Which is better for an inflamed plantar plate in a runner who wants to run? Icing, cryotherapy, NSAIDs, which one is going to help the most? Well, great question and that is what we’re talking about today on the Doc On The Run Podcast.
The injury to the plantar plate is at the bottom of the foot, like the ball of the foot, so we are talking about this is where your toes bend, right? And it is right where the toes connect to the metatarsals at the metatarsal phalangeal joint. The plantar plate ligament is a very small ligament on the bottom of the foot, right there.
It gets inflamed, it gets irritated, it may feel weird at first, it may not even feel sprained, or sore, or injured. It might just feel like this weird sort of fullness. Well, what that is, is inflammation, inflating the joint capsule, stretching the plantar plate, and that is what you notice initially, in many cases, if you are a runner.
So, I got a question from a runner who has called me for a second opinion, and wanted to know which is more important, cryotherapy, things like icing, or contrast bath soaking, where you’re alternating hot water and cold water, or non-steroidal anti-inflammatory drugs, most often referred to as NSAIDs for short, like ibuprofen, Aleve, Naproxen, those kind of things. Which one is better? Well, they do different things. And so, let’s talk about what the difference is, and why I recommend some and not others.
The first thing is many people ask me, will NSAIDs delay healing? Well, maybe. There’s no evidence, there’s no evidence at all, in the medical literature, that a medication like a non-steroidal anti-inflammatory has been shown to slow down the healing of these injuries in runners. But the absence of evidence doesn’t mean it can’t happen.
There are some animal studies that showed that certain non-steroidal anti-inflammatory drugs did delay healing of tendon to bone junctions. A tendon is a thing that connects a muscle to a bone. It has basically a strand of collagen that attaches right to the bone. A ligament is just a strand of collagen connecting two bones together. So, the way they attach to the bone is very similar. The plantar plate ligament connects two bones and so I always worry that taking NSAIDs might slow that down. I don’t have any proof that that would happen, but I’m always sort of thinking about that when a runner asks me if they should take it. A couple of reasons I don’t really recommend NSAIDs for plantar plate sprains specifically.
Now, if you had a very, very, very important race, like it took you forever to get into the Tokyo Marathon, and you wanted to do it, and you only had a week. Well, if you took ibuprofen, yes, it would hurt less when you ran, but that might make you more prone to injuring it more because you just wouldn’t feel the pain as much. So that is the first thing. Non-steroidal anti-inflammatories cover up the pain, and it doesn’t really stop the inflammation right away.
The reason most runners want to take it is they say, well, I have plantar plate injury that is attached to the joint capsule. I have capsulitis. Itis means inflammation. Since I have inflammation in there, a non-steroidal anti-inflammatory should stop that inflammation. And you would think so, but you have to take it very consistently for a period of time before you really get true anti-inflammatory benefits.
It doesn’t happen each time you take the pill, but it does decrease the pain sensations, and that can lead you astray because covering up the pain doesn’t really stop the swelling. It just makes it so you don’t feel it as much or notice it as much, and that always worries me. We want to know.
If you signed up for one of those second opinion consultations with me, I would have you track your pain consistently because that is what I use more than anything else to track when it’s safe for you to do an activity. If you can’t feel it because you took non-steroidal anti-inflammatories, then you don’t know if you’re on the right track or not. And the whole key here is paying close attention and taking what you know in training and applying it to recovery so you can run sooner and get back to training faster.
Cryotherapy does something different. It doesn’t really stop the pain. It decreases the blood flow to decrease the inflammation. So, if you’re doing icing, if you’re soaking in ice water, if you’re doing contrast baths and alternating hot and cold, you’re only modulating the amount of blood flow to the area and thereby reducing the inflammation in a different way. So, that is sort of like a vascular mechanical way to reduce the inflammation and get the swelling out. And if you do that and you suddenly have a lot less pain, it’s because you have less fluid in there. That is a good thing.
So, you know more when you do cryotherapy versus when you’re taking NSAIDs. And the whole goal is to ramp up your training without stressing that little plantar plate ligament too much and if you can’t feel it, you don’t know if you’re passing over your threshold for recovery or re-injury or not. That is why I don’t usually recommend it. Now, if you want to learn more about plantar plate injuries and the strategies I use with runners who want to get back to running as fast as possible, you can join me in the plantar plate masterclass and you can get it for free at www.docontherun.com/plantarplatemasterclass. So, go sign up and I’ll see you in the training.
