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7 Steps When a Runner is Not Healing

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Today on the Doc On The Run Podcast, we’re talking about the seven steps a runner should take when you’re not healing.

If you’re listening to this right now, you’re probably a runner and you’ve probably been injured for some time. You probably just didn’t get injured last week when you were running a race, but you probably got injured a while back, and then a lot of things happened. You probably took a little bit of time and kind of took care of yourself, took off a few days from running. Maybe you iced it. Maybe you changed your routine a little bit, tried to do a little bit shorter runs, tried to in some way kind of slow down your training, slow down the intensity, and see if you could just get back on track.

But, something didn’t work. You didn’t get better. You maybe started to improve, felt like you were getting all better. Maybe even got to the point you were pain free, but then you started running again and the pain ramped back up. And now you’re sitting here wondering why it is that you’re not better and trying to figure out what to do next, and you’re probably incredibly frustrated because all of your fitness has dwindled away over this whole course of really half training and not really doing what you need to be doing in order to maintain all your running fitness.

So, there are always things you can do, but you have to really figure out what you can really do if you’re not healing. And today we’re going to talk about that.

Take Inventory

The first thing that you have to do when you get injured and you’ve tried some things and you haven’t gotten better, is that you need to take inventory. You really need to just stop, and you really need to sit down and figure out what you’ve done and what could be the cause of you actually not recovering. There are lots of reasons for that.

But you need to start out with really and truly just making a list. Talk about, just write down and say, okay these are the things I’ve actually done. Maybe it’s running less, maybe it’s not running at all. Maybe it’s icing, maybe it’s wearing compression socks. Maybe it’s elevating. Maybe it’s getting massages.

But take the time to actually create a list of all the things that you have done. So this will be one thing that’ll actually help you because you need to figure out what it is that you’ve done, what you’re not doing, and what you need to do differently in order to actually recovery.

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Now if you are still running, and you’re just now getting better, but you’re doing some other things and you’re not getting worse, that’s actually good news for you. So, you need to know what it is because if you called me on a virtual doctor visit and I was talking to you, the first thing I would do, I’d ask you all these questions. What have you done? Well what have you tried? What have you not tried? Are you running? Okay, how much are you running? What kind of intensity are you running? Are you running at one minute slower than your marathon pace? Are you running really slow, like walk/run routine? Where are you running? Are you running in the street, are you running in the sidewalk? Are you running the same places you normally run when you’re training or someplace different? You need to make a list of all those things.

So that information is going to help you really assess what you could do differently because you’ve got to come up with something to change. I mean let’s face it, if you got injured and you’re not getting better, if you don’t change anything, there’s no reason to believe that you’re going to get better. It just doesn’t make any sense. So you’ve got to do something different.

Take an inventory. Figure out where you are, figure out what you’ve done and try to think of the things that you haven’t done that might be able to help you. And we’ll get to that part a little bit later, but the first thing is just make a list of everything you have done. So you’ve got to get control of this situation, and you’ve got to get back on track. And whether you do it by yourself or if you do it with the help of a running doctor, they’re going to want to know what you’ve done and so make sure you have a complete list of all the things you’ve tried, all the things that you think you have done to try to get it to heal. Even if that means skipping a race or running less, or whatever it is. So make a list of all that stuff, that’s number one.

Reconsider your diagnosis

The second thing is to reconsider your diagnosis. If you’ve been doing stuff to treat it, even if it’s self treatment, we presume that you have a diagnosis and that means that you know what the problem is. So if you think you have a tibial stress fracture, for example, but you actually don’t have a tibial stress fracture you actually have media tibial stress syndrome or you have anterior shin splints or you have exertional compartment syndrome, those are all different things. They respond to different treatments and they’re not going to get better if you treat it the same way as the other conditions. You’ve got to figure out what the thing is that’s bothering you.

