shoes, hardwood floors versus carpet, it actually gives you numbers you can use to decide, do I need to take time off, or is it safe for me to try to ramp up? You have to try to ramp up. Your coach’s job when you’re training for a marathon is to actually push you as close as possible to your threshold for injury, without pushing you over that line.

Your job as a recovering runner, whether it’s a stress fracture or a flat foot reconstruction, or an Achilles tendon rupture, or anything else, your job is to actually try to figure out how do you make these calls on when you can do more activity and when you should be doing less activity. Yesterday I did a call with somebody and she basically… I was having pain and trying to figure out what to eliminate. She had a stress fracture.

I just said, “Look, what I would do is like and as I said, which one of all the things that you’re doing right now, what do you think is causing the most trouble? She said, “I think it’s the four mile walks that I added.” A walk, first of all, to any runner does not seem stressful. That seems like something you do for locomotion, to get from one place to another. Not stress, right? Running is stressful. Hill repeats are stressful. But in her case, she was pretty sure she just had this intuitive sense that the four mile walks were messing her up.

And I said, “Well, then what I would do is I would get the pain numbers. I would figure out what my pain numbers are right now, and then I would eliminate the four mile walk and do not eliminate or add anything else. And over the next two or three days, see what happens. If the pain dramatically drops off, you know that was the one offending activity and you should just leave it out for maybe a week, and then sort of add it back in gradually. And watch your pain numbers. And the same thing in your case right now.

Because what the doctor’s going to do is the same thing that every doctor does, and what we do is we hear your story and say, “Oh, we have this pain. Okay. Well, you don’t want to mess that up. You don’t want a cuboid stress fracture. Just quit running. We’ll see you in a month.” Well, you just did that. My immediate response would be like, “Well, no offense, doc, but I just did that. And I’m telling you, all I did was go run a mile and it hurt. What’s plan B? What, start swimming? I don’t want to be a swimmer. I’m a runner.”

The follow-up question then is, okay, I know you want me to stop running, but I’m not going to stop running. My goal is to run. That’s why I had a flat foot reconstruction, not so that I could come back a year later and have you tell me to quit running. I actually want to run? The question is, number one, what do you think is the actual problem that’s causing this pain that feels like my cuboids getting squished?

And number two, how can you modify something in my foot the way it’s positioned, whatever, so that it reduces the stress and strain to the cuboid so I can do more activity and maintain my running fitness while I’m waiting for this specific thing, whether it’s cuboid syndrome or a stress fracture or whatever? What can I do to reduce the stresses as it continues to improve so that I can maintain my running fitness?

Now, we’ll tell you upfront that will really annoy most doctors, because most of them are already reaching for the door knob by the time you get halfway through that description, but all doctors want to help you. So even if they seem initially kind of like put off by this question that you pose to them, we always want to help you.

We always will stop and try to think, okay, what could she do to reposition and we’ll oftentimes suddenly say, “Okay, well, let’s try a cuboid pad, or let’s try adding a little bit of felt to the bottom of the insert as an arch support to move some of the stress from the outside of your foot, to the medial side of your foot to see if that reduces stress enough that you can actually go run a mile without any pain.” And then you try it, and you watch those pain numbers. That’s really the crucial thing is that you’ve got to do that. You’ve got to do something.

If you track the pain numbers and you really pay attention to what’s going on, and then you try these simple things, then you can very quickly make readjustments and reassessments. A month is not a good reassessment. The reason that when I do this thing on these webinars is that this whole thing of like you get a webcam call and you get the follow-up call a week later and the courses is that I gave you the Runners Rapid Recovery journal cause you need to track everything.

And it talks a whole lot, I mean, it’s a whole book about how to pay attention to these things and track these things and specific exercises so that you actually identify the stuff that you normally do in training that you’re actually not doing right now. And that’s the amazing part to me is that I see athletes who know how to do all this stuff to damaged tissue in training, let it heal, and then go do it again so you get stronger and stronger. And most of the time when you’re injured as an athlete, you kind of abandon all of that and you’re sort of lost.

You’re like just adrift at sea, and yet you already know how to do that process as a runner. The Rapid Recovery Journal just kind of redirect you in that way so that you can actually start looking for these things that you do that will actually help you continue to recover and improve as quickly as possible. On the first call, we’d basically talk about like, what’s going on? What’s happening right now? Why you’re having trouble? What can you do right now to try to shift these forces? What can you do to try to shift your activities and reassess every single day.

And then in a week, you’ve got a lot of information and you can really understand that process, and then you can do it from there on out. But it’s all about making sure you’re paying attention to these little changes that you make so that you can progress as fast as possible. And again, you do have a timeline. You can’t take a month off and not expect to lose a lot of fitness. Obviously I’m sure you went through that after surgery. You take months off because you’re recovering from flat foot reconstruction.

You’re going to lose a lot of fitness, and then it’s a lot more work to get it back. The less time you take off, the better off you’re doing. That’s the long and short of it. Makes sense?

Runner patient:
Yeah, for sure.

Dr. Segler:
Okay. Any other questions?

Runner patient:
I think I’m good. I’m going to track myself. Thank you very much.



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