#860 Radiologist and Orthopedic doctor disagree on my stress fracture diagnosis - DOC

#860 Radiologist and Orthopedic doctor disagree on my stress fracture diagnosis

What do you do if you think you have a stress fracture, you see an orthopedic doctor and the radiologist who actually reads your studies actually disagrees about what your diagnosis is. Well, that’s what we’re talking about today on the Doc On The Run Podcast.



Just this morning, I was doing a live presentation of the stress fracture masterclass, and this is where I go through the strategies that I use with every athlete who calls me for a second opinion consultation when they’ve got a stress fracture, how I treat them if I see them in person, and the same strategies that I teach to physicians at medical conferences when I lecture on stress fractures.

The story went like this. This was an athlete who is a State ranked high school cross country and track runner, and he does lots of different events, including 5000 meter, 3200 meters, 1600,  800, but is best at the 800 and 3200 meter distances. And what happened was he stopped running due to intense pain that started about 15 days ago, so a little over two weeks ago.

He went and saw a doctor. He got x-rays, he got an MRI, had a physical exam where the orthopedic doctor poked around and tried to figure out what was going on and then they got the diagnosis. This is where the trouble comes in. So, they were told a couple of different things, a stress reaction, or a stress fracture, possibly of the third metatarsal or the intermediate cuneiform bone, which is the bone that’s at the base of the third metatarsal.

Alright, so a couple of problems. So, one is you have two different possible conditions, which is a stress reaction or a stress fracture. Those are different things, and you have two different bones, third metatarsal or cuneiform bone. Well, which is it? Well, you’ve got to figure out what is wrong and how bad it is, if you’re going to move forward.

Part of the problem with an MRI is that you can get an MRI that actually shows inflammation in the cuneiform bone but that’s not actually where the real trouble is. There’s no crack in that bone and maybe there’s not even any pain or tenderness in that specific bone. In that case, that would be a stress response. It’s not pathologic, it’s not something you have to treat and based on that thing alone, I would never stop your training regimen or decrease your running volume.

It could be that you had the reverse that it actually is pathologic, and it is in the cuneiform bone, that is the stress reaction. But if there’s no crack, it’s not a stress fracture, for sure. So, you’ve got to figure out, is it really a stress fracture? Is it really a stress reaction? And I don’t know, because I didn’t read the MRI, I didn’t do a consultation with this patient. This is not my patient. It’s just somebody who’s trying to get some information on the strategies that I use when I treat these myself with athletes like this.

If you’re getting yourself in this situation where you’re not even sure what the diagnosis is, it’s really hard to move forward confidently, and ramp up your running volume and stay fit while that injury heals. But it’s crucial that you do that, obviously. So, you really have three options in this situation.

The first one is that you could get a second opinion or in this case, since you’ve had two doctors, a radiologist, an orthopedist doctor look at it, you’re really technically you’re getting a third opinion. But you should get another opinion from a completely different doctor and here’s the key, do not tell the doctor what I just told you. Do not tell them that you had this specific diagnosis of a stress reaction or a stress fracture in the third metatarsal or the cuneiform. Don’t tell any of that stuff.

You want him to look at it. You want them to try to figure out what’s going on and you want them to make a separate decision that clears things up for you. So, don’t muddy the water for them by telling them what you think they should be looking for.

The second option you have is to actually call the orthopedist and talk to them and say, “Look, the radiologist says something different than what you say. Can you call the radiologist and actually speak with them and come to some sort of agreement on what the two of you based on what the radiologist sees and what you see in clinic when you look at my flight. What is my real diagnosis? Which body is it? What condition is it and how bad is it? That could be the next thing.

The other thing is you can do what most runners do who come here, which is they tried to figure it out themselves, not just completely blindly on their own, but following the stress fracture paradigm that I have created, the things that I teach the doctors, the things I kind of share with you in this stress fracture masterclass. And the things I showed shared in detail about how you test everything and how you decrease the stress and strain to the metatarsal, how you track your pain to determine the severity. All of those things, they’re in the stress fracture course for runners that you can get at www.docontherun.com.

But you have to understand what the condition is and the severity of it to start moving forward. You can’t do that if you don’t know where to start because you’ve got to test things and start adding fitness, rebuilding activities right away.

If you want to learn more about this and you want to sit in on the stress fracture masterclass that I do live where you can get that for free. You can join me live if you go to www.docontherun.com/stressfracturemasterclass. So, come check it out, and I’ll see you in the training.