If you think you have a metatarsal stress fracture and you have a neuroma, you are not going to get better. The nerve is not going to improve if you’re treating a bone problem. It’s a completely different kind of tissue and it responds differently to treatments that are geared specifically for that condition in that tissue. And if you have plantar plate sprain at the ball of the foot and you think you have a neuroma, it is not going to get better. In fact, if you get an injection it might well get worse.

So you have to make sure that you’ve got the right condition and then you can make sure that you picked the right treatment. But that’s step two. You’ve got reconsider your diagnosis and if necessary, you’ve got to reevaluate, think about the other things that are in that area that could be hurting and try to think could this be something else? That’s number two.

Be Honest with Yourself

Number three, this is a tough one but you really need to be honest with yourself. If you think you have the right diagnosis and that you’ve tried a bunch of treatments, the third thing is that you need to really sit down and figure out is there any way you’ve been cheating yourself? Like, if you tell yourself you should be wearing shoes at home because you think that’s going to help protect your foot while it’s healing and you stopped running, you’re eating healthy food, you’re sleeping well, you’re applying ice and you think that it should help wearing shoes at home but you’re actually about 75% of the time you’re not wearing shoes in the house and you’re walking around on tile and hardwood floors. You need to know that because that’s a simple thing you could change. If you feel like you knew that decreasing the running was helping it but then you started ramping up your runs again, you need to also be honest with yourself with that.

And then you also need to be honest with yourself in terms of your diet. Are you reverting to a less than healthy ideal diet? Or, you’re kind of eating junk food, comfort food, that sort of stuff when you should be eating like an athlete in training? Just because you’re not training doesn’t mean you’re not an athlete in training when you’re recovering from a running injury. It’s a more exaggerated version of the same stuff that happens in training.

So, if you get injured, you need to eat like an athlete in training. Try to be honest with yourself and think about what are the thing that you’ve done or not done during this course of recovery that hasn’t really made any progress, so that you can really make a decision about what you should do next. That’s super important.

Get a Second Opinion

The fourth thing is you should a second opinion. If you went to a doctor, you got a diagnosis and you’ve done, you’re honest about it and you know that you’ve done all the stuff that you should do to get that condition better and you’re not getting better, then you probably have the wrong diagnosis and you need to get a second opinion. Because there are really only two possibilities. One of them is that you have the wrong diagnosis and so you’re doing the wrong things for a different condition. Or you’ve got the right diagnosis but you’re just not doing the treatments correctly.

If you are honest with yourself and okay well I should have been doing this, I should’ve been doing that, I shouldn’t have been running, I shouldn’t have been doing this other thing. I should have been doing Crossfit instead of running, I should’ve been taking it easier. Then you need to be honest about that. But if you think that you’ve got the right diagnosis or you think you’re doing the treatments correctly, you’ve got to get a second opinion because you need to figure out what is the deal here? Is it that you’re just doing the treatment wrong? Or are you actually treating the wrong condition because you have the wrong diagnosis? So get a second opinion, that’s number four.

Okay, now number five, this is something that you would do in training. If you are training and you’re training at an elite level, the differences between you and your competition are always very, very small. So, you’re not going to go out and run an extra hundred miles a week and beat your competition. It doesn’t work like that. You have to find the minutia, the small things, the limiters. The things that you’re doing that are actually holding you back. Not the things that can push you forward because you’re already pushing yourself as hard as you can. This holds true in training as well.

Look for the Limiters

So, number five, you need to look for the limiters. You need to find the things that are limiting your recovery. You need to think about it, what is it? Are you driving and that’s holding you back? Is that the only thing that you’re doing that’s actually putting stress on your foot in a way that’s preventing it from recovering? Is it because you’re doing too much time at the gym? Is it because you’re standing too much?

You have to really evaluate. You need to look at the limiters and figure out what it is. Are you not sleeping enough? Are you not hydrating enough? Are you not eating meals frequently enough? Do you not have collagen and protein and other things in your diet that are going to help you heal? What’s missing? There’s some limiter that is missing and that’s step number five is to try to look for those things that are limiting your recovery. That’s super important.

