#557 4 Things you need for a running injury second opinion - DOC

#557 4 Things you need for a running injury second opinion

Today on the Doc On The Run podcast, we’re talking about the four things you need for a running injury second opinion.



I do lots of running injury second opinions and I do most of those over webcam. Sometimes I do them over phone, but webcam’s way better because I can see you, we can talk, I can show you some stuff on screen, share if I need to, and I can look at stuff that you have that might be really useful for me to help you figure out what’s going on. So, whether you’re seeing me for a webcam visit or if you’re seeing your doctor in your neighborhood, there are four things that you really should make sure that you have together and that you take to get your most valuable running injury second opinion. We’re going to talk about those.

When you go see the doctor, the thing that most runners do wrong, the biggest mistake they make is they go in and they say, “My foot hurts and I want you to help me get it to stop hurting.” That’s not what you’re after. Remember, you’re a runner. So, most definitely, your goal is not going to be to get that pain to go away. Your goal is going to be to get back to running, to be able to run a marathon, do an Ironman, an ultramarathon, whatever it is, doesn’t really matter, that’s the first thing.


Thing number one is you want to make sure that you go in with your goal and your goal needs to be clearly defined. You don’t want to go in and just say, “Well, I want to run,” because they may tell you, “Okay, we can run in the pool.” That’s not what you’re talking about.

You really want to do something that’s meaningful to you in terms of running. So you want to say, “I’m signed up for the Houston Marathon, this is the date, this is when I have to be ready. Based on that date, this is when I have to start training.

Therefore, I need to have this problem that’s interfering with that goal fixed by then.” That’s number one. Make sure you write that down, you have it clearly defined, you know the date, you know the timeline, you know what you need to get the doctor to do to make that timeline happen. That’s number one.

Pain Journal

Number two is you need to go in and make sure that you have a copy of your pain journal. Now, fascinating fact, most of the runners I talked to who will tell me what their heart rate is, their resting heart rate, they’ll tell me what their pace was on the last run that they did, they have no idea what their pain was last Tuesday or Wednesday. Why? Because they’re not keeping track of it, they’re not writing it down and if you want to make decisions based on numbers, you have to have the numbers of the thing that’s actually showing you what is changing on the fastest interval possible, and that’s your pain.

Your pain changes day by day, it changes sometimes hourly. Sometimes, it doesn’t hurt in the morning, sometimes it hurts in the afternoon. But you have to write that down, you have to record it. So, your pain journal really is your record of progress with your injury or lack of progress with your injury.

If you have an overtraining injury, you need to track what’s going on with the injury the same way that you would track your heart rate, your pace, your perceived exertion, all the kinds of things that you track when you’re in training. Right now, you’re in training. It’s just a little different and most of the runners that get off of track, they’re basically pretending like they’re not off track and that they’re just injured and they’re just taking time off of training.

You can’t do that if you’re a runner. You have to maintain your fitness and you need a pain journal to help you make decisions on what you can do, and you have to take that to your second opinion to get the most information out of the doctor to get you back on track.

Now, if you need a copy of that, we’ll have a link in the website, at the show notes for this particular episode where you can get a copy of one that I’ve already made. You can make your own, I really don’t care, but I have one that’s a single page PDF you can print out and it’ll kind of clue you in on what you really need to record. But you’ll be able to get that on the show notes at docontherun.com under the podcast tab for this episode if you want to get that one and printed out.

Imaging studies

The third thing you need is imaging. So let’s say you saw a doctor, you saw a podiatrist, you went in their office and they took foot x-rays. My guess is you don’t have copies of those x-rays right now because you didn’t think to ask for them because you didn’t even know you could ask for them or if you went and got an MRI, you probably don’t have a copy of the MRI, you probably just have a report that’s printed out by the radiologist. And all the report is really is their impression of what happened with you.

That’s interesting and everything, but if you’re going to get a really great second opinion, you need to let the doctor look at it. So, if I do a webcam visit with you, I’ll actually load it, I’ll put it into an image viewing program, have all those images pulled up, and when I get on the webcam with you, I’ll do a screen share and actually walk you through what each of those images really means and how it’s relevant to you and your particular situation. The report does not do that and.

I think it’s very helpful for an injured runner to actually see those images and then talk about what’s progressed since the time that you got the MRI and since the time that the injury actually started. So, make sure you get a copy of that. If you got it at a podiatrist office, just call them and tell them you want a copy of the films. If you got it in imaging center, call them and tell them you want a copy of the disc with your MRI, your x-rays, everything. You need that stuff. You need to take it to your second opinion. Don’t show up for your second opinion and realize you didn’t get any of that because now you just wasted a visit. Make sure you get it in advance and take it.

Running shoes

Now, the fourth thing, everybody has this, almost nobody ever brings it, that is your running shoes. Okay, so why? What’s the big deal here? Why do you need your running shoes? Well, you need your running shoes, so your running shoes, first of all, don’t think, “I’ve used the ASICS Gel-Nimbus for the last 18 years so I don’t really need to bring my running shoes.” Don’t say, “Well, I use the Adrenaline so I’ll just tell my doctor I run in Adrenaline and they’ll know what that means.” We’re not looking for style, we’re not looking for choice of footwear. We are looking for wear patterns that actually could contribute to your injury and might help us decide what to do to not only get your injury to resolve, but to actually make sure that you don’t get another injury in the future.

We want to look at the wear pattern and when we want to do that, we want old running shoes, preferably old running shoes, that you only ran in. Like when I run in my running shoes and then decide I’ve retired them, that I’m done running in them, I start using them for other things like going for short hikes or walking around, taking my kids water skiing, doing whatever that’s not running, I kind of use the retired running shoes. For that, I never walk around in my actual running shoes though. But the wear patterns change. So, your gait when you’re walking is very different from your gait when you’re running. But the gait pattern that you have when you’re running puts a wear pattern on the shoes that helps us make decisions and shows us some of your unique biomechanics that actually are instrumental in contributing to your running injury.

So, if we’re going to do something to correct your biomechanics, whether that’s custom orthotics, or a shift in running form, or some adjustments on the surfaces you run on, we need your shoes to make those decisions. So, those are the four things you really need. You want to make sure you have your goal, make sure you have your pain journal, make sure that you have your imaging studies, whether it’s an x-ray, MRI, CT, whatever, get copies of those things, and bring some running shoes that will actually show the wear pattern to us when we’re looking at it so we can make the right decisions together.

Those are the four things that you really need to bring when you’re going to get a running injury second opinion. Now, again, if you don’t have a pain journal yet, start recording it now, not tomorrow, now, today. Write it down. Write down what you feel right now, go walk around your house, go upstairs, downstairs, and if you need a copy of that pain journal, you can go to docontherun.com, the Podcast tab, click on this episode, and there’ll be a link where you can get it for free there. Make sure that you print that out. If you like this episode, please share it with somebody, please like it, please subscribe and we’ll see you in the next episode.

Download the Pain Journal here