#634 Mistakes mean the most time off running - DOC

#634 Mistakes mean the most time off running

Today, on the Doc On The Run Podcast, we’re talking about how mistakes mean the most time off running.



If you’re a runner and you’ve had an injury, probably the thing you’re worried about more than anything else is how long you’re going to be off of running. And when people call me for webcam consultations or an in-person evaluation for a second opinion, I can tell you that I see the same mistakes runners have made over and over and over. Now, if you’ve made one of these mistakes, don’t beat yourself up too much. There’s not that much you can do about it anyway, so try to change course and get focused on what you really need to do to get back to running instead of dwelling on what you’ve done that might have been a mistake. But you should be aware of these things if you have an injury and if you really want to run.

So some of them are simple. Some of them are not. The first one we’re going to talk about are extreme mistakes, and these are really obvious. In fact, when runners do them, it’s hard to not go, “Are you kidding? You thought that was a good idea?” And I’m sure you’re aware of them, but it doesn’t mean that you won’t to make these mistakes and it’s tough sometimes. So the first one is ignoring the pain. And that sounds obvious, but it is crazy how many times I see runners who have run with the same pain that’s not only not going away, it’s actually getting worse. And why would you do that? Well, one of the main reasons people do that is not deliberate, but it’s because their training calendar is telling them to do it.

We all go through this thing. We sign up for a race, we sign up for a marathon, we put a training calendar on our refrigerator so we’ll psych ourselves up and remember that if we do every one of these workouts, if we put that workout, that exercise time in the bank, it will pay off on race day and we’ll be able to finish our marathon in our goal time. So we get an injury and then we look at the calendar and it’s like, “Well, today’s only a three mile recovery run. That shouldn’t be that bad. I’ll just go do that and then I can check that one off the list. And then, well, it didn’t hurt that much. It felt a little bit better on my rest day, so now I’ll go do my speed work on the track and it hurts a little worse.” And then you’re like, “Oh no, but now I have my long run and that one’s really important, so I’m going to do that one too.”

You keep doing this pattern and your runs get slower, maybe even get a little bit shorter. You’re dumbing everything down in every direction, but you’re not really getting any better. It’s just hurting a little bit less. It’s still not progress though, and you’re not making progress on your training plan. So that’s the first thing, I see people do that. The other is the other extreme, no exercise at all because a doctor told you, you have to recover. Okay, if you want to be a runner, you’re going to have to run. If you want to be fit, you’re going to have to train. That’s a fact. And so what happens is, many times, because we as physicians are in a rush, we just tell you, “Look, you need to rest. You need to chill out. You need to stop all this craziness. You need to just rest and let this thing heal.” Well, that is true, you need to rest and let that one thing heal.

All of you is not broken. All of you is not injured. You can still train all of those uninjured parts without damaging that one injured thing if you know what you’re doing. It takes a lot of time to explain that, which is why we as physicians often just tell you to take this other extreme and just rest. But that leads to serious problems. If you do that, you’re going to get weakness, stiffness, loss of neuromuscular connections. You’re going to lose your aerobic fitness. You’re going to be more unstable. You’re going to load things asymmetrically when you start running and you’re going to be more at risk of a running injury later. That’s why so many runners who get injured actually get another injury. It’s not because they had a stress fracture. It’s because they got de-conditioned and they put themselves in a situation where they were prone to another injury later. So those two extremes are extreme reasons that you can actually get trouble and take time off of running that’s not really necessary.

Now, not all mistakes are extreme mistakes. Most of them, frankly, are minor mistakes, but these are the ones that will get you. Remember, it’s not the lions and tigers. It’s the gnats and mosquitoes you got to worry about. The first thing I’m going to talk about is running on the wrong side of the road. Let’s say that you have an injury like a fifth metatarsal stress fracture. It’s on the outside of your foot. If you run on the road facing traffic and it’s in the right fifth metatarsal on the outside of your foot and you’re running that direction, the road is actually forcefully pronating that foot. It’s tilting you upward. That actually puts more force and more stress on the fifth metatarsal bone. That overloads it so it takes longer for it to heal. If you were literally running on the other side of the road, it would do the exact opposite because of the slope of the road is the opposite if you’re running in the same direction down the road. That’s a simple thing.

