Today on the Doc On The Run Podcast, we’re talking about my six-step stress fracture framework.
I know I talk a lot about stress fractures, and how to run with stress fractures, and how to keep working out if you have stress fractures, because if you are a runner, it is really critical that you make sure you do not lose your running fitness, get stiffer, weaker, and lose all your neuromuscular connections, lose your running form, in a way that puts you at risk of getting another stress fracture once you actually recover and start running again. That is a big key.
I am always trying to think about a way that I can simplify the explanations of what I do with runners when they call me for consultations and second opinions, particularly when they are not getting better after a period of being in a fracture walking boot for what seems like way too long. There really is a thing that I was thinking about this morning, I was on my way to the gym, and I was thinking about this, and I thought there are really six steps in the simplest sense that I do.
The very first one is that I try to figure out how stable it is, just before I would do anything else, I have to confirm that the stress fracture is stable. Now, if you push on the stress fracture and it moves and it hurts a lot, well then it is not stable. If you can barely stand on it, it may not be stable. If you get an x-ray and it is definitely broken and moved out of position, it is probably not stable, but you don’t necessarily need an x-ray to do that, and the overwhelming majority of patients who call me for a second opinion can figure this out without any x-rays, MRIs, or CT scans, or anything else.
If you know that it is stable, you know that you can walk on it, it really doesn’t hurt, it doesn’t move when you push on it, all of those kind of things, the doctor has told you it is stable, something like that, the second step is to figure out what it really feels like, like how bad does it really hurt, how tender is it, what do you notice, what do you feel? You have to really make an assessment on how bad it is based on how it feels, not just what it looks like on an x-ray.
The third thing is how much tissue distension do you have? How much stretching of the soft tissues do you have that could be falsely elevating your pain and contributing to your pain? That’s step number three.
Number four is once you have these basic assessment pieces, is start immediately figuring out what can I do right now to work out, to strengthen everything that is not actually injured? Everything other than that one injured bone, how can I strengthen everything else as fast as possible right now, and then the last piece is how can I start running without making it worse.
I know that seems like a really simple thing, but to just go out the door and run is a huge mistake. I have been advised to do that myself when I have had surgery long ago before I went to med school. I know what it is like to be given bad advice, and I also know that I see runners who in due periods of time on crutches, in a fracture walking boot, they even have surgery, and then when they start running, they get injured again because they’re not figuring out how they can run without making the injury worse.
There are some really simple things you can ask yourself to figure that out. If you do ask those things, and you could start working out tomorrow, wouldn’t that be helpful? I mean, if you are sitting around, you are told you can’t do anything, you can’t run, whatever, and you are really just sitting there doing no activity, what if you could start rebuilding your running fitness tomorrow without making the injury worse?
What if I told you I had the ability to figure that out without waiting for the next x-ray in two to four weeks, and without waiting for prior authorization for an MRI, without actually going to see a doctor, and without actually waiting for some arbitrary timeline in a fracture walking boot like four weeks or six weeks. What if I could tell you that you could do that safely without waiting for any of those things.
Well, if you can ask yourself some simple questions, and you can really pay attention to what’s going on in your own body, you should be able to get some information that can help you do exactly that. It is simple. So, I have put together a worksheet for you. It is two pages. It is the stress fracture worksheet and if you go through that stress fracture severity worksheet, and you ask yourself all those questions, I guarantee you that you are going to be asking yourself a lot more questions about how your foot actually feels and what it actually looks like than the doctor asked you when you went to see the doctor.
Then if you take that information back to your doctor, and you ask the doctor, okay, how can I strengthen everything else right now? How can I start running without making it worse right now based on this? You get a new perspective.
If you want to get that worksheet, you want to get, it is free. You can go get it. You can download it at www.stressfracturesecrets.com. I have it there for you. Download it, fill it out. Think about what it actually means. Communicate that to your doctor, and it will help you figure this out a whole lot faster.
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