What are the two worst things about inflammation when you have a stress fracture? Well, that is what we’re talking about today on the Doc On The Run Podcast.
When you get a stress fracture, the main thing you are trying to do is figure out how bad it is, how much does it hurt, how can you get it to heal as quickly as possible, and inflammation, although it is an important part of the healing process, it can be very disruptive to two parts of your process of getting back to running.
The first thing that is really one of the worst things about a stress fracture is that it makes it feel like your stress fracture is worse than it really is. What do I mean by that? Well, if you think about it, part of the reason you get pain when you have a stress fracture before the bone cracks, when it is still just a stress reaction, is that you have swelling within the bone and that causes discomfort.
When you have swelling between the periosteum, which is the covering of the bone in the bone itself, that causes pain. If you then push on it and you have fluid in there, it really hurts because you are sort of squishing and moving that fluid at either end of where it is already lifted off the periosteum. But when you are trying to test it out, if you have lots of inflammation, it makes your pain numbers feel more elevated than they really are.
In that sense, it can falsely elevate your pain and kind of frighten you into thinking it is a lot worse than it really is. That is one of the reasons it is important to get the inflammation out right away, so that you can get a clear assessment on how much of the pain is from true tissue damage versus just distension or stretching of the soft tissue and the nerves around the stress fracture.
The second thing that is really bad about stress fractures is that that chronic inflammation, if you ignore it, which a lot of people do, is they don’t get rid of the inflammation at all. They figure that is part of the healing process. It’ll take care of itself. It’ll eventually go away. But if you are running on the stress fracture, if you are exercising to maintain your running fitness, but you are putting too much stress on that one injured bone that is already been stressed to the point of getting a stress fracture, well, you stimulate more inflammation. So, you oftentimes can get caught in this sort of cycle of chronic inflammation and that constant aching from the distension of the stretching to the soft tissues, that causes a problem, and it is not just pain. What that does is it disrupts and slows down the healing process.
You have got three phases of healing. You have the inflammatory phase, where you get inflammation. You have the proliferative phase, where you get proliferation of collagen, actual strengthening and stabilizing of the fracture itself with collagen, the glue that holds it together. Then after that, it starts to calcify and then after that is the third phase, which is the remodeling phase, where the bone gets much, much stronger by becoming much organized, diversion canals and restructuring of the bone to make it stronger. So, you can really run on it without it breaking again.
But that gets disrupted when you have chronic inflammation because you have to have collagen forming in that proliferative phase and chronic inflammatory fluid has degradative enzymes, particularly one called collagenase that breaks up collagen. That collagen is stabilizing the stress fracture itself and when you degrade it, you slow down the healing process. And that really increases the amount of time that it takes you to get back to running. So, you have to really pay attention to the inflammation itself.
The signs that you can see yourself, not with an x-ray and MRI, but things you can see yourself about how much swelling you have and what happens over time. Are you getting less swelling? Are you getting less redness? Do you have less pain? Do you have less tenderness? Does it hurt less when you push on it or move it or step on it? All of those things are indicators of how much inflammation is changing throughout the course of your recovery and they’re things that you should really track. They’re things that I ask you initially.
In fact, just today, I got a call from a guy who is scheduled to call. Well, he didn’t call me. I called him. He’s scheduled a consultation call for tomorrow afternoon and I called him and said, Hey, it is Dr. Segler. I don’t mean to interrupt you. However, I really want to make sure that you get the most out of your call tomorrow. So let me send you something. I want you to try to do these things between now and our call and that’ll make our call a lot more productive. A lot of that has to do with being able to assess the amount of inflammation that is there and that is what you have to do yourself if your doctor is not doing it for you.
The truth is, is that stress fracture analysis is really not all that complicated. It is things that anybody can do and any runner can do themselves. You just have to understand the right questions to ask. So, you don’t have to have a medical degree. You don’t have to have an x-ray machine. You don’t have an MRI. I don’t get MRIs on the overwhelming majority of runners who have stress fractures because I don’t believe that it is useful.
But doctors, we often pretend that it is really complicated, that you don’t understand all the intricacies of why the crack’s not showing up on the x-ray or why you might benefit from an MRI or why we’re not going to get an ultrasound. It is not that complicated. You need to know what it feels like. You need to see what it looks like. and you need to be able to make assessments you can measure over time.
The way that I do that is ask you a whole bunch of questions and it is in a thing that I put together that I started giving away for free. It is a two-page PDF with the exact questions I would be asking you if we were on a consultation call to try to make a plan based on how it really feels in terms of its severity right now. You can get that free if you go to www.stressfracturesecrets.com because it is no big secret. It is not that complicated. You just have to know what to look for, what questions to ask and if your doctor’s not asking you, then you should ask yourself.
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