#838 My Stress Fracture Framework simplified - DOC

#838 My Stress Fracture Framework simplified

Today on the Doc On The Run Podcast we’re talking about my stress fracture framework simplified.



If you’re a runner and you get a stress fracture, the number one most important thing that you do is to actually get it to calm down while you maintain your running fitness. And based on those ideas, I built a framework that I’ve been using for years with injured runners who want to get better, want to get healed, and want to get back to running. And I’m going to go through my stepwise process with you what I call my framework of how I do this.

Where this comes from and why I’m doing this episode today is that in a few days, I’m actually giving a lecture at the International Foot and Ankle Foundation meeting, which is one of the conferences where doctors go to get their continuing medical education credits. I’ve been asked to give a lecture called “Stress fracture management paradigms for athletes” and a paradigm really is just a framework.

So, how does this work? Well, it’s really simple. There are a few things you have to do, Seven, in fact, seven different things that you’ve got to do that are the ways that I go through this. So, number one is goal. Number two is severity. Number three is inflammation reduction. Number four is stress reduction. Number five is fortifying the bone. Six is workout and seven is run. Let’s talk about these really quickly so you can understand the basic strategy behind how I treat athletes with stress fractures.

The first thing is your goal. The biggest mistake is people want to know what kind of injury do I have, what is the injury and then focus on the injury, forget about the goal. So, any injured runner cannot figure out how they’re going to get from point A to point B to knowing what your pace is going to be. So, you have to understand if you’re going to direct your recovery correctly, you want to know the speed at which you need to get someplace, where you’re going to get to that place. And in addition to that, as physicians we have to be able to tell you about your expectations whether they’re reasonable or not.

If you break your femur and it’s actually broken and you can’t walk out, well, obviously you can’t run a marathon this weekend. But in many cases, in fact, I would say most of the time that I talked to injured runners who have a race planned and they get a stress fracture, I helped them figure out how to actually complete that race without making stress fracture worse. But you can’t do that without a goal. You got to figure that out first.

Then second is severity. So ,you need to know how bad it is and you can do this a couple of ways. You can do this by making sort of monitoring your pain and seeing how bad it is. You can sometimes do it with medical imaging like MRI or ultrasound or X-rays and sometimes you can do it from testing on your own. I usually use a combination of those things when I talk to injured runners, but everybody wants to believe that imaging is the most important and I don’t believe it is the most important. But you’ve got to figure out how bad it is so that you can assess how quickly you can actually go along your pace and how realistic it is for you to achieve your goal.

The next thing is inflammation reduction. So, you’ve got to figure out, I’ve done other episodes on this, but you have to figure out how much pain you have that you’re attributing to the stress fracture is from the tissue injury or the fracture in the bone and how much is really from the inflammation that’s causing stretching of tissues and causing pain just because there’s excess fluid in there. That’s the next thing.

The fourth thing is that you’ve got to actually do some stress reduction. Remember, it’s called a stress fracture. It’s not called a running fracture. It’s not called run too much fracture. It’s called a stress fracture. So, the next thing you have to do is once you figure out where you’re going, you’re figuring out how fast you’re going to try to get there and you figured out how bad it is. Well, you’ve got to figure out how you can reduce the stress and strain on the stress bone. If you really want it to improve quickly. It’s really that simple. But many people skip this step. And then of course, you have to strengthen the bone. You need to let it heal, you need to get it better. You need to fortify the bone. You’ve got to get it stronger and you got to do that as quickly as possible with every tool at your disposal, and you have to understand those.

The next thing is you’ve got to work out again. If you have a goal and you want to do a race whether it’s the Houston Marathon at the beginning of the year, or it’s the California International Marathon in the fall, you cannot lose all your running fitness. Remember, waiting is not a treatment plan. Waiting is a way to get weaker. You have to work out and you have to add exercises that will maintain your running fitness without stressing the bone. It’s not complicated.

The next thing is you have to run. You have to test and retest and you have to systematically return to running while tracking your pain and your progress the same way that you would track step if you’re training for a marathon and that’s really it, that’s my seven step framework. If you understand all of those pieces, you will definitely get back to running a whole lot faster. But you have to understand those pieces and if you talk to a doctor who seems to be missing some of those pieces, it’s your job to bring it up.

If you want to learn more about stress fractures in runners and more of these specifics where you can sign up for the stress fracture masterclass. It’s a deep dive in all things stress fracture related about really the specifics of the strategies that I use with injured runners and you can get it for free at www.docontherun.com/stressfracturemasterclass. So, go check it out, and I’ll see you in the training.