#540 No Proof No Permission to Run - DOC

#540 No Proof No Permission to Run

No proof, no permission to run. That’s what we’re talking about today on the Doc On The Run podcast.



Today we’re talking about no proof and no permission to run. What does that mean? Well, 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 for two reasons.

Number one, I don’t know anything about you. I don’t know anything about your history. I don’t have any of the information that I would actually need to make a decision about whether or not that would be safe or reasonable for you. Reason number two is that a doctor told you not to run. Now, 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.


The first one is timeline. Now, if you have watched any videos on stress fractures, I’m sure you found somebody that said it takes six weeks for a stress fracture to heal. Well, that’s not really true. We like to have these general ideas about how long it takes for something, but six weeks is not actually accurate at all. It could be six weeks and as a ballpark you could say, “Well, roughly six weeks.”

But if you actually look this up, there was a research study that actually showed and published that it took where from four weeks to 52 weeks for runners to actually get back to running with these injuries, and that is a pretty wide margin of time, anywhere from a month to a year. The arbitrary timelines of saying, “Well, it’ll take you six weeks or eight weeks or 12 weeks or four weeks or a year,” I wouldn’t rely on that at all.

But if a doctor says, “I’m confident this will be healed in a year if you just take a year off of running and wear a fractured walking boot,” well, that’s one way to do it. But that is the strictest guideline and it’s based on an arbitrary number where the doctor is basically making a guess and saying that, “For sure, by this time you should be okay to run. We’ll just wait that time, and then you can run.” But you may be able to run earlier if you’re better sooner, so that one’s unreliable.


Second one is an x-ray. It’s very popular with doctors. You come into the office. They see you. They take an x-ray of your foot. They charge your insurance for the x-rays, and then they tell you, well, I don’t say anything. What are we going to do? We’re going to have you back and do another x-ray. And if there’s nothing on the x-ray, well, I guess we’ll just keep you in the boot until you come back and get another x-ray, and then we’ll bill your insurance for that we’ll see. And if something doesn’t show up that looks like it’s stable and healed, we’ll put you back in the boot again. Then a couple weeks later, guess what? Another x-ray.

The x-rays show something has changed in the bone. So yes, it shows a crack or a change in position or whatever, but that’s not what we’re talking about with stress fractures in general. When you have an x-ray for something like a stress fracture, what you’re looking for is evidence of healing. You’re looking for some sort of knot in the bone, a lump of bone showing that it’s stable, that the crack has disappeared and been filled in with bone, but that process takes a lot of time.

It is definitely true that you start getting healing that happens before a doctor actually says it’s healed. The day your doctor looks at that x-ray and says, “Hey, I got good news. It’s definitely healed. We can see that it’s all healed,” that did not happen that morning. Probably didn’t happen in the previous morning. Could have happened weeks ago. Depending upon the timeline you’re waiting to get those x-rays, you could lose a lot of fitness in a lot of time while you’re waiting for that x-ray to give you permission to run.


The third thing is an MRI. Now, an MRI can be more reliable because it gives you more detail, shows you a lot more about what’s going on in the tissue, but you have to wait for that. I just got an MRI in someone who we tried to fast track this as much as possible. It took 11 days to get their MRI, which to me was excruciating. I’m sure it was a hundred times worse for the person that needed the MRI. If you’re trying to get an MRI, that doesn’t always show you for sure that it’s completely healed. It can also show inflammation that kind of freaks you out and makes it look like it’s really inflamed and keep you off of activity unnecessarily. The MRI is also not a fantastic way to give you permission to run.

Clinical Findings

The other way is what we call clinical findings. What this means is what we tell when we look at you in clinic, what we find in clinic when we talk to you, when we ask you, what were your pain numbers at the beginning? What are they now? What did it feel like this morning when you stepped out of bed? What does it feel like when I push on it right here where the fracture was?

What does it feel like stand up on your toes? What does it feel like when you do all of these things that you do all day long in your home? Has it improved? Is it way better? Is it not better at all? If you have no pain, that’s a very good sign. If you have lots of pain and you have swelling, that’s a very bad sign. Those are bad clinical findings. But in my mind, the clinical findings are actually much more reliable and give you permission to run much faster than all these other imaging studies and things that we want to wait on, and even worse, an arbitrary timeline.

If you have an injury and you feel like it’s improving very quickly, the chances are good that you’re going to get back to running very quickly, at least if you continue to do the things that decrease the stress and strain on that injured tissue so it can continue to heal and recover at an accelerated pace. That does not mean you have to stop running entirely all the time, and it certainly does not mean that you have to lose all your running fitness.

It may mean that you have to modify some things, but your task as an injured runner, whether you’re waiting for the clinical findings to change, you’re waiting for your next MRI, you’re waiting for x-ray, or you’re waiting for some ridiculous arbitrary timeline of like six months or something, you can’t wait to stay fit. You need to do something. You’ve got to stay fit if you want to run faster. That’s as simple as that.

If you haven’t checked it out, go look up the 12 steps that will walk you through the process I would use with you if you called me for a consultation. It’s at docontherun.com/12steps. You can check it out there and I’ll see you in the training.