When is an MRI most reliable for a bone running injury like a stress fracture? Well, that’s what we’re talking about today on the Doc The On Run Podcast.
One of the things about getting an MRI has to do with timing of the injury and what do I mean by that? Well, it means timing in terms of when the MRI is done relative to how long it has been since you actually beat it up and injured that structure. For example, I saw a guy one time who actually wrote me this amazing review where he thought I was a genius, but I got lucky truthfully, and I told him so. What had happened is that he ran a 50-mile trail race. Well, he got an injury. And then he went, I think, two days afterward, after this 50-mile trail race. He saw a doctor that did an MRI and they made the wrong diagnosis. And then he called me. He had lots of footage of himself running on the beach barefoot where I could look at his running form. He had his MRI, he had actually had another MRI since that time because it had been a long time and he wasn’t getting better.
When I saw him for the second opinion, I made the diagnosis right away and he actually got really upset that the doctors right after his race missed it. And what I did was actually took his MRI and I went through it and showed him what happened. And by the way, he did really well. He was an elite runner. He didn’t win his age group. He had won the entire thing. And so he was really upset and really frustrated. But when I went through the MRI, I just said, “Look, there’s so much inflammation here on your MRI. If I saw you, I wouldn’t have made the right diagnosis either.” So he had done it way too close to that race to actually make the right diagnosis.
There’s some interesting studies, I’ll try to put the references in the show notes at docontherun.com under the podcast tab. But there’s a couple of studies, one of them on professional marathoners, another one on the Trans Europe Foot Race that actually showed that through the course of training for professional runners for long distance stage races like the Trans Europe Foot Race, that you actually get inflammation that shows up in the bones that looks like a stress injury, like a stress reaction or a stress fracture during heavy blocks of training and even during events that is actually not a problem. It’s not pathologic. It’s not broken, it’s not fractured, it’s not even injured. It’s a normal process. Just like if you were to do an MRI of your biceps on your arm right now, it would look normal.
If you then went to the gym and you spent one hour doing biceps curls over and over and over to the point of failure, you would injure the muscle so much from that fatigue that if you got an MRI the next day, it would be probably diagnosed as a muscle strain, a muscle tear, something like that. Now, this is true in the foot as well. If you were to go and get an MRI right after a race, like I really wish that I had done an MRI right after I did my first 50-mile trail race because I felt really beaten up. And I’ll bet that if I’d gotten an MRI, a radiologist would’ve said that I had multiple stress fractures in my feet, but the bones were not injured.
That would be true if I did it right after, but if I did it a week or two after, that wouldn’t be the case. There would not be a lot of massive rebound inflammation in the bones. It would only show inflammation in the bones on the MRI if it was still injured and had a thing like a stress fracture or a stress reaction. So in short, you want to make sure that you don’t get an MRI of the bones if you think you have a stress fracture right after a race. You want to give it some time and let it calm down a little bit so that you can remove the distractors, the things that look like they’re broken or look like they’re injured that actually aren’t. That way you don’t get over diagnosed by the MRI. So I hope that explanation is helpful.
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