Should I get an MRI to tell me if it is okay to run now? Well, that is a great question and that is what we’re talking about today on the Doc On The Run Podcast.
One of the questions I often get from runners is whether or not they can get a clear indication that the overtraining injury has healed enough that they can start running. This is most common with stress fractures and plantar plate injuries, and things like Achilles tendonitis.
All of these injuries, regardless of which specific one it is, whether it is a tendon, a ligament, or a bone, which those are all three different injuries to tendons, ligaments, and bones, you want to know if you can start running and if it is healed. And it makes sense that you would want to get an MRI. Let me just say that up front.
You get injured, you get an MRI, the doctor sees some inflammation in the bone, or they see a little tear in the plantar plate ligament, or they see some inflammation in or around the Achilles tendon, and therefore, you think that when it is healed and you should be allowed to start running, you could go get that same study, an MRI, and see that the inflammation is no longer around the Achilles tendon, or that the little bitty tear in the plantar plate ligament has completely healed, or that the inflammation or crack within the bone has completely gone away. Well, it doesn’t work that way, unfortunately, and the reason is that your body continues to remodel those tissues and heal them and make them stronger for a long time after you start running.
To make this simpler, let’s talk about stress fractures and how this works. There are five different grades of stress fracture on the Kaeding-Miller classification scheme. One, two, three, four, five. A one is not a stress fracture. It is what I call a stress response. It is where you have inflammation that happens within the bone that shows up on an MRI, but it is not pathologic. Nothing is wrong. That is a normal response, just like if you picked up heavy weights and you started doing biceps curls, your biceps muscle would have inflammation in it the next day that would show up on an MRI because you did tissue damage. That is what makes the muscles grow.
Tissue damage to the bone on a small scale is what makes the bones get stronger. That shows up on an MRI, but it is not a pathologic process. This is normal physiologic process. Now, when you get too much stress applied to the bone, you run and you don’t let it recover fully, and then you do a long run or speed work the next day and you get pain and you have that showing up on an MRI as inflammation, that is pathologic. It is not good. It is bad. It hurts.
If you keep doing that, then eventually you get an actual crack in the bone. That obviously is worse. That is just the first three grades, but the very first one of those is not an actual problem. The reason I’m telling you that is that once you get a crack in the bone and you get some collagen stabilizing and bridging the two pieces of bone together, filling in that space where there’s a crack, and then eventually you get calcification or hardening of the bone that can show up on an x-ray, it is stable enough for you to run on it.
But at that point that you go in and look at it on an ultrasound and see that it is starting to heal, or you go into the doctor’s office, get an x-ray, and you see that it is starting to heal, if you were to get an MRI, you would still have inflammation in the bone because your body is continuing to remodel it, make it stronger, make it stiffer, make it more robust. And the only way you can have that process happening is that you have inflammation within and around the bone.
When the radiologist looks at it and they see that you’ve had a problem, like a stress fracture, and they see inflammation there, they say, this is a problem. There’s a process going on that is healing the bone still. So, it is not really healed, it is still healing. That is where the trouble comes in. I know you want to get an MRI that says you can run. Doesn’t work that way.
Ultrasound is better because if I look at your foot with ultrasound and can see that the bone’s starting to calcify and it is starting to fill in and the amount of fluid in between the periosteum and the bone is resorbed and resolved as compared to when you first did it, I know it is improving. Depending upon which actual research study you believe, one author says that ultrasound can let you run two weeks ahead of x-ray, and another study says three weeks ahead of x-ray and that is what I typically see.
I go see people, I look at their foot with ultrasound, I can see that they have a stress fracture, and then I can usually let them run on it two or three weeks earlier than I would if I was only relying on x-ray. MRI is worse, you would have to wait months before that inflammation and change gives you the confidence that you can run on it.
Although I understand why runners would love to get an MRI that gives them a clear green light to start running, it just doesn’t work that way because of the way your body heals and the way inflammation shows up with overtraining injuries when you’re a runner and you’re trying to get back to running. Now, if you like this episode, please like it, please subscribe, and I’ll see you in the next training.
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