Another thing is waiting to get a second opinion. Okay, if you’re not getting better, even if you like your doctor, you need to get a second opinion. You’ve got to get a second opinion to make sure that something isn’t being missed and to see if there’s some little things that maybe you’re missing, maybe some little mistakes you’re making, some little opportunities to heal a little bit faster that you’re just not picking up on. It never hurts you to get a second opinion. It blows me away when people will say, “My doctor told me to have surgery,” and they never even got a second opinion. If somebody came to your house and said, “You need a new roof,” you would never in a million years go, “Okay, let me get my checkbook.” You would get three bids, you would make sure that you really need a new roof, that it doesn’t need to just be patched or something and the same is true with your body.

I mean, for goodness sakes, you need to run. You need to make sure that you’re on the right path. The best way to do that is to get a second opinion. The next thing that’s a minor mistake but actually really can cost you in the long run is failing to keep track of your pain. It’s unbelievable to me that somebody will say, “I did 13,872 steps yesterday.” “Okay, what was your heart rate?” “My resting heart rate was this. I had this much heart rate variability. This was my pace when I ran.” “How much pain did you have?” “A little bit.” “What do you mean a little bit? Does that mean you had a little bit of heart rate variability?” You measure all these things, you don’t even keep track of your pain? Your pain is the most important indicator that you have to determine whether or not it’s safe for you to actually ramp up more or if you need to back off and do less with any given activity as you’re maintaining your running fitness. Keep track of your pain. Keep a pain journal.

The next thing is not really exercising everything that you can, and what I mean by that is everything that is uninjured. If you get a stress fracture, it is a stress related injury to one thing. Now, you only have one bone when you have a stress fracture, one. If it’s your fifth metatarsal stress fracture that we’re talking about, that is one bone out of 26 bones in one foot. That is not most of your body. So you can exercise most of your body and maintain most of your running fitness if you’re diligent about protecting that one injured part, and not doing that is a minor mistake, but, again, it adds up over a long period of time if you’re not doing that. If you think about this, all of the things that you do, whether you do the right thing or the wrong thing, if you’re doing a lot of the right things a little bit, a lot of the time it’s going to cost you in the end. And if you’re doing a lot of the right things a little bit most of the time, it’s going to pay off big time.

One of the studies that I always cite when I actually give this lecture on metatarsal stress fractures in runners and how to treat them to physicians, by the way, these are doctors who are coming to get their continuing medical education credits and learn new techniques, when I lecture on that, there’s a study that I cite and it’s talking about running injuries. And I actually have the citation on the screen and everything, and it says that the average time for return to sport, meaning getting back to running, for people with stress fractures, runners, athletes, the average time or the meantime for return to sport ranged from four weeks to 52 weeks. I want you to stop and think about that for a second. That is anywhere from one month to a year. That’s a big difference. Now, if you think about it, which would you rather, would you rather take a year to get back to running or would you rather take a month to get back to running?

Well, what’s the difference? There is a difference and you really need to think about this. The difference is not the injury. The difference is the athlete. Which do you want to be? You really do get to make a decision about this. You can decide to look at and focus on all the little things that add up that get you back to running faster or you can ignore them and it can take you a lot longer. It really is that simple. So it’s up to you and your doctor to work together and figure out how to identify all those good things and bad things so you can have the time to get back to running as quickly as possible. Now, if you want to know more about all that, I’m doing a live Masterclass. Depending upon when you’re listening to this episode, you may or may not be able to get in because it might be over, but you should go check it out and see if you can get in.

Basically, it’s called Running with A Suspected Stress Fracture: Dos and Don’ts. And I really am going to talk about the dos and the don’ts. I’m going to talk about the principles. I actually teach two physicians when I lecture at these medical conferences, teaching them what I actually do with injured runners. I’m going to go over some of the strategies and the principles that I always discuss with runners when I do an in-person evaluation for a second opinion or a webcam consultation for a second opinion. I’m going to talk about all those things in great details. And as a bonus, if you sign up and you send me your questions, I’ll actually answer your questions live. So your specific questions, I will answer them live during the web class. You can get it for free. It doesn’t cost you anything. But you go to docontherun.com/stressfracturelive, all one word, and you can sign up there and I’ll see you in the Masterclass.