Make a Goal Timeline

Number six is to make a goal timeline. So look, everybody that signs up for a race, you have an instant goal timeline, that’s the advantage of signing up for a race. That’s why people like doing it so much for fitness. They don’t necessarily like want to run this particular race but they know if they sign up for a race they’re going to train. That’s true for me too, I always train way more and way more effectively when I’m signed up for an event that I know I have to finish in a specific time. Because as soon as I sign up for a marathon, I know I want to finish in this particular time, on this particular day and then you start working backwards that you’re going to have to do this certain level of training and you have to get there by that date.

It’s the same thing with an Ironman Triathlon. It’s just more stuff, you have to swim and you have to bike and you have to run, so you have to train for a whole bunch of different disciplines but you still need to have it all done and finished by race day.

You need to think about this. If you have a goal race that you want to do then you need to do the same thing. You need to move that timeline. If you have a timeline that’s really close up and it’s just not realistic because that you’re not getting better and you’re not making any progress, well if you don’t change something significant now you’re not going to be ready for that race. So you may as well move that race, or do something drastic to try to increase your recovery now.

But you need to sit down and come up with a goal timeline. Figure out what you really want to do on what date and then start working your way backward from that. The same way you would with a training schedule. And if you do that then you can kind of see what activities should I be able to do now. And is it realistic, given what I can do now based on this injury, is it realistic I’m going to be able to do this goal and finish on time? So you need to create a goal timeline. That will actually help direct your recovery.

Take Action!

Step number seven, it’s really simple. You need to take action. It’s a really simple thing but if you keep doing the same thing you’re doing, you’re going to get the same results you’ve been getting. So, you can’t just sit around hoping that you’re going to get better tomorrow if you can barely walk today, you’re not going to run tomorrow. It’s just that simple.

You need to take action. You’ve got to do all these things. You need to sit down, you need to make your timeline, you need to make a list of the things that you’ve done. You need to make a list of the limiters. You need to see if you can get a second opinion. But you’ve got to do something. You have to take action, that’s the whole deal. Nobody finishes a marathon with a new personal record if they don’t take a lot of action.

And it’s the same thing here, if you want to recover, you want to get better, and you want to get back to running, you have to take action. Figure out what the one thing is you can do today that’s going to get you towards your goal. Figure out what that is. Figure out one limiter, one thing you’ve been missing, and one thing you’ve done wrong. One way you can take action today. I mean it’s really simple, if you take an action, you swing it every single day three times at a tree, sooner or later the tree’s going to fall down, right?

So that’s what you need to do here, you need to take action and you need to be swinging away at this injury every day trying to figure out what is it I can do differently today? What can I do today that’s going to make me heal faster, get this thing stronger, so you can get back to running. If you do these seven things, you will get back to running.

If you have a question that you would like answered as a future addition of the Doc On The Run Podcast, send it to me PodcastQuestion@docontherun.com. And then make sure you join me for the next edition of the Doc On The Run Podcast!

Dr. Christopher Segler is a podiatrist and ankle surgeon who has won an award for his research on diagnosing subtle fractures involving the ankle that are often initially thought to be only ankle sprains. He believes that it is important to see the very best ankle sprain doctor in San Francisco that you can find. Fortunately, San Francisco has many of the best ankle sprain specialists in the United States practicing right here in the Bay Area. He offers house calls for those with ankle injuries who have a tough time getting to a podiatry office. You can reach him directly at (415) 308-0833.

But if you are still confused and think you need the help of an expert, a “Virtual Doctor Visit” is the solution. He has been “meeting” with runners all over the world and providing just that sort of clarity through online consultations for years. He can discuss your injury, get the answers you need and explain what you REALLY need to do to keep running and heal as fast as possible.

You can arrange a Virtual Doctor Visit with a true expert on running injuries. Right from the comfort of your own home you can meet online with the doctor, discuss your running history, talk about your running injury and figure out a customized recovery plan that will help you heal the running injury so you can get back to running as quickly as possible.

Book your Virtual Doctor Visit with Doc On The Run now!